Patients' accounts of calling the doctor out of hours: qualitative study in one general practice

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Abstract
Objective: To investigate patients' accounts of calling the doctor out of hours. Design: Qualitative analysis of semi-structured interviews with two groups of patients who called their doctors out of hours from one general practice. Subjects: 23 people who had called the doctor on their behalf or on behalf of another adult and 23 people who had called on behalf of a child between 6 pm and 8 am on a week day (omitting the weekend from 6 pm on Friday to 8 am on Monday). Results: Although respondents described symptoms as the main reason for the call, they also described a range of other factors that led to the call, including their feelings, concerns about specific illnesses, their responsibility for others, and their previous attempts to manage the problem themselves. They also described past experiences with health services that were important in explaining the current out of hours call or explaining their general approach to using services. Conclusions: The pursuit of a model of out of hours care based on medical necessity that neglects the psychosocial context of illness may not be appropriate. The importance of previous experiences of health services and contacts with health professionals in explaining current service use requires wider acknowledgement by health professionals across sectors. Separate educational programmes to encourage patients to use out of hours services more appropriately that neglect these issues may be too simplistic. In this study, respondents described the context of the out of hours call, as well as the patient's symptoms Descriptions of previous experiences of health services and contacts with health professionals were also important in explaining the current call and respondents' general approach to using services The role of health professionals in developing and maintaining patterns of service use is important Separate educational campaigns that focus on symptoms and neglect the con- text of the call may be too simplistic