Access to care in advanced COPD: factors that influence contact with general practice services.

AIMS: To explore factors that influence the use of general practice services by people with advanced COPD. METHOD: An exploratory qualitative study using in-depth interviews at home with 16 patients who had advanced COPD, recruited through general practices in south-east London. The Framework Approach was used to analyse interview transcripts. RESULTS: Interviewees had a mean age of 70 and a mean FEV1 of 24% predicted. All reported severe breathlessness. They contacted general practices for routine, urgent and emergency care. Contact was influenced by perceptions of ease of access, quality of relationship with their general practitioner (GP), and perceived disease severity and threat. Some patients wanted to avoid bothering the doctor or found travelling to the surgery too difficult. CONCLUSION: Factors other than need influenced patterns of health service use. Expectations of difficulty in access, and poor relationships with their GP, may have delayed help-seeking in severe acute exacerbations.