A qualitative study of GP, nurse and practice manager views on using targeted case-finding to identify patients with COPD in primary care

Abstract

‘Finding the missing millions’ with chronic obstructive pulmonary disease became part of the Department of Health strategy for England in 2010. Targeted case-finding within primary care is one potential pro-active strategy, but currently little is known about the views of healthcare professionals on this approach. In this study, 36 healthcare professionals (12 GPs, 14 nurses, and 10 practice managers) from 34 UK practices participated in semi-structured telephone interviews about targeted case-finding. Interviews followed an interview guide, were audio-recorded, transcribed verbatim, coded and analysed using ‘Framework Approach’. Most of those interviewed practiced opportunistic case-finding. The main perceived barriers to wider case-finding programmes were the resource implications associated with running such programmes and identifying more chronic obstructive pulmonary disease patients. Financial incentives, support from specialist clinicians, and comprehensive guidance were viewed as facilitators. While targeted case-finding is conceptually accepted by primary care staff, scepticism surrounding (1) the value of identifying those with mild disease and (2) the availability of effective targeted case-finding methods, may lead some to favour an opportunistic approach. Key concerns were a lack of unequivocal evidence for the relative benefits vs. disadvantages of diagnosing patients earlier, and resource constraints in an already over-burdened system. Barriers to practical implementation of case-finding studies may be addressed with financial, human and educational resources, such as additional staff to undertake searches and perform spirometry tests, and practical and educational support from specialist teams.

Case-finding for COPD in primary care: a qualitative study of patients’ perspectives

“…Exploration of the views of health care professionals involved in the case-finding trial highlighted limited capacity, resources, and expertise among primary care practitioners as potential explanations for this delay. 18 A more recent UK study by Summers et al 19 found that although health care professionals implementing targeted case-finding in primary care agreed that diagnosing COPD earlier had benefits, patients’ increased stress and negative responses added more strain on limited resources.…”

Model-based evaluation of the long-term cost-effectiveness of systematic case-finding for COPD in primary care

“…Ten yearly systematic active case-finding was the most cost-effective screening interval, although policymakers need to balance this against a greater proportion of the cohort remaining undiagnosed for longer and the value patients and practitioners place on early diagnosis 38…”

Case-finding for COPD clinic acceptability to patients in GPs across Hampshire: a qualitative study

“…Therefore, addressing potential barriers, challenges and concerns to patient uptake in GP may aid future case-finding implementation strategies. To date, only one research paper has explored the perceptions and experiences of patients attending a case-finding clinic while others have focussed on the views of health care professionals 26 – 28 .…”