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How do general practitioners implement decision-making regarding COPD patients with exacerbations? An international focus group study

How do general practitioners implement decision-making regarding COPD patients with exacerbations? An international focus group study
How do general practitioners implement decision-making regarding COPD patients with exacerbations? An international focus group study
Purpose: To explore the decision-making of general practitioners (GPs) concerning treatment with antibiotics and/or oral corticosteroids and hospitalization for COPD patients with exacerbations. Methods: Thematic analysis of seven focus groups with 53 GPs from urban and rural areas in Norway, Germany, Wales, Poland, Russia, the Netherlands, and Hong Kong.

Results: Four main themes were identified. 1) Dealing with medical uncertainty: the GPs aimed to make clear medical decisions and avoid unnecessary prescriptions and hospitalizations, yet this was challenged by uncertainty regarding the severity of the exacerbations and concerns about overlooking comorbidities. 2) Knowing the patient: contextual knowledge about the individual patient provided a supplementary framework to biomedical knowledge, allowing for more differentiated decision-making. 3) Balancing the patients? perspective: the GPs considered patients? experiential knowledge about their own body and illness as valuable in assisting their decision-making, yet felt that dealing with disagreements between their own and their patients? perceptions concerning the need for treatment or hospitalization could be difficult. 4) Outpatient support and collaboration: both formal and informal caregivers and organizational aspects of the health systems influenced the decision-making, particularly in terms of mitigating potentially severe consequences of ?wrong decisions? and concerning the negotiation of responsibilities.

Conclusion: Fear of overlooking severe comorbidity and of further deteriorating symptoms emerged as a main driver of GPs? management decisions. GPs consider a holistic understanding of illness and the patients? own judgment crucial to making reasonable decisions under medical uncertainty. Moreover, GPs? decisions depend on the availability and reliability of other formal and informal carers, and the health care systems? organizational and cultural code of conduct. Strengthening the collaboration between GPs, other outpatient care facilities and the patients? social network can ensure ongoing monitoring and prompt intervention if necessary and may help to improve primary care for COPD patients with exacerbations.
1176-9106
3109-3119
Laue, Johanna
a0645c78-8637-44de-85cb-a5fdf3238d0c
Melbye, Hasse
be60ca95-b236-48e5-8eb9-c9a153d54a8f
Halvorsen, Peder
2e97bd71-c59a-426c-b2c7-efb6a580baaa
Andreeva, Elena
6f19d217-aef9-4b37-a140-f9b965e2ab3f
Godycki-Cwirko, Maciek
306b5836-4955-470d-bf1f-77c6ac282138
Wollny, Anja
03a942d7-7817-4870-92b2-3aafc3421242
Francis, Nicholas Andrew
9b610883-605c-4fee-871d-defaa86ccf8e
Spigt, Mark
d81b9f01-cce1-43d3-9c3b-3b2836978c81
Kung, Kenny
6aafd432-66e6-4d70-aff3-3fbc73947f8f
Risør, Mette
1d925c4b-bb8f-4e9f-8367-748fed982660
Laue, Johanna
a0645c78-8637-44de-85cb-a5fdf3238d0c
Melbye, Hasse
be60ca95-b236-48e5-8eb9-c9a153d54a8f
Halvorsen, Peder
2e97bd71-c59a-426c-b2c7-efb6a580baaa
Andreeva, Elena
6f19d217-aef9-4b37-a140-f9b965e2ab3f
Godycki-Cwirko, Maciek
306b5836-4955-470d-bf1f-77c6ac282138
Wollny, Anja
03a942d7-7817-4870-92b2-3aafc3421242
Francis, Nicholas Andrew
9b610883-605c-4fee-871d-defaa86ccf8e
Spigt, Mark
d81b9f01-cce1-43d3-9c3b-3b2836978c81
Kung, Kenny
6aafd432-66e6-4d70-aff3-3fbc73947f8f
Risør, Mette
1d925c4b-bb8f-4e9f-8367-748fed982660

Laue, Johanna, Melbye, Hasse, Halvorsen, Peder, Andreeva, Elena, Godycki-Cwirko, Maciek, Wollny, Anja, Francis, Nicholas Andrew, Spigt, Mark, Kung, Kenny and Risør, Mette (2016) How do general practitioners implement decision-making regarding COPD patients with exacerbations? An international focus group study. International Journal of Chronic Obstructive Pulmonary Disease, 11 (1), 3109-3119. (doi:10.2147/COPD.S118856).

Record type: Article

Abstract

Purpose: To explore the decision-making of general practitioners (GPs) concerning treatment with antibiotics and/or oral corticosteroids and hospitalization for COPD patients with exacerbations. Methods: Thematic analysis of seven focus groups with 53 GPs from urban and rural areas in Norway, Germany, Wales, Poland, Russia, the Netherlands, and Hong Kong.

Results: Four main themes were identified. 1) Dealing with medical uncertainty: the GPs aimed to make clear medical decisions and avoid unnecessary prescriptions and hospitalizations, yet this was challenged by uncertainty regarding the severity of the exacerbations and concerns about overlooking comorbidities. 2) Knowing the patient: contextual knowledge about the individual patient provided a supplementary framework to biomedical knowledge, allowing for more differentiated decision-making. 3) Balancing the patients? perspective: the GPs considered patients? experiential knowledge about their own body and illness as valuable in assisting their decision-making, yet felt that dealing with disagreements between their own and their patients? perceptions concerning the need for treatment or hospitalization could be difficult. 4) Outpatient support and collaboration: both formal and informal caregivers and organizational aspects of the health systems influenced the decision-making, particularly in terms of mitigating potentially severe consequences of ?wrong decisions? and concerning the negotiation of responsibilities.

Conclusion: Fear of overlooking severe comorbidity and of further deteriorating symptoms emerged as a main driver of GPs? management decisions. GPs consider a holistic understanding of illness and the patients? own judgment crucial to making reasonable decisions under medical uncertainty. Moreover, GPs? decisions depend on the availability and reliability of other formal and informal carers, and the health care systems? organizational and cultural code of conduct. Strengthening the collaboration between GPs, other outpatient care facilities and the patients? social network can ensure ongoing monitoring and prompt intervention if necessary and may help to improve primary care for COPD patients with exacerbations.

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More information

Accepted/In Press date: 20 October 2016
Published date: 1 December 2016

Identifiers

Local EPrints ID: 435975
URI: http://eprints.soton.ac.uk/id/eprint/435975
ISSN: 1176-9106
PURE UUID: 9e1304a7-68ed-4d21-9313-2136fe26ef65
ORCID for Nicholas Andrew Francis: ORCID iD orcid.org/0000-0001-8939-7312

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Date deposited: 25 Nov 2019 17:30
Last modified: 17 Dec 2019 01:20

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Contributors

Author: Johanna Laue
Author: Hasse Melbye
Author: Peder Halvorsen
Author: Elena Andreeva
Author: Maciek Godycki-Cwirko
Author: Anja Wollny
Author: Mark Spigt
Author: Kenny Kung
Author: Mette Risør

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