Campbell Neil C, Iversen Lisa, Farmer Jane, Guest Clare, MacDonald John
Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Centre, Westburn Road, Aberdeen, AB25 2AY, UK.
BMC Fam Pract. 2006 Apr 26;7:26. doi: 10.1186/1471-2296-7-26.
Patients vary widely when making decisions to consult primary care. Some present frequently with trivial illness: others delay with serious disease. Differences in health service provision may play a part in this. We aimed to explore whether and how patients' consulting intentions take account of their perceptions of health service provision.
Four focus groups and 51 semi-structured interviews with 78 participants (45 to 64 years) in eight urban and rural general practices in Northeast and Southwest Scotland. We used vignettes to stimulate discussion about what to do and why. Inductive analysis identified themes and explored the influence of their perceptions of health service provision on decision-making processes.
Anticipated waiting times for appointments affected consulting intentions, especially when the severity of symptoms was uncertain. Strategies were used to deal with this, however: in cities, these included booking early just in case, being assertive, demanding visits, or calling out-of-hours; in rural areas, participants used relationships with primary care staff, and believed that being perceived as undemanding was advantageous. Out-of-hours, decisions to consult were influenced by opinions regarding out-of-hours services. Some preferred to attend nearby emergency departments or call 999. In rural areas, participants tended to delay until their own doctor was available, or might contact them even when not on call.
Perceived barriers to health service access affect decisions to consult, but some patients develop strategies to get round them. Current changes in UK primary care are unlikely to reduce differences in consulting behaviour and may increase delays by some patients, especially in rural areas.
患者在决定咨询初级医疗服务时差异很大。一些人经常因小病前来就诊；另一些人则因重病而拖延。医疗服务提供方面的差异可能在其中起到一定作用。我们旨在探讨患者的咨询意图是否以及如何考虑到他们对医疗服务提供的认知。
在苏格兰东北部和西南部的八个城乡全科诊所，对78名参与者（45至64岁）进行了四个焦点小组讨论和51次半结构化访谈。我们使用案例来激发关于该怎么做以及为何这样做的讨论。归纳分析确定了主题，并探讨了他们对医疗服务提供的认知对决策过程的影响。
预期的预约等待时间会影响咨询意图，尤其是在症状严重程度不确定时。不过，人们会采取策略来应对这一情况：在城市，这些策略包括以防万一提前预约、坚定自信、要求就诊或拨打非工作时间电话；在农村地区，参与者利用与初级医疗人员的关系，并认为表现得不过分要求是有利的。在非工作时间，咨询决策会受到对非工作时间服务看法的影响。一些人更倾向于前往附近的急诊科或拨打999。在农村地区，参与者往往会推迟到自己的医生有空时，或者即使医生不值班也可能会联系他们。
感知到的医疗服务获取障碍会影响咨询决策，但一些患者会制定策略来克服这些障碍。英国初级医疗目前的变化不太可能减少咨询行为上的差异，反而可能会增加一些患者的延迟，尤其是在农村地区。
