Satisfaction with access to healthcare: qualitative study of rural patients and practitioners

Abstract

Aim: To gain insight into factors affecting patient and practitioner satisfaction with access to healthcare in a remote rural island community. Background: General practice based primary care is the focus of health service delivery in rural areas of the UK. Individuals from rural populations have reported inequalities in access to healthcare. User satisfaction with service performance is recognised as an important outcome of healthcare. Further investigation into factors underpinning patient and practitioner satisfaction with access to rural healthcare is required. Design of Study: Qualitative interviews with patients and primary healthcare practitioners. Setting: Isles of Scilly, Cornwall, UK. Methods: A topic guide was developed following review of the literature. In-depth, semi-structured interviews with a purposive sample of 23 participants were conducted with individuals from all inhabited islands. Detailed field notes were kept, and interview content was partially transcribed and analysed thematically. Findings: Principal themes identified were common to patient and practitioner participants. These were: concerns expressed regarding the equitable provision of services; obstacles to using health services; and the outlook of patients and professionals, including expectations, choice, patient-practitioner relationships and community cohesiveness. Emerging themes gave insight into a range of factors affecting satisfaction with access to healthcare. Conclusion: Despite numerous policy initiatives aimed at reducing inequities in health service provision, problems with access and uptake of health services persist amongst individuals from remote rural populations. If implemented, recent National Health Service proposals may address some of the challenges identified by participants. Service developments need to take account of local priorities, expectations, geography and demography to achieve favourable outcomes.

Does team-based primary health care improve patients’ perception of outcomes? Evidence from the 2007–08 Canadian Survey of Experiences with Primary Health

“…patient satisfaction, management of diabetes and hyperlipidemia) associated with practices that included non-physicians such as nurses and physician assistants [31,32]. A recent study using UK general practice data also indicated that team-based practice is associated with better processes of care for patients with diabetes, improved continuity of care, access to care, and patient satisfaction [14]. Studies based on Australian data found evidence of improved diabetes control in patients who were treated by a multidisciplinary team and had a pre-care plan for managing their HbA1c levels [33].…”

“…Some studies suggest that teambased practice is positively associated with improved patient outcomes, such as increased access, improved quality of service, effective management of chronic diseases [3,5,[11][12][13][14][15][16][17]. By contrast, other studies suggest a negligible impact of team-based PHC delivery on patient outcomes: limited access to physicians, compromised continuity of care, duplication of efforts, creation of barriers of disciplinary territoriality, systems inertia and organizational complexity [11,[18][19][20][21][22].…”

Views of residents of rural areas on accessibility to specialist care through videoconference

“…Local professionals and politicians must take into account that the conditions of rural geography create different health care needs when planning for rural citizens [1]. People in rural areas do not have access to the same range of services as those in urban areas [2].…”

Factors affecting rural volunteering in palliative care – an integrated review

“…When someone is dying, the whole community knows. Patients may not divulge personal information for fear of loss of anonymity, but are conversely more trusting of the health care staff because they know them . Equally there is a level of professional risk for health professionals and volunteers if patients or caregivers become disenfranchised with the care they receive …”