Left in limbo: patients' views on care across the primary/secondary interface

Objectives-To discover the views of patients about their experiences across the interface between primary and secondary health care, including referra l from general practitioners, outpatient and inpatient care, discharge, and aftercare. Design-A qualitative study involving individual and focus group interviews of patients and interviews of carers. Subjects-33 patients who had attended at least one outpatient appointment o r had been an inpatient between two and four months previously, and eight c arers of patients with chronic conditions. Setting-Three acute hospitals and one community health service in Leicester shire. Main outcome measures-Common themes in the views of patients and carers tow ards their experiences of care. Results-Five themes emerged. The first four were: "getting in" (access to a ppropriate care), "fitting in" (orientation of care to the patient's requir ements), "knowing what's going on" (provision of information), and "continu ity" (continuity of staff and coordination and communication among professi onals). The fifth theme was "limbo" (difficulty in making progress through the system), which was influenced by failures in care in relation to the ot her four themes. Conclusions-The concept of progress is central to patients' views of care. It involves both progress through the healthcare system and progress toward s recovery or adjustment to an altered health state. Patients' views on how well they progress through the healthcare system may be an appropriate ind icator for monitoring health service performance.