title: A qualitative study in rural and urban areas on whether--and how--to consult during routine and out of hours.
abstract: BACKGROUND
  Patients vary widely when making decisions to consult primary care. Some present frequently with trivial illness: others delay with serious disease. Differences in health service provision may play a part in this. We aimed to explore whether and how patients' consulting intentions take account of their perceptions of health service provision.
  
  
  METHODS
  Four focus groups and 51 semi-structured interviews with 78 participants (45 to 64 years) in eight urban and rural general practices in Northeast and Southwest Scotland. We used vignettes to stimulate discussion about what to do and why. Inductive analysis identified themes and explored the influence of their perceptions of health service provision on decision-making processes.
  
  
  RESULTS
  Anticipated waiting times for appointments affected consulting intentions, especially when the severity of symptoms was uncertain. Strategies were used to deal with this, however: in cities, these included booking early just in case, being assertive, demanding visits, or calling out-of-hours; in rural areas, participants used relationships with primary care staff, and believed that being perceived as undemanding was advantageous. Out-of-hours, decisions to consult were influenced by opinions regarding out-of-hours services. Some preferred to attend nearby emergency departments or call 999. In rural areas, participants tended to delay until their own doctor was available, or might contact them even when not on call.
  
  
  CONCLUSIONS
  Perceived barriers to health service access affect decisions to consult, but some patients develop strategies to get round them. Current changes in UK primary care are unlikely to reduce differences in consulting behaviour and may increase delays by some patients, especially in rural areas.
authors.affiliation: Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Centre, Westburn Road, Aberdeen, AB25 2AY, UK. n.campbell@abdn.ac.uk
authors.forename: Neil C
authors.initials: NC
authors.lastname: Campbell
authors.forename: Lisa
authors.initials: L
authors.lastname: Iversen
authors.forename: Jane
authors.initials: J
authors.lastname: Farmer
authors.forename: Clare
authors.initials: C
authors.lastname: Guest
authors.forename: John
authors.initials: J
authors.lastname: MacDonald
mesh_terms: D039602:After-Hours Care; D003657:Decision Making; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D036301:Qualitative Research; D019035:Rural Health Services / Q000706:statistics & numerical data*; D012606:Scotland; D011795:Surveys and Questionnaires; D019037:Urban Health Services / Q000706:statistics & numerical data*