Time pressured deprioritization of COPD in primary care: a qualitative study.

Publisher: Taylor & Francis Country of Publication: United States NLM ID: 8510679 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1502-7724 (Electronic) Linking ISSN: 02813432 NLM ISO Abbreviation: Scand J Prim Health Care Subsets: MEDLINE

Publication: Philadelphia, PA : Taylor & Francis
Original Publication: Stockholm, Sweden : Almqvist & Wiksell Periodical Co., [1983-

Health Priorities* ; Office Visits* ; Physicians, Primary Care* ; Practice Patterns, Physicians'* ; Primary Health Care* ; Workload*; Pulmonary Disease, Chronic Obstructive/*therapy; Adult ; Aged ; Attitude of Health Personnel ; Comorbidity ; Female ; Focus Groups ; Humans ; Male ; Middle Aged ; Physician-Patient Relations ; Qualitative Research ; Referral and Consultation ; Sweden

Objective: To identify factors that hinder discussions regarding chronic obstructive pulmonary disease (COPD) between primary care physicians (PCPs) and their patients in Sweden.
Setting: Primary health care centres (PHCCs) in Stockholm, Sweden.
Subjects: A total of 59 PCPs.
Design: Semi-structured individual and focus-group interviews between 2012 and 2014. Data were analysed inspired by grounded theory methods (GTM).
Results: Time-pressured patient-doctor consultations lead to deprioritization of COPD. During unscheduled visits, deprioritization resulted from focusing only on acute health concerns, while during routine care visits, COPD was deprioritized in multi-morbid patients. The reasons PCPs gave for deprioritizing COPD are: "Not becoming aware of COPD", "Not becoming concerned due to clinical features", "Insufficient local routines for COPD care", "Negative personal attitudes and views about COPD", "Managing diagnoses one at a time", and "Perceiving a patient's motivation as low''.
Conclusions: De-prioritization of COPD was discovered during PCP consultations and several factors were identified associated with time constraints and multi-morbidity. A holistic consultation approach is suggested, plus extended consultation time for multi-morbid patients, and better documentation and local routines.
Key Points: Under-diagnosis and insufficient management of chronic obstructive pulmonary disease (COPD) are common in primary health care. A patient-doctor consultation offers a key opportunity to identify and provide COPD care. Time pressure, due to either high number of patients or multi-morbidity, leads to omission or deprioritization of COPD during consultation. Deprioritization occurs due to lack of awareness, concern, and local routines, negative personal views, non-holistic consultation approach, and low patient motivation. Better local routines, extended consultation time, and a holistic approach are needed when managing multi-morbid patients with COPD.

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Keywords: Barriers; COPD; Sweden; general practice; guideline; management; multi-morbidity; primary care; primary care physicians; qualitative study type

Date Created: 20160206 Date Completed: 20161219 Latest Revision: 20181113

20231215

PMC4911027

10.3109/02813432.2015.1132892

26849465