title: The complexity of patients' satisfaction with out-of-hours care: a qualitative study.
abstract: BACKGROUND
  The national health service in the Republic of Ireland is one of a number of European health services currently undergoing significant reform. Out-of-hours primary care has been at the forefront of this process of change, and although patients appear satisfied, the complexity of their response to changes in out-of-hours care has not been fully explored.
  
  
  OBJECTIVE
  To conduct an analysis of qualitative data collected during a recent study of patients' satisfaction with out-of-hours care in order to explore the full range of patients' views and experiences.
  
  
  METHODS
  All patients contacting a family-doctor out-of-hours cooperative over a designated 24-day period were forwarded a postal questionnaire. The questionnaire contained a section giving the patient the opportunity to add qualitative comments concerning their experience. The data were analysed according to the principles framework analysis using Nvivo software.
  
  
  RESULTS
  Analysis of the data resulted in the development of the following thematic categories: service availability, service accessibility, efficiency, continuity of care and quality of care. There was a range of views, both positive and negative, apparent around these themes, with evidence of patients engaging in careful decisions and "trade-offs" in respect of their options for out-of-hours care.
  
  
  CONCLUSIONS
  Patients hold a range of views that suggests the complexity around patient satisfaction with out-of-hours care. A qualitative methodological approach can compliment current approaches to the evaluation of patient satisfaction, facilitating the exploration of the full range of patients' views and experiences.
authors.affiliation: Ballyvaughan Medical Centre, Ballyvaughan, County Clare, Ireland. liam.glynn@nuigalway.ie
authors.forename: Liam G
authors.initials: LG
authors.lastname: Glynn
authors.forename: Anne
authors.initials: A
authors.lastname: MacFarlane
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Murphy
mesh_terms: D000328:Adult; D039602:After-Hours Care / Q000458:organization & administration; D000368:Aged; D005260:Female; D006801:Humans; D007494:Ireland; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011795:Surveys and Questionnaires