Data collection continued until theoretical saturation was reached, determined through periodic discussion within the research team whose members also read the transcripts [16]. Fifty patients took part in a semi-structured interview. All patients were registered with a general practitioner, and most were

White British (n = 42); 34 were retired or unable to work due to ill-health. selleck chemicals Asthma was the most common condition (n = 10), followed by diabetes (n = 9), but almost half (n = 24) reported more than one of the four LTCs of interest. Most patients reported other co-morbidities, such as arthritis (n = 28) and high blood pressure (n = 28). Age ranged from 39 to 86 years (mean 63.6). Thirty-six patients had used EC in the past year. Table 1 summarises participants’ socio-demographic characteristics, as well as information on use of EC during the year. Patients described a variety of symptoms prompting them to consider using EC, particularly breathlessness, pain, dizziness, and unusual sensations. They described the use of EC as unavoidable because of the inherent urgency of their need. However, buy LY2835219 analysis showed that the judgement that need was urgent, and choice of EC provider,

were influenced by previous experiences mafosfamide of care. We present illustrative data to characterise these findings, below. The ellipsis in parentheses (…) signifies omitted text. Square brackets denote explanatory text. When patients were asked about EC services, they consistently described reluctance to use them. This reluctance was expressed as a desire not to feel like a “burden” on services: I’d prefer not to be a nuisance, you know, and I’ll phone them [hospital staff] up

and take advice, but I’d sooner not go round and bother people (P23, female, 53 yrs, asthma) Hospital EDs were seen as a “last resort”, a service only to be accessed when other options were exhausted: I kind of think that hospital is the last resort where you’d, where you’ve been through the doctor, or whatever and that’s where you end up when you’ve got to have something done that the GP can’t do (P09, female, 62 yrs, CHD & diabetes) Patients recognised that need for help had to be unequivocally serious to justify using EC. Consistent with this, patients who used EC described doing so as unavoidable, using language such as “had to”, “got to go”, “I just knew” or “I needed it”. There was no evidence of deliberation or uncertainty: It’s not something, it’s not something you think about.