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|Title: ||Access to general practice :a qualitative study of appointment making in general practice|
|Authors: ||Gallagher, Morris|
|Issue Date: ||2003 |
|Publisher: ||Newcastle University|
|Abstract: ||The aim of this thesis was to observe appointment negotiations in general
practice, and investigate patients' and receptionists' experiences of
appointment making. Improving access to health care is a National Health
Service priority. These priorities are manifest when patients' request an
appointment to see their GP.
This study was conducted in three general practices on Tyneside: a singlehanded
practice; a three doctor practice; and a seven-doctor practice. Two
methods were used, participant observation, consisting of observing and
recording practice activities and observations with informal interviews, and long interviews with patients and professionals.
Activity recordings and observations were conducted in waiting rooms, behind
reception counters, and in other settings. There were 35 activity recordings and
34 periods of observation. Thirty-eight patients and 15 professionals were
interviewed. Participants were selected by theoretical sampling. These included 12 short interviews with patients attending an 'open access'surgery.
Six groups of patients (23) and 15 professionals were selected for long
interview. These included patients who complained about appointment making
or who complimented the receptionists.
Transcripts of observations and interviews were analysed by theoretical coding
and data display to identify concepts and categories of data. Several methods
were used to enhance the research's quality.
Outcomes from appointment negotiations are influenced by patient's illness behaviour, the process of negotiation, and appointment availability.
Appointment requests are legitimised by receptionists enforcing practice rules
and requesting clinical information. Receptionists also work outside 'official'
practice rules to manage limited appointment availability. These strategies include 'fitting patients in, ' reserving appointments, referring to other
professionals and using advocates to support their actions. Patients volunteer
information to provide evidence that their complaint is appropriate, and employ
strategies, such as assertiveness, and threats, to try and obtain appointments.
Receptionists have a crucial role in managing patient access that remains
unacknowledged by policy makers.|
|Description: ||MD Thesis|
|Appears in Collections:||Institute of Health and Society|
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