Barriers and outcomes of an evidence-based approach to diagnosis and management of chronic obstructive pulmonary disease (COPD) in Australia: A qualitative study

Sarah Dennis, Helen K. Reddel, Sandy Middleton, Iqbal Hasan, Oshana Hermiz, Rosemary Phillips, Alan J. Crockett, Sanjyot Vagholkar, Guy B. Marks, Nicholas Zwar

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Abstract

Background. Chronic obstructive pulmonary disease (COPD) is commonly managed in primary care but there is poor awareness of evidence-based guidelines and the quality and interpretation of spirometry is suboptimal. Objectives. The aims of this qualitative study were to explore how an intervention involving case finding and management of COPD was implemented, and the extent to which the GPs and practice nurses (PNs) worked in partnership to diagnose and manage COPD. Methods. Semi-structured interviews with PNs (n = 7), GPs (n = 4) and patients (n = 26) who had participated in the Primary care EarLy Intervention for Copd mANagement (PELICAN) study. The Theoretical Domains Framework was used to guide the coding and analysis of the interviews with PN and GPs. The patient interviews were analysed thematically. Results. PNs developed technical skills and understood the requirements for good-quality spirometry. However, many lacked confidence in its interpretation and felt this was not part of their professional role. This was reflected in responses from the GPs. Once COPD was diagnosed, the GPs tended to manage the patients with the PNs less involved. This was in contrast with PNs' active role in managing patients with other chronic diseases such as diabetes. The extent to which the GPs and PNs worked in partnership to manage COPD varied. Conclusions. PNs improved their skills and confidence in performing spirometry. Beliefs about their professional role, identity and confidence influenced the extent to which PNs were involved in interpretation of the spirometry results and managing the patient in partnership with the GP.

Original languageEnglish
Pages (from-to)485-490
Number of pages6
JournalFamily Practice
Volume34
Issue number4
DOIs
Publication statusPublished - 1 Jan 2017
Externally publishedYes

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Chronic Obstructive Pulmonary Disease
Nurses
Spirometry
Professional Role
Interviews
Primary Health Care
Nurse's Role
Case Management
Chronic Disease
Guidelines

Cite this

Dennis, Sarah ; Reddel, Helen K. ; Middleton, Sandy ; Hasan, Iqbal ; Hermiz, Oshana ; Phillips, Rosemary ; Crockett, Alan J. ; Vagholkar, Sanjyot ; Marks, Guy B. ; Zwar, Nicholas. / Barriers and outcomes of an evidence-based approach to diagnosis and management of chronic obstructive pulmonary disease (COPD) in Australia : A qualitative study. In: Family Practice. 2017 ; Vol. 34, No. 4. pp. 485-490.
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abstract = "Background. Chronic obstructive pulmonary disease (COPD) is commonly managed in primary care but there is poor awareness of evidence-based guidelines and the quality and interpretation of spirometry is suboptimal. Objectives. The aims of this qualitative study were to explore how an intervention involving case finding and management of COPD was implemented, and the extent to which the GPs and practice nurses (PNs) worked in partnership to diagnose and manage COPD. Methods. Semi-structured interviews with PNs (n = 7), GPs (n = 4) and patients (n = 26) who had participated in the Primary care EarLy Intervention for Copd mANagement (PELICAN) study. The Theoretical Domains Framework was used to guide the coding and analysis of the interviews with PN and GPs. The patient interviews were analysed thematically. Results. PNs developed technical skills and understood the requirements for good-quality spirometry. However, many lacked confidence in its interpretation and felt this was not part of their professional role. This was reflected in responses from the GPs. Once COPD was diagnosed, the GPs tended to manage the patients with the PNs less involved. This was in contrast with PNs' active role in managing patients with other chronic diseases such as diabetes. The extent to which the GPs and PNs worked in partnership to manage COPD varied. Conclusions. PNs improved their skills and confidence in performing spirometry. Beliefs about their professional role, identity and confidence influenced the extent to which PNs were involved in interpretation of the spirometry results and managing the patient in partnership with the GP.",
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Dennis, S, Reddel, HK, Middleton, S, Hasan, I, Hermiz, O, Phillips, R, Crockett, AJ, Vagholkar, S, Marks, GB & Zwar, N 2017, 'Barriers and outcomes of an evidence-based approach to diagnosis and management of chronic obstructive pulmonary disease (COPD) in Australia: A qualitative study' Family Practice, vol. 34, no. 4, pp. 485-490. https://doi.org/10.1093/fampra/cmw103

Barriers and outcomes of an evidence-based approach to diagnosis and management of chronic obstructive pulmonary disease (COPD) in Australia : A qualitative study. / Dennis, Sarah; Reddel, Helen K.; Middleton, Sandy; Hasan, Iqbal; Hermiz, Oshana; Phillips, Rosemary; Crockett, Alan J.; Vagholkar, Sanjyot; Marks, Guy B.; Zwar, Nicholas.

In: Family Practice, Vol. 34, No. 4, 01.01.2017, p. 485-490.

Research output: Contribution to journalArticleResearchpeer-review

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T2 - A qualitative study

AU - Dennis, Sarah

AU - Reddel, Helen K.

AU - Middleton, Sandy

AU - Hasan, Iqbal

AU - Hermiz, Oshana

AU - Phillips, Rosemary

AU - Crockett, Alan J.

AU - Vagholkar, Sanjyot

AU - Marks, Guy B.

AU - Zwar, Nicholas

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N2 - Background. Chronic obstructive pulmonary disease (COPD) is commonly managed in primary care but there is poor awareness of evidence-based guidelines and the quality and interpretation of spirometry is suboptimal. Objectives. The aims of this qualitative study were to explore how an intervention involving case finding and management of COPD was implemented, and the extent to which the GPs and practice nurses (PNs) worked in partnership to diagnose and manage COPD. Methods. Semi-structured interviews with PNs (n = 7), GPs (n = 4) and patients (n = 26) who had participated in the Primary care EarLy Intervention for Copd mANagement (PELICAN) study. The Theoretical Domains Framework was used to guide the coding and analysis of the interviews with PN and GPs. The patient interviews were analysed thematically. Results. PNs developed technical skills and understood the requirements for good-quality spirometry. However, many lacked confidence in its interpretation and felt this was not part of their professional role. This was reflected in responses from the GPs. Once COPD was diagnosed, the GPs tended to manage the patients with the PNs less involved. This was in contrast with PNs' active role in managing patients with other chronic diseases such as diabetes. The extent to which the GPs and PNs worked in partnership to manage COPD varied. Conclusions. PNs improved their skills and confidence in performing spirometry. Beliefs about their professional role, identity and confidence influenced the extent to which PNs were involved in interpretation of the spirometry results and managing the patient in partnership with the GP.

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