Titre :
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With an attack I associate it more with going into hospital : Understandings of asthma and psychosocial stressors ; are they related to use of services ? (2008)
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Auteurs :
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REES JONES (Ian) : GBR. School of Social Sciences. Bangor University. Neuadd Ogwen. Bangor Gwynedd. ;
Nilufar AHMED ;
Graham BOTHAMLEY ;
GRIFFITHS (Chris) : GBR. Mrc Asthma Uk Centre in Allergic Mechanisms of Asthma. Centre for Health Sciences. Barts and the London Queen Mary's School of Medicine and Dentistry. London El. ;
Moira KELLY ;
Anne O'MALLEY ;
Raja RAJAKULASINGAM ;
VICTOR (Christina) : GBR. University of Reading. ;
Homerton Hospital. London. GBR ;
Queen Mary. University of London. GBR
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Type de document :
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Article
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Dans :
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Social science and medicine (vol. 66, n° 3, 2008)
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Pagination :
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765-775
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Langues:
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Anglais
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Mots-clés :
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Asthme
;
Hôpital
;
Connaissance
;
Europe sociale
;
Stress
;
Utilisation
;
Soins santé primaire
;
Utilisation service
;
Homme
;
Europe
;
Bronchopneumopathie obstructive
;
Maladie chronique
;
Facteur psychosocial
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Résumé :
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[BDSP. Notice produite par INIST-CNRS eR0xr24L. Diffusion soumise à autorisation]. Asthma is still a major cause of morbidity and mortality. Patients who use hospital services frequently tend to have more severe asthma and lack formal support. Attitudes to self-management also tend to differ and qualitative studies of frequent attenders have identified differing views of the appropriateness of service use between patients and their physicians. We undertook a qualitative study of patients with severe asthma admitted and not admitted to hospital in a 12-month period in the UK. The aim of the study was to investigate the relationship between perception of life events, psychosocial factors, coping and asthma admission in these two groups of patients. We interviewed 50 patients (aged 16 and over) admitted to two large teaching hospitals in London with asthma exacerbations, 25 patients with similar levels of asthma severity (step 3 or higher of the British Thoracic Society guidelines) sampled in General Practice and 19 general practitioners (GPs). Data were analysed using an adapted framework analysis. Patients admitted to hospital reported high levels of psychosocial problems and life events but tended to make few connections between these and their asthma attacks or their ability to manage their asthma. Patients reporting frequent hospital use tended to value professionals working in hospitals while reporting poor relationships with GPs ; views that appeared related to delays in seeking help from primary care. Among GPs, knowledge of patients having attended hospital was generally poor, although they appeared more aware of those who were high users of General Practice (whether they were high attenders at hospital or not). GPs perceived stressful life events in patients with asthma to compound existing dispositions and be related to poor control and poor adherence. These findings suggest that vulnerable patient groups often face poor material circumstances and chaotic lives, impacting on their capacity to manage their illness and on their ability to derive benefit from primary care. Policy interventions aimed at reducing'unnecessary'admissions will need to be tailored to the psychosocial circumstances and health beliefs of vulnerable patient groups.
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