Understanding the Patterns and Processes of Primary Care Use: A Combined Quantitative and Qualitative Approach

This paper addresses the combined use of quantitative and qualitative methodologyto understand the relationship between need, demand and use of primarycareservices.The study conducted in three different areas in the North west of England wasdesigned to, link health status to subsequent use of health care in a waywhichmight be used for service planning and the allocation of resources, and toprovide data to inform a long term programme examining the relationship betweenneed and demand for primary care. The study was in two stages, a survey anddiary study designed to ascertain frequency of health care utilisation andhealth status of households, followed by a linked qualitative study consistingof in-depth interviews on a subset of people experiencing a range of commoncomplaints seen in primary care. The mixture of methodologies gave a broaderunderstanding of the dynamics of health utilisation in the localities studied.The survey and diary data showed the way in which key variables can be used tomap the patterns of primary care utilisation in a population and the extent ofself care actions and lay management of illness undertaken within households. Wefound that ill people are far more likely to use self care than professionalhealth care services, and when they do use formal services, this tends to be inaddition to self care practices. The qualitative data illuminated more about theprocesses of health care utilisation, particularly the way in which the pastexperience of illness and service contact coalesced with peoples’ more immediatedecision making about using primary care services. The findings suggest thathealth care use is most appropriately viewed as an interplay between agency andstructure rather than the outcome of ‘expressedneed’, individual decision makingor ‘supply induced’ demand.