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 methodology to understand the relationship between need, demand and use of primary careservices. The study conducted in three different areas in the North west of England was designed to, link health status to subsequent use of health care in a waywhich might be used for service planning and the allocation of resources, and to provide data to inform a long term programme examining the relationship between need and demand for primary care. The study was in two stages, a survey and diary study designed to ascertain frequency of health care utilisation and health status of households, followed by a linked qualitative study consisting of in-depth interviews on a subset of people experiencing a range of common complaints seen in primary care. The mixture of methodologies gave a broader understanding 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 to map the patterns of primary care utilisation in a population and the extent of self care actions and lay management of illness undertaken within households. We found that ill people are far more likely to use self care than professional health care services, and when they do use formal services, this tends to be in addition to self care practices. The qualitative data illuminated more about the processes of health care utilisation, particularly the way in which the past experience of illness and service contact coalesced with peoples’ more immediate decision making about using primary care services. The findings suggest that health care use is most appropriately viewed as an interplay between agency and structure rather than the outcome of ‘expressedneed’, individual decision making or ‘supply induced’ demand.