title: Exploring the impact of patient views on 'appropriate' use of services and help seeking: a mixed method study.
abstract: BACKGROUND
  There are commonly-held views relating to what constitutes appropriate and inappropriate use of finite NHS resources. However, very little is known about how and why such views have an impact on consultation patterns.
  
  
  OBJECTIVE
  To quantify the prevalence of opinion on whether people use health services unnecessarily within primary care and accident and emergency (A&E) in order to examine the impact of these views on help-seeking behaviour.
  
  
  METHODS
  A mixed method study utilising cross-sectional questionnaire survey and semi-structured interviews.
  
  
  METHODS
  A primary care practice in South West England, UK.
  
  
  METHODS
  Responders to the questionnaire survey were drawn from a random sample of individuals, stratified by sex, selected from one practice in the UK (n = 911). The qualitative sample (n = 22) were purposefully selected from the same general practice.
  
  
  RESULTS
  The quantitative data suggest that the majority of people believe individuals utilise either GP or A&E services inappropriately (65.6%; 95% confidence interval [CI] = 62.4 to 68.7). However, strong views relating to this inappropriate healthcare use were not associated with reported seeking of immediate care (odds ratio [OR] = 0.98, 95% CI = 0.66 to 1.46 for 'lump' vignette). Responders tend to consider other people as time wasters, but not themselves. Individuals' generally describe clear rationales for help seeking, even for seemingly trivial symptoms and anxiety level was strongly predictive of health-seeking behaviour (OR = 2.88; 95% CI = 1.98 to 4.19 for lump vignette).
  
  
  CONCLUSIONS
  Perceptions that individuals' use health services inappropriately are unlikely to explain differences in help-seeking behaviours. The findings suggest that people do not take the decision to consult health services lightly and rationalise why their behaviour is not time wasting.
authors: Department of Health Sciences, University of York, Heslington, York. ja14@york.ac.uk
authors: Joy
authors: J
authors: Adamson
authors: Yoav
authors: Y
authors: Ben-Shlomo
authors: Nish
authors: N
authors: Chaturvedi
authors: Jenny
authors: J
authors: Donovan
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004739:England / Q000453:epidemiology; D004812:Epidemiologic Methods; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D017060:Patient Satisfaction