Class and language get in the way of referral for angina in deprived areas

Inequitable access to revascularisation procedures for patients with angina has been shown in quantitative studies. Factors cited include socioeconomic status, sex, race, and ethnicity. Little qualitative work has been carried out on the reasons behind these inequalities, particularly those centred in the patients. Gardner and Chapple (p 418) examined qualitatively the barriers to referral in patients with angina in an inner city practice. Barriers operated within the patients, their community, and culture and within the doctor-patient relationship. They included myths and fears about hospitals and treatment, perceptions about age and worthiness for treatment, low expectations, and cultural gaps between doctor and patients leading to communication difficulties. The barriers represent aspects of deprivation that need to be addressed if inequalities in access to health services are to be tackled, and they have implications for resources for health care in deprived areas.

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Barriers to referral in patients with angina: qualitative study • Commentary: Generalisability and validity in qualitative research

Katy Gardner, Alison Chapple, and Judith Green
BMJ 1999 319: 418-421. [Abstract] [Full Text] [PDF]