A qualitative study of integrated care from the perspectives of patients with chronic obstructive pulmonary disease and their relatives

Abstract

BackgroundDisease management programmes have been developed for chronic obstructive pulmonary disease (COPD) to facilitate the integration of care across healthcare settings. The purpose of the present study was to examine the experiences of COPD patients and their relatives of integrated care after implementation of a COPD disease management programme.MethodsSeven focus groups and five individual interviews were held with 34 patients with severe or very severe COPD and two focus groups were held with eight of their relatives. Data were analysed using inductive content analysis.ResultsFour main categories of experiences of integrated care emerged: 1) a flexible system that provides access to appropriate healthcare and social services and furthers patient involvement; 2) the responsibility of health professionals to both take the initiative and follow up; 3) communication and providing information to patients and relatives; 4) coordination and professional cooperation. Most patients were satisfied with their care and raised few criticisms. However, patients with more unstable and severe disease tended to experience more problems.ConclusionsParticipant suggestions for optimizing the integration of healthcare included assigning patients a care coordinator, telehealth solutions for housebound patients and better information technology to support interprofessional cooperation. Further studies are needed to explore these and other possible solutions to problems with integrated care among COPD patients. A future effort in this field should be informed by detailed knowledge of the extent and relative importance of the identified problems. It should also be designed to address variable levels of severity of COPD and relevant comorbidities and to deliver care in ways appropriate to the respective healthcare setting. Future studies should also take health professionals’ views into account so that interventions may be planned in the light of the experiences of all those involved in the treatment of COPD patients.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6963-14-471) contains supplementary material, which is available to authorized users.

The Influence of Doctor-Patient Communication on Health Outcomes: A Systematic Review

“…In contrast Auerbach et al (2002) realized a better doctor-patient relationship to be associated with improved diseaserelated behavior and a better health status, and Wodskou et al (2014) reported that the physicians' empathy correlated with a better health status of their patients. Furthermore, Parchman et al (2010) showed that participatory decision making led to improved patient activation and consequently to better medication adherence and an enhanced health status.…”

“…Especially in the field of cancer (Kimberlin et al 2004;Kuzari et al 2013;Mackenzie et al 2013;Wright et al 2008) but also for other diseases (Wodskou et al 2014), high quality information and education were important for the patients themselves as well as for their families and caregivers. This was appropriate not only for giving support and for understanding the patients' situation, but also for dealing with the fatal consequences of the disease: Wright et al (2008) for example described how end-of-life discussions with advanced cancer patients and their families were able to have a positive impact on the long-term bereavement adjustment after death.…”

Informal caregivers of patients with COPD: Home Sweet Home?

“…Home visits by a nurse, combined with the availability of a nurse specialist by phone, have been shown to reduce symptoms of depression in patients with COPD [60]. Patients and their informal caregivers need care that is coordinated within and between care settings, by a person who shows empathy and cooperation [61].…”

User profiling for coordinated and integrated care

“…The datasharing nature associated with TH was seen as an important concept that could lead to the effective implementation of IC. In one recent research, TH has been suggested as a solution to optimise the care process by patients and carers [12]. ICT was highlighted as an important enabler for IC in the literature [7].…”

“…Patients and carers perceive IC as a flexible system that addresses their needs by granting them access to appropriate HC and social care services, involving them in care decisions and optimising follow-up, communication and information provision by HCPs who are responsible for their care while at the same time facilitating the coordination and cooperation between all HCPs involved in their care [12,13,14]. For HCPs, IC is perceived as a streamlined process of care that provides clarity and structure to the care delivered [15].…”