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Time pressured deprioritization of COPD in primary care: a qualitative study.
Sandelowsky, Hanna; Hylander, Ingrid; Krakau, Ingvar; Modin, Sonja; Ställberg, Björn; Nager, Anna.
Afiliación
  • Sandelowsky H; a NVS, Section for Family Medicine, Karolinska Institutet , Huddinge , Stockholm , Sweden ;
  • Hylander I; a NVS, Section for Family Medicine, Karolinska Institutet , Huddinge , Stockholm , Sweden ;
  • Krakau I; a NVS, Section for Family Medicine, Karolinska Institutet , Huddinge , Stockholm , Sweden ;
  • Modin S; a NVS, Section for Family Medicine, Karolinska Institutet , Huddinge , Stockholm , Sweden ;
  • Ställberg B; b Department of Public Health and Caring Science, Family Medicine and Preventive Medicine , Uppsala University , Uppsala , Sweden.
  • Nager A; a NVS, Section for Family Medicine, Karolinska Institutet , Huddinge , Stockholm , Sweden ;
Scand J Prim Health Care ; 34(1): 55-65, 2016.
Article en En | MEDLINE | ID: mdl-26849465
OBJECTIVE: To identify factors that hinder discussions regarding chronic obstructive pulmonary disease (COPD) between primary care physicians (PCPs) and their patients in Sweden. SETTING: Primary health care centres (PHCCs) in Stockholm, Sweden. SUBJECTS: A total of 59 PCPs. DESIGN: Semi-structured individual and focus-group interviews between 2012 and 2014. Data were analysed inspired by grounded theory methods (GTM). RESULTS: Time-pressured patient-doctor consultations lead to deprioritization of COPD. During unscheduled visits, deprioritization resulted from focusing only on acute health concerns, while during routine care visits, COPD was deprioritized in multi-morbid patients. The reasons PCPs gave for deprioritizing COPD are: "Not becoming aware of COPD", "Not becoming concerned due to clinical features", "Insufficient local routines for COPD care", "Negative personal attitudes and views about COPD", "Managing diagnoses one at a time", and "Perceiving a patient's motivation as low''. CONCLUSIONS: De-prioritization of COPD was discovered during PCP consultations and several factors were identified associated with time constraints and multi-morbidity. A holistic consultation approach is suggested, plus extended consultation time for multi-morbid patients, and better documentation and local routines. KEY POINTS: Under-diagnosis and insufficient management of chronic obstructive pulmonary disease (COPD) are common in primary health care. A patient-doctor consultation offers a key opportunity to identify and provide COPD care. Time pressure, due to either high number of patients or multi-morbidity, leads to omission or deprioritization of COPD during consultation. Deprioritization occurs due to lack of awareness, concern, and local routines, negative personal views, non-holistic consultation approach, and low patient motivation. Better local routines, extended consultation time, and a holistic approach are needed when managing multi-morbid patients with COPD.
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Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Visita a Consultorio Médico / Atención Primaria de Salud / Pautas de la Práctica en Medicina / Carga de Trabajo / Enfermedad Pulmonar Obstructiva Crónica / Médicos de Atención Primaria / Prioridades en Salud Tipo de estudio: Prognostic_studies / Qualitative_research Límite: Adult / Aged / Female / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: Scand J Prim Health Care Año: 2016 Tipo del documento: Article

Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Visita a Consultorio Médico / Atención Primaria de Salud / Pautas de la Práctica en Medicina / Carga de Trabajo / Enfermedad Pulmonar Obstructiva Crónica / Médicos de Atención Primaria / Prioridades en Salud Tipo de estudio: Prognostic_studies / Qualitative_research Límite: Adult / Aged / Female / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: Scand J Prim Health Care Año: 2016 Tipo del documento: Article