Evaluating health-care: the perspectives of sufferers with upper limb pain.
OBJECTIVE
There is considerable uncertainty over the diagnosis, treatment and management of upper limb pain, which has implications for patient care. Research into patient experiences and evaluation of health-care has been neglected and the study presented here aims to fill this gap.


METHODS
A two-staged, mixed methodology was adopted. Phase 1 involved a postal survey of a random sample (n = 2781) of the working age population (25-64) of an area in south-west England. Phase 2 consisted of follow-up, informal face-to-face interviews with a purposive sample of 47 informants identified, according to pre-defined criteria, from the survey sample.


RESULTS
Our data showed that concerns about the effectiveness of treatments for alleviating pain were fundamental to users' evaluations of both orthodox and non-orthodox health-care. This took priority over the need for a diagnosis and other information. There was a general recognition that the treatments available were, at least, only partially effective and the pragmatic approach led some to eventually withdraw from both orthodox care and complementary and alternative medicines (CAM).


CONCLUSIONS
Patients' priorities for health-care, in this context, were perceived to involve the provision of treatments which alleviated pain and were safe and painless. Orthodox and non-orthodox care needed to be more closely integrated into primary care services.
Calnan
M
M
MRC HSRC, Department of Social Medicine, University of Bristol, Bristol, UK. m.w.calnan@bristol.ac.uk
Wainwright
D
D
O'Neill
C
C
Winterbottom
A
A
Watkins
C
C
D000328:Adult; D000529:Complementary Therapies / Q000706:statistics & numerical data; D003625:Data Collection; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology; D010361:Patients / Q000523:psychology*; D011787:Quality of Health Care; D006113:United Kingdom; D034941:Upper Extremity / Q000503:physiopathology*