title: Access to care in advanced COPD: factors that influence contact with general practice services.
abstract: OBJECTIVE
  To explore factors that influence the use of general practice services by people with advanced COPD.
  
  
  METHODS
  An exploratory qualitative study using in-depth interviews at home with 16 patients who had advanced COPD, recruited through general practices in south-east London. The Framework Approach was used to analyse interview transcripts.
  
  
  RESULTS
  Interviewees had a mean age of 70 and a mean FEV1 of 24% predicted. All reported severe breathlessness. They contacted general practices for routine, urgent and emergency care. Contact was influenced by perceptions of ease of access, quality of relationship with their general practitioner (GP), and perceived disease severity and threat. Some patients wanted to avoid bothering the doctor or found travelling to the surgery too difficult.
  
  
  CONCLUSIONS
  Factors other than need influenced patterns of health service use. Expectations of difficulty in access, and poor relationships with their GP, may have delayed help-seeking in severe acute exacerbations.
authors.affiliation: Department of General Practice and Primary Care, King's College London, London, UK. catherine.shipman@kcl.ac.uk
authors.forename: Cathy
authors.initials: C
authors.lastname: Shipman
authors.forename: Suzanne
authors.initials: S
authors.lastname: White
authors.forename: Marjolein
authors.initials: M
authors.lastname: Gysels
authors.forename: Patrick
authors.initials: P
authors.lastname: White