| Popis: |
Background: Literature indicates underutilization of Palliative Care Services in the UK, with possible inequalities of access. These trends in underutilization are seen in Adult-Palliative Day-Care (APDC), a Specialist Palliative Care Service delivered in the outpatient setting. However, gaps in knowledge remain regarding if underutilization in APDC is real, and the identity and nature of the factors which determine access. Aim: The overall research question was “What are the factors which act to determine access to APDC?”. Five sub-questions for exploration in the context of access were formulated relating to the: perceived health care needs of users; the benefits of using APDC, and understandings of the role of APDC as a palliative care service. Methods: The study site was a cancer network in the Midlands of England which covered rural and urban areas. It contained 5 APDC units, 3 Primary Care Trusts, and 3 Acute Care Trusts. Fifty semistructured in-depth interviews were conducted with: 19 providers of APDC; 13 health professional referrers; 11 palliative care patients who had used the service; and 7 of their carers. The reasons for non-attendance for 149 patients who were referred to day-care but did not attend were also analysed. Thematic analysis with constant comparison and content analysis were used to analyse transcripts and document data respectively. Results: Eighteen determinants of access were identified arising out of the characteristics of the: potential service user (2), the health service or organization (9), and from interactions between potential service users, the family, the wider society, and the health service (7). The study found that utilization measures in APDC may not be accurately representing service use, as APDC units maybe functioning at their maximum capacity while current calculation methods report underutilization. Conclusion: New insights into accessing APDC are presented which and may have applications for future policy and research. |
