Quotes from participants reflecting challenges patients and clinicians face in the present ambulatory care system set in the context of elements of the candidacy framework
| Candidacy framework | Quote | Participant |
| Identification of candidacy | Sometimes, we think that people have a reasonable understanding of their heart condition and then, you know, you might find out later on that they don't. It’s always hard to gauge… | CI 5 |
| Access to service | A lot of the ACHD patients, are often expected to travel long distances … They're often the kind of population that aren't in a position to do that…young people with work commitments, children, they might not have English as their first language, or they may have other comorbidities. | LC 3 |
| Accessibility of services | So, inflow to the clinic is via direct referral from other cardiologists or from transition clinic, or via established follow up and/or transfer from another ACHD unit. | AS 8 |
| Appearance at services | I think for a lot of people it’s, well, managing symptoms and avoiding admission where possible, you know, there’s not many patients that want to go into hospital. | GP 4 |
| Professional responses | I think that face to face interactions are a really important part of care, you know… it’s [video] fine for listening to a talk or a lecture or something like that, but it’s not fine for delivering care to people | CI 3 |
| Sustainability of resources | The problem with ACHD is that the number of patients are growing and the number of specialists is not really growing.… | CI 3 |
| Doctor–patient relationships | …and with ACHD, these patients are very chronic, they’ve had these conditions for years, so these professional relationships are very important. | LC 1 |
ACHD, adult congenital heart disease; AS, ACHD specialist; CI, cardiologist with interest in ACHD; GP, general practitioner; LC, local cardiologist.