Patients’ perspectives on point-of-care diagnostics and treatment by emergency medical technicians in acute COPD exacerbations: A qualitative study

Abstract

Background In Denmark emergency medical technicians transport patients with acute COPD exacerbations to the nearest emergency department. From a clinical and economic perspective, this transport and assessment at the hospital may be inconvenient if the patient is immediately discharged from the emergency department. We established an emergency technical technicians point-of-care diagnostics and treatment program of patients with COPD with use of ultrasound and blood analysis. Patients' perspectives on treatment at home and sense of security are important to qualify clinical practice at home with patients with acute exacerbation. Aim and objectives To explore patient's and relatives' experience of treatment at home during emergency calls due to COPD in exacerbation and to investigate their attitude to avoid hospitalization as well as experience of stress during point-of-care diagnostics in their own home. Method A qualitative study comprising semi-structured interviews with 16 patients carried out from April 1st, 2019 to March 31st, 2020 in Denmark. Data was analysed inspired by Malteruds’ text condensation and informed by Critical Psychology with first person perspective focusing on the patient's views on point-of-care diagnostics and treatment of their COPD in acute exacerbation. Results The interviews revealed that in order to ensure an experience of quality in the assessment and treatment of patients in their own homes, it was important that the ambulance staff showed great safety and experience in the use of the technical equipment and treatment of dyspnea. It was also of importance that the patients felt confident that their general practitioner followed up on the home treatment initiated. Conclusion Patients’ perspectives showed that point-of-care diagnostics and treatment of acute COPD in exacerbation was considered a qualitative offer by the patients and their relatives. At the same time, it was crucial that the emergency medical technicians showed experience and safety in handling shortness of breath as well as the technical equipment. Trial registration: Approved by the Danish Data Protection Agency Project-ID: 20/24845.

Prehospital Release of Patients After Treatment in an Anesthesiologist-Staffed Mobile Emergency Care Unit

“…Other studies investigating patients with chronic obstructive pulmonary disease, however, point toward patients considering it appealing to avoid admission to the hospital. 1 …”

“…One major limitation in this retrospective cohort study is that no information was available concerning the patients’ perspectives of being released at the scene. Other studies investigating patients with chronic obstructive pulmonary disease, however, point toward patients considering it appealing to avoid admission to the hospital …”

“…The release of a patient at the scene is becoming more relevant to patients and health administrators. 1,5 Owing to the increasing level of competency among prehospital services, in some instances even a patient with a high-acuity problem may receive prehospital treatment and subsequently be released, avoiding hospital transport. 6 Paramedics or EMTs rarely release patients in the prehospital setting.…”

“…Other studies investigating patients with chronic obstructive pulmonary disease, however, point toward patients considering it appealing to avoid admission to the hospital. 1 Patients were lost to follow-up if living outside the Region of Southern Denmark, because it was not possible to gain access to their medical records. Although their general distribution of diagnoses did not differ substantially from the patients residing in the Region of Southern Denmark, this loss of follow-up may bias our results toward fewer patients registered as seeking unplanned ED contact.…”

“…Many patients treated in a prehospital setting do not wish to be transported to a hospital. Safe nonconveyance may be an attractive solution for such patients . However, even patients with low-acuity illness released at the scene by emergency medical technicians (EMTs) and paramedics may later be diagnosed with a time-critical condition …”