Barriers to uptake of services for coronary heart disease: qualitative study

Objectives To identify factors within the South Yorkshire coalfields that i nfluence use of health services by people with angina. Design Qualitative study using semistructured individual and group intervie ws. Setting General practice and community settings in Barnsley and Rotherham h ealth authorities. Participants 14 patients with stable angina and nine primary care staff had individual interviews plus five community groups and one group of general practitioners. Main outcome measures Barriers to accessing health services. Results A complex web of factors was identified that prevented, delayed, or facilitated referral to secondary care. Delay, denial, and self management by patients meant that the Rill extent of symptoms often remained hidden f rom general practitioners, resulting in a delayed or missed referral. Barri ers identified fell into six categories: structural personal, social and cu ltural, past experience and expectations, diagnostic confusion, and knowled ge and awareness. Conclusions Many of the factors influencing referral operate before general practitioners become involved. Community development could be one way of t ackling inequalities and promoting sustainable change. Structural changes a re needed to improve access and increase the acceptability of general pract ice services. Primary care staff should be educated to detect under-reporti ng of symptoms and promote appropriate referral.