Barriers to referral in patients with angina: qualitative study

Objectives To explore barriers to patients being referred for possible reva scularisation. Design Qualitative study using semi-structured interviews. Participants 16 patients aged under 75 years with stable angina and their d octors. Setting General practice in Toxteth, Liverpool. Results Fear of both hospitals and medical tests was common and largely hid den from the doctors. Patients felt they were old, had low expectations of treatment, viewed angina as a chronic illness, and knew little about new de velopments in angina treatment Patients and doctors had difficulty in recog nising angina symptoms that were not textbook definitions amid multiple com orbidity. Patients saw doctors as busy and did not want to bother them with their condition. Cultural gaps and communication difficulties existed desp ite all but one patient having English as their first language. Conclusions Listening to patients is vital to address inequitable access to health services: how patients are treated by doctors today affects accepta bility of referral tomorrow. Primary care groups in deprived areas should w ork With communities to address local fears. This will involve collaboratio n between primary, secondary, and tertiary care. Cultural gaps exist betwee n patients and doctors in deprived areas, and diagnostic confusion can occu r particularly in die presence of other psychological and physical morbidit y. Adequate time and resources-for example, education for doctors and patie nts and provision of interpreters-need to he provided if inequitable access to revascularisation procedures is to be addressed.