How do general practitioners implement decision-making regarding COPD patients with exacerbations? An international focus group study

Johanna Laue, Hasse Melbye, Peder A Halvorsen, Elena A Andreeva, Maciek Godycki-Cwirko, Anja Wollny, Nick A Francis, Mark Spigt, Kenny Kung, Mette Bech Risør

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Abstract

PURPOSE: To explore the decision-making of general practitioners (GPs) concerning treatment with antibiotics and/or oral corticosteroids and hospitalization for COPD patients with exacerbations.

METHODS: Thematic analysis of seven focus groups with 53 GPs from urban and rural areas in Norway, Germany, Wales, Poland, Russia, the Netherlands, and Hong Kong.

RESULTS: Four main themes were identified. 1) Dealing with medical uncertainty: the GPs aimed to make clear medical decisions and avoid unnecessary prescriptions and hospitalizations, yet this was challenged by uncertainty regarding the severity of the exacerbations and concerns about overlooking comorbidities. 2) Knowing the patient: contextual knowledge about the individual patient provided a supplementary framework to biomedical knowledge, allowing for more differentiated decision-making. 3) Balancing the patients' perspective: the GPs considered patients' experiential knowledge about their own body and illness as valuable in assisting their decision-making, yet felt that dealing with disagreements between their own and their patients' perceptions concerning the need for treatment or hospitalization could be difficult. 4) Outpatient support and collaboration: both formal and informal caregivers and organizational aspects of the health systems influenced the decision-making, particularly in terms of mitigating potentially severe consequences of "wrong decisions" and concerning the negotiation of responsibilities.

CONCLUSION: Fear of overlooking severe comorbidity and of further deteriorating symptoms emerged as a main driver of GPs' management decisions. GPs consider a holistic understanding of illness and the patients' own judgment crucial to making reasonable decisions under medical uncertainty. Moreover, GPs' decisions depend on the availability and reliability of other formal and informal carers, and the health care systems' organizational and cultural code of conduct. Strengthening the collaboration between GPs, other outpatient care facilities and the patients' social network can ensure ongoing monitoring and prompt intervention if necessary and may help to improve primary care for COPD patients with exacerbations.

Original languageEnglish
JournalInternational Journal of Chronic Obstructive Pulmonary Disease
Volume11
Pages (from-to)3109-3119
Number of pages11
ISSN1178-2005
DOIs
Publication statusPublished - 2016
Externally publishedYes

Keywords

  • Administration, Oral
  • Adrenal Cortex Hormones/administration & dosage
  • Ambulatory Care
  • Anti-Bacterial Agents/administration & dosage
  • Attitude of Health Personnel
  • Clinical Decision-Making
  • Cooperative Behavior
  • Cross-Cultural Comparison
  • Delivery of Health Care, Integrated
  • Disease Progression
  • Europe
  • Focus Groups
  • General Practitioners/psychology
  • Health Care Surveys
  • Health Knowledge, Attitudes, Practice
  • Hong Kong
  • Hospitalization
  • Humans
  • International Cooperation
  • Lung/drug effects
  • Patient Participation
  • Practice Patterns, Physicians'
  • Pulmonary Disease, Chronic Obstructive/diagnosis
  • Rural Health
  • Severity of Illness Index
  • Uncertainty
  • Unnecessary Procedures
  • Urban Health

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