Availability of pulmonary rehabilitation in primary care for patients with COPD: a cross-sectional study in Sweden

Arne, Mats; Emtner, Margareta; Lisspers, Karin; Wadell, Karin; Ställberg, Björn

doi:10.3402/ecrj.v3.31601

Cited by 26 publications

(23 citation statements)

References 30 publications

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“…Our previous study [15] and a recent systematic review [37] showed that healthcare professionals sometimes felt they themselves lack competence in supporting self-management, or they considered self-management to be outside their daily practice, and therefore they chose to refer patients to others for support. The access to pulmonary rehabilitation in Swedish primary care is rather low [15,43], and the organization (management in primary care) must provide opportunity for its healthcare professionals to feel competent enough and have time to educate and support empowerment among people with COPD.…”

Section: Discussionmentioning

confidence: 99%

Enhancing Confidence and Coping with Stigma in an Ambiguous Interaction with Primary Care: A Qualitative Study of People with COPD

Lundell

Wadell

Wiklund

et al. 2020

COPD: Journal of Chronic Obstructive Pulmonary Disease

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Meaningful and high-quality interactions between people with COPD and healthcare professionals are essential to accomplish effective and efficient self-management. This study's aim was to explore how people with COPD experience COPD-related interactions with healthcare professionals in primary care, and how these interactions influence their self-management and how they cope with their disease. Interviews were performed with eight women and five men with COPD, and grounded theory guided data collection and analysis. The analysis resulted in a theoretical model and the core category (Re)acting in an ambiguous interaction, representing a dynamic process in which healthcare priorities, healthcare professionals' attitudes and participants' personal emotions were important for the participants' experiences of interactions, and how they managed and coped with their disease. Mutually respectful and regular relationships with healthcare professionals, along with a personal positive view of life, empowered and facilitated participants to accept and manage their disease. In contrast, experiences of being deprioritized and not taken seriously, along with experiences of fear and stigma, disempowered and inhibited participants in making healthcare contacts or forced them to compensate for experienced insufficiencies in primary care. In order to facilitate meaningful and high-quality interactions and enhance patient-provider partnerships in primary care, there is a need to improve the status of COPD, as well as to increase competence in COPD management among healthcare professionals and support the empowerment of people with COPD. Findings from this study could guide the implementation of improved self-management support in primary care for COPD and other chronic conditions.

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Section: Discussionmentioning

confidence: 99%

Enhancing Confidence and Coping with Stigma in an Ambiguous Interaction with Primary Care: A Qualitative Study of People with COPD

Lundell

Wadell

Wiklund

et al. 2020

COPD: Journal of Chronic Obstructive Pulmonary Disease

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“…The results of this study also indicate that telemonitoring may have a potential role as a valuable complement to existing health care. It is known that patients with COPD do not receive the recommended health care [ 39 , 52 ]. Considering this, it would be unethical not to further explore eHealth solutions, such as telemonitoring, since it can contribute to more equity in health care.…”

Section: Discussionmentioning

confidence: 99%

Perceptions of Home Telemonitoring Use Among Patients With Chronic Obstructive Pulmonary Disease: Qualitative Study

Lundell

Modig

Holmner

et al. 2020

JMIR Mhealth Uhealth

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Background Chronic obstructive pulmonary disease (COPD) is a major health problem and an economic burden globally. There is growing interest in how electronic health (eHealth) can be used to provide efficient health care. Telemonitoring, where the patient’s health-related data is transmitted to a health care provider, can be used to detect early signs of exacerbations. A successful implementation of telemonitoring systems into clinical practice requires in-depth knowledge of the users’ preferences. Objective The aim of this study was to explore perceptions of the use of a home telemonitoring system among patients with COPD. Methods Semistructured individual interviews were carried out with 8 women and 5 men who were participants in a project aimed at developing and evaluating a telemonitoring system. The web-based telemonitoring system measured pulmonary function, subjective symptoms, and oxygen saturation. Participants were interviewed after having used the system for 2-4 months. Interview transcripts were analyzed with qualitative content analysis. Results The analysis resulted in the theme A transition toward increased control and security and four categories: using with (in)security, affecting technical concern or confidence, providing easy access to health care, and increasing control over the disease. The participants reported various perceptions of using the telemonitoring system. They expressed initial feelings of insecurity, both in terms of operating the system and in terms of their disease. However, the practical management of the telemonitoring system became easier with time; the participants gradually gained confidence and improved their self-management. New technology was perceived as an important complement to existing health care, but the importance of maintaining a human contact in real life or through the telemonitoring system was emphasized. Conclusions This study captured a transition among the participants from being insecure and experiencing technical concerns to acquiring technical confidence and improving disease management. Telemonitoring can be a valuable complement to health care, leading to increased self-knowledge, a sense of security, and improved self-management. Suggestions to improve the further development and implementation of telemonitoring systems include better patient education and the involvement of end users in the technical development process. Additional research is needed, particularly in the design of user-friendly systems, as well as in developing tools to predict which patients are most likely to find the equipment useful, as this may result in increased empowerment, improved quality of life, reduced costs, and a contribution to equity in health.

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“…Our study revealed that GPs did not refer patients to PR as often as they should have. This is particularly noteworthy given the accessibility of PR in Swedish primary care [ 25 ]. Previous researchers found that GPs’ inadequate knowledge of the role of PR in treatment, insufficient experience, and lack of routines explained their low rates of referral to PR [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

COPD management by Swedish general practitioners – baseline results of the PRIMAIR study

Sandelowsky

Natalishvili²,

Krakau

et al. 2018

Scandinavian Journal of Primary Health Care

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BackgroundChronic obstructive pulmonary disease (COPD) is a common cause of suffering and death. Evidence-based management of COPD by general practitioners (GPs) is crucial for decreasing the impact of the disease. Efficient strategies include early diagnosis, smoking cessation and multimodal treatment.AimTo describe knowledge about and skills for managing COPD in GPs in Sweden.MethodsPrior to COPD education (the PRIMAIR Study), GPs at primary health care centers (PHCCs) in Stockholm replied to 13 written, patient-case based, multiple choice and free-text questions about COPD. Their knowledge and practical management skills were assessed by assigned points that were analyzed with non-parametric tests.ResultsOverall, 250 GPs at 34 PHCCs replied (89% response rate). Total mean score was 9.9 (maximum 26). Scores were highest on ‘management of smoking cessation’, ‘follow-up after exacerbation’ and ‘diagnostic procedures’. Spirometry was used frequently, although interpretation skills were suboptimal. ‘Management of maintenance therapy’, ‘management of multimorbidity’ and ‘interprofessional cooperation’ had mediocre scores. Scores were unrelated to whether there was a nurse-led asthma/COPD clinic at the PHCC.ConclusionsSwedish GPs’ knowledge of COPD and adherence to current guidelines seem insufficient. A nurse-led asthma/COPD clinic at the PHCC does not correlate with sufficient COPD skills in the GPs. The relevance of this study to participants’ actual clinical practice and usefulness of easy-to-access clinical guides are interesting topics for future investigation. To identify problem areas, we suggest using questionnaires prior to educational interventions.Key PointsGeneral practitioners (GPs) play a crucial role in providing evidence-based care for patients with chronic obstructive pulmonary disease (COPD) who are treated in primary care.Swedish GPs’ knowledge about COPD and adherence to current guidelines seem insufficient.Areas in greatest need of improvement are spirometry interpretation, management of maintenance therapy, management of multimorbidity in patients with COPD and interprofessional cooperation.

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Availability of pulmonary rehabilitation in primary care for patients with COPD: a cross-sectional study in Sweden

Cited by 26 publications

References 30 publications

Enhancing Confidence and Coping with Stigma in an Ambiguous Interaction with Primary Care: A Qualitative Study of People with COPD

Enhancing Confidence and Coping with Stigma in an Ambiguous Interaction with Primary Care: A Qualitative Study of People with COPD

Perceptions of Home Telemonitoring Use Among Patients With Chronic Obstructive Pulmonary Disease: Qualitative Study

COPD management by Swedish general practitioners – baseline results of the PRIMAIR study

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