Feasibility of a team-based person-centred intervention for patients at risk of or diagnosed with COPD in general practice – a qualitative inquiry

Abstract

Background Symptoms and complications of chronic obstructive pulmonary disease (COPD) can affect daily activities and quality of life, and patients with COPD require long-term follow-up by their general practitioner (GP). Providing patients with or at risk of COPD practical skills and motivation to improve their self-management is important. On this background, we designed an interdisciplinary follow-up programme based on the Guided Self-Determination (GSD) counselling method to facilitate problem-solving and mutual decision-making between healthcare professionals and patients. The aim of the study was to explore patients and healthcare professionals` experiences with the GSD-program. Methods Thirteen patients with COPD (mean age 71.7±7.7 years) four were current smokers, and seven at risk of COPD (mean age 54.1±9.9 years) all current smokers, received the GSD follow-up program. The intervention consisted of structured consultations with the nurse and patient in collaboration with the GP at baseline and after 3, 6 and 12 months. The GSD comprised facilitation of a mutual reflection process between the patient and the nurse to enhance self-management skills. Each consultation lasted for 60 minutes. We performed individual interviews after the 12-months GSD-program with two patients at risk of COPD, four patients with COPD, three nurses, and five GPs. The interviews were analysed using thematic analyses. Results We identified two themes: 1) A structured follow-up is challenging but motivating. 2) A counselling method that opens for conversation, but it requires resources. At 12-month follow-up, three with COPD and six in the risk group had quit smoking. Conclusions People with or at risk of COPD may benefit from the GSD method with a structured team-based follow-up in general practice. Our findings indicated that the GSD method gave the patients better self-management strategies. The regularity of the follow-up seemed to be important to succeed to help the patients making lifestyle changes to improve health benefits. However, the GSD was experienced as time consuming among the GPs and nurses, and there are currently no available financial rates for this type of treatment in Norway which may be a barrier to further implementation. The trial is registered in ClinicalTrials.gov (ID: NCT04076384).