Background
Methods
Study background
Sampling of participants
Data collection
• To what extent was your GP / a GP involved in the decision making process that led to your ED visit? | |
• Did you contact your GP / a GP before visiting the ED? Why did you choose to do so? | |
• What role does GP care play in your health care? Why? | |
• How would you describe your relationship to your GP? Why? | |
• Patients without GP: How would you describe your past experiences and relationships with GPs? Why? |
Data analysis
Results
Sample characteristics
Patient characteristic | n (%) |
---|---|
Gender | |
Female | 9 (52.9) |
Male | 8 (47.1) |
Age group, years | |
20–39 | 5 (29.4) |
40–59 | 6 (35.3) |
≥ 60 | 6 (35.3) |
Mean | 50.9 |
Median | 49.5 |
GP status | |
Yes | 13 (76.5) |
No | 4 (23.5) |
Morbidity* | |
Chronic obstructive pulmonary disease (COPD) | 8 (47.1) |
Asthma | 2 (11.8) |
Acute respiratory tract infection (RTI), e.g. bronchitis, pneumonia | 4 (29.4) |
Subjective dyspnoea, exclusion of serious illness (like e.g. pulmonary embolism) | 3 (17.6) |
ED consultation* | |
Out-of-hours | 6 (35.3) |
Referred by physician** | 7 (41.2) |
Triage category*† | |
2 very urgent | 1 (5.9) |
3 urgent | 8 (47.1) |
4 standard | 6 (35.3) |
5 non urgent | 2 (11.8) |
Subjective urgency* | |
1 must be seen immediately | 5 (29.4) |
2 must be seen as soon as possible | 7 (41.2) |
3 must be seen today | 3 (17.7) |
4 less urgent | 2 (11.8) |
Previous ED visit in past 6 months*‡ | 7 (41.2) |
GP visit in past 6 months*‡ | 13 (76.5) |
The role of GP care
Long-term regular consulters | • GP central as first contact person • Important role in chronic disease care • GP as supporter and health advisor |
Sporadic consulters | • Occasional GP visits, heterogeneous utilization • Factors: skepticism concerning competence, lack of confidence, past negative experiences |
Patients without GP | • GP has no important role • Prevalent mistrust in regard to GPs’ skills and knowledge • Limited demand due to good health condition |
Long-term regular consulters
Almost all long-term regular consulters reported to have contacted their GP before visiting the ED, most were referred there. One patient related futile efforts to reach his GP on the weekend, and another interviewee decided to go to the ED directly without consulting the GP due to a high subjective urgency. Patients stressed the central importance of the GP in their continuous medical care, for example in monitoring and treating chronic disease. The GP was depicted as a crucial advisor and supporter in all medical matters.‘When I'm sick, I always go to the GP.’ (P10, male, in his 20s)
‘A large role [...] because from my point of view, he can answer all my questions if I have problems with my health.’ (P6, female, in her 50s)
‘Actually a very large one, because […] he principally determines what needs to be done to improve my health.’ (P10, male, in his 20s)
Sporadic consulters
The comparable lack of relevance of GP care in sporadic consulters was attributed to a diverse set of reasons. Some interviewees described past experiences of dissatisfaction with GPs, like not being issued with a prescription of antibiotics when they desired so. Additionally, a general but mostly unspecified lack of confidence was frequently expressed, as well as scepticism regarding the GP’s comprehensive view of their health situation.‘[...] I wanted to see a GP on Monday. But there was no one and no replacement.’ (P15, male, in his 40s)
‘And I think, the GP [...] does not have such an overview. I don’t really trust him anyway.’ (P8, female, in her 60s) The capacities of GP care were seen as limited by some interviewees, and time constraints were also mentioned critically.
Interviewees frequently expressed scepticism in regard to GPs competence due to their generalist orientation, and some clearly stated preference of specialist medical care. Participants voicing such attributed to specialists greater competence and superior overview, especially in cases of chronic disease.'When I go there, he has little time […]. It is not great.’ (P3, male, in his 60s)
‘He is so general, you could say, just like myself. [...] I ask him something, then he takes a big book and starts reading. This is something I could do myself […], if I have questions.’ (P5, female, in her 40s)
Some interviewees described a change over time: the GP used to play an important role (comparable to long term regular consulters), but this has diminished as a result of negative experiences.‘Compared to my lung specialist he is a zero, the GP.’ (P3, male, in his 60s)
‘So he has played a very big role for a while. But [...] I decided not to go there anymore. Because I ended up in hospital every time.’ (P11, female, in her 50s)
Patients without GP
Altogether, patients in the no GP group attributed their habitual non-utilization of GP care to two main reasons: mistrust in regard to GPs’ competence – subjectively confirmed by personal experiences – and an absence of any real need for regular medical care due to good health.‘In the morning I tried to call the doctor, this big GP practice. And I couldn’t get any contact.’ (P13, female, in her 60s)
‘I wanted a diagnosis. [...] He just couldn't determine what I had [...]. And that disturbed me so much [...]. [...] So neither a smear nor anything. I would have wished that he […] actually would investigate.’ (P14, female, in her 30s)
‘No GP, because I [...] am in fact rarely ill. That's why I don't actually utilize these physicians.’ (P14, female, in her 30s)
Relationship to GPs
Positive and supportive | • Strong emphasis on favorable aspects of doctor-patient-relationship • Interviewees relate positive experiences |
Ambivalent | • Relationship has both positive and negative facets • Mixed experiences |
Aversive | • Relationship is primarily experienced and depicted as negative |
Positive and supportive relationship
‘I would say very friendly. [...] I mean, I have known him for over twenty years.’ (P12, male, in his 50s)
‘[…] I have noticed that it is better to have a doctor who knows a bit about the story.’ (P16, female, in her 30s)
All eight long-term regular consulters as well as one patient from the sporadic consulters group related an overall positive and supportive relationship.‘Because I feel comfortable there. I know this doctor and he is competent, he is nice. And there is a degree of trust, too.’ (P10, male, in his 20s)
Ambivalent relationship
‘He is nice, […] and he makes an effort.’ (P11, female, in her 50s)
The same patient related dissatisfaction with the limited opening hours and availability of the practice he sporadically frequents.‘[…] but of course, it is very impersonal. [...] another reason why I went to the ED, because my trust in the ED was simply greater than in a GP whom I don’t even really know.’ (P15, male, in his 40s)
Another patient attributed the ambivalent relationship to past disappointments resulting in a loss of trust, namely a number of instances where she had the impression of having been prescribed antibiotics too late by the GP, finally resulting in a necessity for inpatient care.‘And the service level is so bad: Monday in the afternoon 13:00 to 15:00, and Tuesday morning 9:00 to 12:00, and Wednesday not at all […] this is super unprofessional [...] seems more like a hobby practice to me.’ (P15, male, in his 40s)
Aversive relationship
As already outlined, patients without a GP nevertheless related views and past experiences concerning GP care. As in the statements of patients consulting their GP at least sporadically, but describing and overall aversive relationship, lack of trust was strongly thematized. As to trust loss, patients reported episodes of feeling insufficiently investigated and treated by GPs in the past.‘Now, I don't think he knows me very well, […] I don’t really trust him. (P8, female, in her 60s)
‘[...] we were a total mismatch. I had to point out that he should please investigate this [...]. […] I had to worm everything out of him […]. And I didn’t like that. […] I just didn't feel well looked after anymore.’ (P14, female, in her 30s)
‘Trust [...], that’s what I miss here.’ (P13, female, in her 60s)
‘I know, there was this epidemic recently and they just had this ‘one size fits all’-approach. And in my case, it was worse, and it annoyed me so much (…) this was overlooked. ’ (P14, female, in her 30s)
‘[…] always just listened to my lung and wanted to give me stronger medication for obstruction, but never a blood analysis.’ (P13, female, in her 60s)