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Abstracto

Patient choice: an exploration of primary care dermatology patients’ values and expectations of care

Sue Horrocks, Joanna Coast

BackgroundSkin complaints are an important cause of ill-health accounting for a large number of general practitioner (GP) consultations and referrals to secondary care. Organisational developments in the UK have led to GPs with a special interest (GPSI) in dermatology offering outpatient services in a primary care setting; however, an in-depth exploration of the values dermatology patients attach to aspects of care or the acceptability of variations in secondary care service delivery has not been reported. AimTo identify and explore the aspects of care dermatology patients deemed important in making choices about service use. DesignA qualitative study carried out alongside a randomised controlled trial to compare effectiveness of a GPSI dermatology service with standard consultant-led dermatology outpatient care. SettingUnited Kingdom. MethodSemi-structured interviews with primary care patients referred for routine dermatology outpatient appointments. ResultsParticipants referred for routine outpatients appointments had skin conditions which ranged in severity and impact on their quality of life. Those with minor skin complaints expected their GP to be able to provide more treatments at their local surgery. Some participants who had experienced unsuccessful treatment by their GP reported difficulties in obtaining a specialist referral. Variation in perception and relative importance of the constituents of specialist care was highlighted. Primary care-based specialist services are not always accessible to those living outside the immediate vicinity. ConclusionGPs should be aware of the impaired quality of life experienced by some patients with chronic skin complaints. GPSI services were acceptable to the majority. However, there is likely to be a group of patients with longstanding, though clinically non-urgent, conditions for whom the service will not be acceptable.