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Reasons for Accident and Emergency department attendance by people with chronic obstructive pulmonary disease or heart failure: recipients and providers’ perspectives. An exploratory study

Jeong Su Lee, Heidi Lampp, Vivek Srivastava and Elizabeth Barley
BMJ Open Respir Res 2018;5:e000244.

The fifteen million people in England who are affected by one or more long-term conditions are frequent users of Accident and Emergency (A&E) services, especially those with heart failure and chronic obstructive pulmonary disease (COPD). The number of admissions for both conditions is reported to have increased for the past ten years, and the literature suggests the decision to attend is considered by patients and community healthcare professionals to be exacerbation-driven and unavoidable. However, there is a gap in understanding the views of family members and hospital clinicians, with no known study comparing the three groups (patients, family members and hospital clinicians).

The exploratory study identifying key factors contributing to A&E attendance was undertaken by Jeong Su Lee and co-workers across these three groups. Input came in the form of interviews with patients and their family members and a survey of hospital clinicians.

All three parties agreed that severe exacerbation was the main reason for A&E attendance. The three key factors highlighted in relation to A&E attendance were: patients’ health-seeking behaviour, perceptions about the services offered by general practitioners and A&E, and patients’ attitudes toward managing their own conditions. Improving patient trust in their GP services might encourage more timely access of primary care services and a decrease in exacerbation-driven attendance in A&E.

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