Research Findings: Understanding health: Understanding of people’s use of health services Summary Papers
Practical and moral dilemmas in living with chronic illness
About half of the drugs prescribed for patients with long-term conditions are not taken as prescribed. This in-depth study explored patient’s feelings about long term use of drugs to manage long-term multiple illness among a sample of respondents from the middle age cohort of the Twenty-07 Study. This research formed part of a wider study on the experience and management of illness among people with multiple chronic conditions and associated symptoms, which focused specifically on why some consulted primary care services more often than others.
We found that drugs were essential to the way people managed their symptoms. Although people expressed dislike in taking drugs, and admitted reluctance in taking them, they realised they could not be free of them and that they were dependent on them to live as “normal” a life as possible. As one respondent told us:-
"I would love to be able to turn round and come off all these things (medications) but to be able to function half normally I’ve got to take them, and if that’s the way it’s got to be, then that’s the way it’s got to be."
When it came to managing their drug intake it was found that people prioritized symptoms and would stick to a more regular schedule in treating one condition while adopting a more flexible approach in treating another according to the severity of symptoms experienced and meeting social demands of their daily life.
To help patients manage symptoms of chronic illness, healthcare programmes and practitioners need to recognise the conflicts patients experience as they negotiate their symptoms, social roles, positive identities, and daily life.
This in-depth project aimed to highlight coping strategies among those in their early 50s from the Twenty-07 study living with long-term illness.
It was found that people use a variety of techniques in managing their symptoms including, talking to others, using medication, and support from social networks such as friends, family and work colleagues. As one respondent told us:-
"I don’t know, I just try and get on with it and I phone my pal and I blether. If she knows I am down in the dumps she’ll phone me and she’ll phone me back an hour later. She always comes up with something funny, you know, to take your mind off things."
However, trying to maintain valued roles in the social aspects of their lives and trying to lead a ‘normal life’ were often prioritized over symptom management leading to tensions and moral dilemmas. People admitted to adopting a range of strategies to cope with social roles. For example in their work or at home as a parent, people would adopt similar methods such as resting, using medication and equipment in order to maintain a sense of independence, despite them often aggravating their symptoms.
Townsend, A., K. Hunt, et al. (2003). "Managing multiple morbidity in mid-life: a qualitative study of attitudes to drug use." British Medical Journal 327: 837-840.
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Townsend, A., S. Wyke, et al. (2006). "Self-managing and managing self: practical and moral dilemmas in accounts of living with chronic illness." Chronic Illness 2(3): 185-194.
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Why do some people consult a GP more often than others?
Over 75% of people consult a GP at least once a year in the UK. However, people in more socially deprived circumstances have been found to consult more frequently. We wanted to uncover the nature of this link between poor health, social deprivation and frequency of consultations. Some researchers suggest that people in socially deprived circumstances may be more ready to visit a GP than those in less deprived circumstances.
Here, we examined data collected from the two older cohorts of the Twenty-07 Study for links between frequent attendances in general practice, socio-economic circumstances, underlying illness, and perceived social support.
We found that people attended a GP more frequently with greater numbers of serious conditions, higher levels of anxiety and lower levels of self-assessed health. Neither socio-economic circumstances or social support were found to be linked with frequency of attendance once this greater burden of ill health in poorer and less supported groups was considered. Therefore, people with poorer social circumstances who visit a GP more often are likely to do so because of higher levels of health needs, and not simply because they have a greater ‘readiness’ to consult a GP for whatever reason. GPs working in deprived areas face challenges in managing high levels of multiple illnesses and policy needs to develop ways of supporting them in delivery of optimum healthcare.
Wyke, S., K. Hunt, et al. (1998). "Gender differences in consulting a general practitioner for common symptoms of minor illness." Social Science and Medicine 46: 901-906.
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Someone to talk to? The role of loneliness in the frequency of GP consultations
There are many reasons why people frequently consult their GP. Although loneliness is increasingly recognised as a problem affecting people’s well-being, it has rarely been addressed as a predictor of the number of GP consultations.
We examined this among the two older cohorts in the localities sample. After taking into account known predictors of consultation such as sex, age, physical and mental health, area of residence, socioeconomic circumstances (social class, home-ownership, access to health care services), and social support networks, loneliness was significantly linked to frequency of consultation at the GP surgery but not with frequency of GP home visits. Respondents who said they felt lonely ‘most of the time’ or ‘often’, had twice as many consultations with their GP in the previous year compared with those who ‘rarely’ or ‘never’ felt lonely. These findings have resource implications for practitioners in terms of cost and management, and can assist in the development of public health strategies to address issues of social inclusion among vulnerable age groups.
Ellaway, A., S. Wood, et al. (1999). "Someone to talk to? The role of loneliness as a factor in the frequency of GP consultations." British Journal of General Practice 49: 363-367.
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Accounts of disagreements with doctors
Understanding patients’ perceptions of healthcare is important to both practitioners and public health researchers to identify ways of improving services. In this study we asked both men and women in the middle cohort from the Twenty-07 Study if they had ever felt that they had disagreed about the diagnosis or treatment a GP had given them or a relative. When some patients’ feel dissatisfied with the healthcare they or a family member have received, some take action yet others do not - we explored why this might be the case. Does the nature of the disagreement (whether it relates to diagnosis or treatment or doctor-patient communication) determine what type of action is taken (do nothing, verbally challenge the doctor’s opinion, make a repeat visit, seek a second opinion, or discontinue treatment)?
Around a third of people said they had disagreed to some extent with a doctor regarding concerns about their own health (75%), about the health of a child (29%); a partner (7%); a parent (6%) and other relatives (1%). People from a non-manual household; who perceived they had a greater vulnerability to illness; worried more about their own health (and to a lesser extent that of a family member); had a long standing illness; and who were very dissatisfied with their GP were more likely to say they had disagreed with a GP.
Figure 1 clearly shows that seeking a second opinion and verbally challenging the doctor are the most frequent actions following a disagreement with a doctor.
We found no clear relationship between the seriousness of the disagreement and action taken which highlights the complexity in understanding patients’ course of action. However, people were more likely to seek a second opinion or challenge the GP’s opinion on behalf of a family member, but more likely to discontinue treatment if their own health was at the centre of the disagreement. Where the nature the disagreement related to patient-doctor communication style, no action was likely to be taken. However, the figure below shows, where diagnosis or treatment relating to a person’s own health was the issue, seeking a second opinion or challenging the GP was the most likely course of action.
Annandale, E. and K. Hunt (1998). "Accounts of disagreements with doctors." Social Science and Medicine 46(1): 119-129.
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