ArticleBMJ open2013
The complexity of managing COPD exacerbations: a grounded theory study of European general practice.
Article in BMJ open, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 3 of them syntheses that pooled it.
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Who cites it
12 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Decision-making and related outcomes of patients with complex care needs in primary care settings: a systematic literature review with a case-based qualitative synthesis.BMC primary care · 2022Pooled it
- General practitioner strategies for managing patients with multimorbidity: a systematic review and thematic synthesis of qualitative research.BMC family practice · 2020Pooled it
- Working with patients suffering from chronic diseases can be a balancing act for health care professionals - a meta-synthesis of qualitative studies.BMC health services research · 2020Pooled it
- Multimorbidity and clinical reasoning through the eyes of GPs: a qualitative study.Family medicine and community health · 2021Article
- Article
- 'Motivational work': a qualitative study of preventive health dialogues in general practice.BMC family practice · 2020Article
- Why do physicians lack engagement with smoking cessation treatment in their COPD patients? A multinational qualitative study.NPJ primary care respiratory medicine · 2017Article
- Self-treatment of acute exacerbations of chronic obstructive pulmonary disease requires more than symptom recognition - a qualitative study of COPD patients' perspectives on self-treatment.BMC family practice · 2017Article
- [Perceptions of patients and health professionals about the quality of care provided to chronic obstructive pulmonary disease patients].Atencion primaria · 2016Article
- How do general practitioners implement decision-making regarding COPD patients with exacerbations? An international focus group study.International journal of chronic obstructive pulmonary disease · 2016Article
- A new diagnosis of asthma or COPD is linked to smoking cessation - the Tromsø study.International journal of chronic obstructive pulmonary disease · 2016Article
- Patients' experience of identifying and managing exacerbations in COPD: a qualitative study.NPJ primary care respiratory medicine · 2014Article
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Authors and funding
9 authors.
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Abstract
objectivesTo understand the concerns and challenges faced by general practitioners (GPs) and respiratory physicians about primary care management of acute exacerbations in patients with chronic obstructive pulmonary disease (COPD).
design21 focus group discussions (FGDs) were performed in seven countries with a Grounded Theory approach. Each country performed three rounds of FGDs.
settingPrimary and secondary care in Norway, Germany, Wales, Poland, Russia, The Netherlands, China (Hong Kong).
participants142 GPs and respiratory physicians were chosen to include urban and rural GPs as well as hospital-based and out patient-clinic respiratory physicians.
resultsManagement of acute COPD exacerbations is dealt with within a scope of concerns. These concerns range from 'dealing with comorbidity' through 'having difficult patients' to 'confronting a hopeless disease'. The first concern displays medical uncertainty regarding diagnosis, medication and hospitalisation. These clinical processes become blurred by comorbidity and the social context of the patient. The second concern shows how patients receive the label 'difficult' exactly because they need complex attention, but even more because they are time consuming, do not take responsibility and are non-compliant. The third concern relates to the emotional reactions by the physicians when confronted with 'a hopeless disease' due to the fact that most of the patients do not improve and the treatment slows down the process at best. GPs and respiratory physicians balance these concerns with medical knowledge and practical, situational knowledge, trying to encompass the complexity of a medical condition.
conclusionsKnowing the patient is essential when dealing with comorbidities as well as with difficult relations in the consultations on exacerbations. This study suggests that it is crucial to improve the collaboration between primary and secondary care, in terms of, for example, shared consultations and defined work tasks, which may enhance shared knowledge of patients, medical decision-making and improved management planning.
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