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

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...

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Autores principales: Sandelowsky, Hanna, Hylander, Ingrid, Krakau, Ingvar, Modin, Sonja, Ställberg, Björn, Nager, Anna
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Taylor & Francis 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4911027/
https://www.ncbi.nlm.nih.gov/pubmed/26849465
http://dx.doi.org/10.3109/02813432.2015.1132892
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author Sandelowsky, Hanna
Hylander, Ingrid
Krakau, Ingvar
Modin, Sonja
Ställberg, Björn
Nager, Anna
author_facet Sandelowsky, Hanna
Hylander, Ingrid
Krakau, Ingvar
Modin, Sonja
Ställberg, Björn
Nager, Anna
author_sort Sandelowsky, Hanna
collection PubMed
description 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: KEY POINTS: 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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spelling pubmed-49110272016-06-17 Time pressured deprioritization of COPD in primary care: a qualitative study Sandelowsky, Hanna Hylander, Ingrid Krakau, Ingvar Modin, Sonja Ställberg, Björn Nager, Anna Scand J Prim Health Care Research Articles 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: KEY POINTS: 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. Taylor & Francis 2016-03 2016-02-03 /pmc/articles/PMC4911027/ /pubmed/26849465 http://dx.doi.org/10.3109/02813432.2015.1132892 Text en © 2016 The Author(s). Published by Taylor & Francis. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Articles
Sandelowsky, Hanna
Hylander, Ingrid
Krakau, Ingvar
Modin, Sonja
Ställberg, Björn
Nager, Anna
Time pressured deprioritization of COPD in primary care: a qualitative study
title Time pressured deprioritization of COPD in primary care: a qualitative study
title_full Time pressured deprioritization of COPD in primary care: a qualitative study
title_fullStr Time pressured deprioritization of COPD in primary care: a qualitative study
title_full_unstemmed Time pressured deprioritization of COPD in primary care: a qualitative study
title_short Time pressured deprioritization of COPD in primary care: a qualitative study
title_sort time pressured deprioritization of copd in primary care: a qualitative study
topic Research Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4911027/
https://www.ncbi.nlm.nih.gov/pubmed/26849465
http://dx.doi.org/10.3109/02813432.2015.1132892
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