Care-seeking and delay of care during COPD exacerbations

Abstract

Patients who receive earlier treatment for acute exacerbations of chronic obstructive pulmonary disease (COPD) have a better prognosis, including earlier symptom resolution and reduced risk of future emergency-department visits (ED) or hospitalizations. However, many patients delay seeking care or do not report worsening symptoms to their healthcare provider. In this study, we aimed to understand how patients perceived their breathing symptoms and identify factors that led to seeking or delaying care for an acute exacerbation of COPD. We conducted semistructured interviews with 60 individuals following a recent COPD exacerbation. Participants were identified from a larger study of outpatients with COPD by purposive sampling by exacerbation type: 15 untreated, 15 treated with prednisone and/or antibiotics in the outpatient setting, 16 treated in an urgent care or ED setting, and 14 hospitalized. Data were analyzed using inductive content analysis. Participants were primarily male (97%) with a mean age of 69.1 ± 6.9 years, mean FEV1 1.42 (±0.63), and mean mMRC dyspnea of 2.7 (±1.1). We identified 4 primary themes: (i) access and attitudinal barriers contribute to reluctance to seek care, (ii) waiting is a typical response to new exacerbations, (iii) transitioning from waiting to care-seeking: the tipping point, and (iv) learning from and avoiding worse outcomes. Interventions to encourage earlier care-seeking for COPD exacerbations should consider individuals’ existing self-management approaches, address attitudinal barriers to seeking care, and consider health-system changes to increase access to non-emergent outpatient treatment for exacerbations.Clinical Trial Registration NCT02725294

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“…Delays in seeking medical care may be multifactorial. Previous studies have demonstrated that delay may occur due to resource availability (including transportation, finances or insurance, homelessness), subjective interpretation of symptoms (minimal versus severe), fear of medical care, fear of infection, fear of overcrowded hospitals, or financial concerns [12][13][14][15][16][17]. The National Healthcare for the Homeless Council in 2019 stated that homeless patients have higher rates of illness and die 12 years earlier than the general population in the United States [18].…”

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“…Experience shows that patients are often slow or loathe to self-report symptoms that indicate an emerging AECOPD. 12 , 13 …”

“…Experience shows that patients are often slow or loathe to self-report symptoms that indicate an emerging AECOPD. 12,13 To pre-identify exacerbations, physiologic and spirometric measures have been used including changes in pulse rate, peripheral oxygen saturation, blood pressure, body temperature, forced expiratory volume in the first second (FEV1), and respiratory rate. 14 However, devices currently available and commonly used by COPD patients, such as spirometers and pulse oximeters, may be inadequate to accurately pre-identify AECOPDs.…”

Long-Term Usage and Improved Clinical Outcomes with Adoption of a COPD Digital Support Service: Key Findings from the RECEIVER Trial

“… 4 Delays in diagnosis and inconsistent delivery of optimized guideline-based COPD care contribute to adverse outcomes. 5 COPD is also a significant driver of UK healthcare expenditure with costs incurred primarily by hospital admissions. 6 The direct costs of managing COPD to the NHS are projected to increase substantially to £2.5bn per year by 2030 due to increases in incidences of COPD.…”