title: Left in limbo: patients' views on care across the primary/secondary interface.
abstract: OBJECTIVE
  To discover the views of patients about their experiences across the interface between primary and secondary health care, including referral from general practitioners, outpatient and inpatient care, discharge, and aftercare.
  
  
  METHODS
  A qualitative study involving individual and focus group interviews of patients and interviews of carers.
  
  
  METHODS
  33 patients who had attended at least one outpatient appointment or had been an inpatient between two and four months previously, and eight carers of patients with chronic conditions.
  
  
  METHODS
  Three acute hospitals and one community health service in Leicestershire.
  
  
  METHODS
  Common themes in the views of patients and carers towards their experiences of care.
  
  
  RESULTS
  Five themes emerged. The first four were: "getting in" (access to appropriate care), "fitting in" (orientation of care to the patient's requirements), "knowing what's going on" (provision of information), and "continuity" (continuity of staff and coordination and communication among professionals). The fifth theme was "limbo" (difficulty in making progress through the system), which was influenced by failures in care in relation to the other four themes.
  
  
  CONCLUSIONS
  The concept of progress is central to patients' views of care. It involves both progress through the healthcare system and progress towards recovery or adjustment to an altered health state. Patients' views on how well they progress through the healthcare system may be an appropriate indicator for monitoring health service performance.
authors.affiliation: Eli Lilly National Clinical Audit Centre, Department of General Practice and Primary Health Care, University of Leicester, Leicester General Hospital, UK.
authors.forename: C
authors.initials: C
authors.lastname: Preston
authors.forename: F
authors.initials: F
authors.lastname: Cheater
authors.forename: R
authors.initials: R
authors.lastname: Baker
authors.forename: H
authors.initials: H
authors.lastname: Hearnshaw
mesh_terms: D003266:Continuity of Patient Care / Q000592:standards*; D017144:Focus Groups; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000592:standards*; D019984:Quality Indicators, Health Care; D012017:Referral and Consultation / Q000592:standards*; D006113:United Kingdom