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Abstract
Objective This study examined why patients with Chronic Obstructive Pulmonary Disease (COPD) or Heart Failure (HF) use Accident and Emergency (A and E) services and whether their perceived reasons are similar to or different from those of their family members or carers, or the hospital medical team.
Design A mixed method approach was undertaken; (i) semi-structured interviews with patients and their family members (or carer) and (ii) a self-developed survey with hospital health professionals.
Participants A purposive sample of 15 patients (9 COPD, 6 HF), six family members and carers (2 COPD, 4 HF) and 12 health professionals (5 doctors, 8 nurses) participated in the study.
Setting The research was in one large teaching hospital in South London, UK, covering a diverse ethnic population.
Results The patients’ main reason for A and E admission was severe exacerbation of their symptoms and all three parties (patients, family members or carers, health professionals) agreed with this decision. Three key factors were highlighted in relation to A and E attendance: (i) patients’ health seeking behaviour, (ii) perceptions about GP and A and E services by patients and (iii) patients’ attitudes towards managing their own conditions.
Conclusions Improving patients’ perceptions of GP services in the management of exacerbations of HF and COPD will be important to increase patients’ trust in GP services so that patients will access primary care in a timely manner to prevent exacerbations of symptoms that require A and E admission. This may be achieved by developing a close collaboration between the patients, family members (carers) and health professionals over time.
Patients’ pathways to A and E.