‘Permeability’ offers a way to conceptualise the impact of these barriers [17]. Highly permeable services require less work and fewer resources from patients who access them – for example, EDs in the UK which are open at all times. A service that seems accessible may in fact be impermeable to particular patient groups [19]. For example, despite general practices being locally available, with designated systems for urgent access, patients in our study described that they were, in fact, impermeable because of

factors such as receptionists’ gate-keeping, and travel cost or mobility problems. In our study, the combination of high permeability and technological expertise led INCB024360 most patients to choose the hospital ED in times of perceived urgent need. In seeking to reduce EC use, healthcare policy this website defines patients as in need of education to use services effectively, or suggests the need for reorganisation of healthcare systems to reduce use of costly emergency care services, especially the ED [2], [7] and [23]. This ‘deficit’ model also dominates previous research investigating EC use, with research focusing on characteristics of

the patient [3], [24], [25] and [26] or the healthcare system [11], [27] and [28] that increase EC use. In contrast, this qualitative study demonstrates that patients understood the array of EC services available and were discriminating in their use of them, influenced primarily by previous experiences of services which recursively shaped their future healthcare choices. It contributes to a growing body of research which emphasises the social processes of help-seeking, and the expertise

patients bring to decision-making around healthcare use [19], [21], [29] and [30]. Our participant sample was large and heterogeneous with respect to age, gender, level of healthcare use (routine care Amino acid and EC) and types of LTCs. We also probed in-depth about instances when they used EC and instances when they did not use EC, and prompted participants to reflect on their decision-making processes about what healthcare options to use and when to use them. This study has several limitations. First, it is possible that patients recounted previous use of EC in what they believed to be publicly defensible ways [31]. The use of serial qualitative interviews [32] examining patients’ healthcare use over time, might enable access to more private accounts, whereby patient’s decision-making can be discussed more openly with a familiar researcher. This approach would enable further insights into the establishment of patterns of healthcare use and how these patterns might be changed. Second, the study was limited to one geographical region, which may limit the transferability of the specific findings to other settings.