The University of Southampton
University of Southampton Institutional Repository

The complexity of managing COPD exacerbations: a grounded theory study of European general practice

The complexity of managing COPD exacerbations: a grounded theory study of European general practice
The complexity of managing COPD exacerbations: a grounded theory study of European general practice
Objectives To understand the concerns and challenges faced by general practitioners (GPs) and respiratory physicians about primary care management of acute exacerbations in patients with chronic obstructive pulmonary disease (COPD).

Design 21 focus group discussions (FGDs) were performed in seven countries with a Grounded Theory approach. Each country performed three rounds of FGDs.

Setting Primary and secondary care in Norway, Germany, Wales, Poland, Russia, The Netherlands, China (Hong Kong).

Participants 142 GPs and respiratory physicians were chosen to include urban and rural GPs as well as hospital-based and out patient-clinic respiratory physicians.

Results Management of acute COPD exacerbations is dealt with within a scope of concerns. These concerns range from ‘dealing with comorbidity’ through ‘having difficult patients’ to ‘confronting a hopeless disease’. The first concern displays medical uncertainty regarding diagnosis, medication and hospitalisation. These clinical processes become blurred by comorbidity and the social context of the patient. The second concern shows how patients receive the label ‘difficult’ exactly because they need complex attention, but even more because they are time consuming, do not take responsibility and are non-compliant. The third concern relates to the emotional reactions by the physicians when confronted with ‘a hopeless disease’ due to the fact that most of the patients do not improve and the treatment slows down the process at best. GPs and respiratory physicians balance these concerns with medical knowledge and practical, situational knowledge, trying to encompass the complexity of a medical condition.

Conclusions Knowing the patient is essential when dealing with comorbidities as well as with difficult relations in the consultations on exacerbations. This study suggests that it is crucial to improve the collaboration between primary and secondary care, in terms of, for example, shared consultations and defined work tasks, which may enhance shared knowledge of patients, medical decision-making and improved management planning.
2044-6055
1-11
Risør, Mette Bech
1d925c4b-bb8f-4e9f-8367-748fed982660
Spigt, Mark
d81b9f01-cce1-43d3-9c3b-3b2836978c81
Iversen, R
71cdafb1-9d7a-4ef3-b5da-eaa6dd4c0699
Godycki-Cwirko, M
49c96dba-8729-4f32-8ee9-fb43f1285b8f
Francis, Nicholas
9b610883-605c-4fee-871d-defaa86ccf8e
Altiner, A
c444295b-0fd4-4cd3-98c1-efdfc3b52b64
Andreeva, E
6f19d217-aef9-4b37-a140-f9b965e2ab3f
Kung, K
6aafd432-66e6-4d70-aff3-3fbc73947f8f
Melbye, H
0af8f977-61f5-414a-82ba-8843eb63df77
Risør, Mette Bech
1d925c4b-bb8f-4e9f-8367-748fed982660
Spigt, Mark
d81b9f01-cce1-43d3-9c3b-3b2836978c81
Iversen, R
71cdafb1-9d7a-4ef3-b5da-eaa6dd4c0699
Godycki-Cwirko, M
49c96dba-8729-4f32-8ee9-fb43f1285b8f
Francis, Nicholas
9b610883-605c-4fee-871d-defaa86ccf8e
Altiner, A
c444295b-0fd4-4cd3-98c1-efdfc3b52b64
Andreeva, E
6f19d217-aef9-4b37-a140-f9b965e2ab3f
Kung, K
6aafd432-66e6-4d70-aff3-3fbc73947f8f
Melbye, H
0af8f977-61f5-414a-82ba-8843eb63df77

Risør, Mette Bech, Spigt, Mark, Iversen, R, Godycki-Cwirko, M, Francis, Nicholas, Altiner, A, Andreeva, E, Kung, K and Melbye, H (2013) The complexity of managing COPD exacerbations: a grounded theory study of European general practice. BMJ Open, 3 (12), 1-11. (doi:10.1136/bmjopen-2013-003861).

Record type: Article

Abstract

Objectives To understand the concerns and challenges faced by general practitioners (GPs) and respiratory physicians about primary care management of acute exacerbations in patients with chronic obstructive pulmonary disease (COPD).

Design 21 focus group discussions (FGDs) were performed in seven countries with a Grounded Theory approach. Each country performed three rounds of FGDs.

Setting Primary and secondary care in Norway, Germany, Wales, Poland, Russia, The Netherlands, China (Hong Kong).

Participants 142 GPs and respiratory physicians were chosen to include urban and rural GPs as well as hospital-based and out patient-clinic respiratory physicians.

Results Management of acute COPD exacerbations is dealt with within a scope of concerns. These concerns range from ‘dealing with comorbidity’ through ‘having difficult patients’ to ‘confronting a hopeless disease’. The first concern displays medical uncertainty regarding diagnosis, medication and hospitalisation. These clinical processes become blurred by comorbidity and the social context of the patient. The second concern shows how patients receive the label ‘difficult’ exactly because they need complex attention, but even more because they are time consuming, do not take responsibility and are non-compliant. The third concern relates to the emotional reactions by the physicians when confronted with ‘a hopeless disease’ due to the fact that most of the patients do not improve and the treatment slows down the process at best. GPs and respiratory physicians balance these concerns with medical knowledge and practical, situational knowledge, trying to encompass the complexity of a medical condition.

Conclusions Knowing the patient is essential when dealing with comorbidities as well as with difficult relations in the consultations on exacerbations. This study suggests that it is crucial to improve the collaboration between primary and secondary care, in terms of, for example, shared consultations and defined work tasks, which may enhance shared knowledge of patients, medical decision-making and improved management planning.

This record has no associated files available for download.

More information

e-pub ahead of print date: 5 December 2013

Identifiers

Local EPrints ID: 436273
URI: http://eprints.soton.ac.uk/id/eprint/436273
ISSN: 2044-6055
PURE UUID: 901449a3-e8ea-4e8c-9e9a-32248c930d20
ORCID for Nicholas Francis: ORCID iD orcid.org/0000-0001-8939-7312

Catalogue record

Date deposited: 05 Dec 2019 17:30
Last modified: 09 Jan 2022 04:08

Export record

Altmetrics

Contributors

Author: Mette Bech Risør
Author: Mark Spigt
Author: R Iversen
Author: M Godycki-Cwirko
Author: A Altiner
Author: E Andreeva
Author: K Kung
Author: H Melbye

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×