Pulmonary rehabilitation in COPD &amp;ndash; available resources and utilization in Swedish primary and secondary care

Sundh, Josefin; Lindgren, Helena; Hasselgren, Mikael; Montgomery, Scott; Janson, Christer; Ställberg, Björn; Lisspers, Karin

doi:10.2147/copd.s135111

Cited by 17 publications

(21 citation statements)

References 33 publications

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“…Limited resources have, in general, been reported as a barrier for adherence to treatment guidelines [ 17 ]. It is known that the access to interventions according to treatment guidelines for COPD is low internationally [ 23 – 25 ], as well as in Swedish contexts [ 26 – 28 ]. In primary care settings, where most Swedish people with COPD are treated, healthcare professionals experienced that COPD was a low priority [ 10 , 29 ], which seems to be the case even in long-term care settings.…”

Section: Discussionmentioning

confidence: 99%

Groping around in the dark for adequate COPD management: a qualitative study on experiences in long-term care

Lundell

Pesola

Nyberg

et al. 2020

BMC Health Serv Res

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Background Chronic obstructive pulmonary disease (COPD) is one of the most common and deadliest chronic diseases worldwide. Since COPD is a chronic and progressive disease, treatment is necessary throughout life. For people with COPD who cannot live independently, long-term care facilities are often required. However, knowledge is very limited about aspects of importance for effective COPD management in these settings in accordance with current treatment guidelines. The aim of this study was to explore aspects of importance in long-term care facilities for providing interventions according to treatment guidelines for people with COPD, from the perspective of healthcare professionals, in an effort to prove novel knowledge that could be used to facilitate implementation of treatment guidelines in these settings. Methods A qualitative study was performed in northern Sweden. In Sweden, municipalities are responsible for providing long-term care. Interviews with 36 healthcare professionals (nurses, physiotherapists, occupational therapists and dieticians) in municipal healthcare were conducted and analysed using qualitative content analysis with triangulation by the authors. Results The overarching theme that emerged from the analysis was Groping around in the dark for adequate COPD management. This represents healthcare professionals’ experiences of working with a complex diagnosis somewhat overlooked in the municipal healthcare, an underdog in the healthcare system. The groping around in the dark theme further represents the healthcare professionals’ lack of COPD-related competence, lack of interprofessional collaboration, and insufficient communication with the county council. The fragile group of people with COPD and their relatives were considered in need of support adapted to their context, but routines and resources for COPD management were limited. This lack of routines and resources also resulted in professionals being pragmatic and adopting short-term solutions without focusing on specific needs related to the diagnosis. Conclusions The COPD management in long-term care settings showed several insufficiencies, indicating a large gap between clinical practice and treatment guidelines for COPD. It is crucial to improve COPD management in long-term care settings. Consequently, several actions are needed, such as increasing professional competence, establishing new routines, acknowledging and making COPD a higher priority, as well as adapting treatment guidelines to the context.

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Section: Discussionmentioning

confidence: 99%

Groping around in the dark for adequate COPD management: a qualitative study on experiences in long-term care

Lundell

Pesola

Nyberg

et al. 2020

BMC Health Serv Res

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“…Patient data were collected from the PRAXIS study, an observational study involving seven county councils in central Sweden [16–26]. In the first PRAXIS-cohort, each county council was represented by the department of respiratory medicine in their central hospital, the department of internal medicine from one randomly selected district hospital and eight randomly selected primary health care centers (PHCCs).…”

Section: Methodsmentioning

confidence: 99%

Changes in smoking prevalence and cessation support, and factors associated with successful smoking cessation in Swedish patients with asthma and COPD

Stegberg

Hasselgren

Montgomery

et al. 2018

European Clinical Respiratory Journal

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Introduction: Our aim was to investigate changes in smoking prevalence, smoking cessation support and factors associated with successful smoking cessation in patients with asthma and COPD. Methods: Questionnaires about available smoking cessation resources were completed by 54 primary health-care centers and 14 hospitals in central Sweden in 2005 and 2012. Patient data were collected using record reviews and patients questionnaires for two cohorts of randomly selected asthma and COPD patients in 2005 (n = 2306; with a follow up in 2012), and in 2014/2015 (n = 2620). Smoking prevalence, available individual and group smoking cessation support, and factors associated with successful smoking cessation were explored. Results: Smoking prevalence decreased from 11% to 6% (p < 0.0001) in patients with asthma but was almost unchanged in patients with COPD (28 to 26%, p = 0.37). Smoking cessation support increased from 53% to 74% (p = 0.01). A high cardiovascular risk factor level, including diabetes mellitus and hypertension was associated with improved smoking cessation in patients with asthma (OR (95% CI) 3.87 (1.04–14.4), p = 0.04). A higher magnitude success was observed in men with asthma (OR (95% CI) 27.9 (1.73–449), p = 0.02). More highly educated women with asthma had successful greater smoking cessation (4.76 (1.22–18.7), p = 0.04). No significant associations were found in COPD. Conclusions: The smoking prevalence in patients with asthma but not in COPD has almost halved in Sweden during a 7-year period. The availability of smoking cessation support has increased. Suggested factors related to successful smoking cessation are higher level of education in women with asthma and cardiovascular risk factors in men and women with asthma.

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“…Los estudios considerados para esta revisión provienen de diferentes contextos internacionales con distintos sistemas sanitarios. En algunos artículos la falta de detalles sobre el contexto o la descripción del sistema de salud estudiado dificulta la transferibilidad de los resultados; esta situación puede ocultar barreras derivadas del sistema de provisión de servicios a través de sistemas de aseguramiento de salud públicos o privados, por lo que la descripción del contexto y los recursos disponibles es fundamental (55,65,66).…”

Section: Discussionunclassified

¿Por qué la rehabilitación respiratoria no llega a todos los pacientes de enfermedad pulmonar obstructiva crónica que lo necesitan? Revisión de la literatura

Rigo

Lourido

2019

Rev. Fac. Med.

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Introducción. La rehabilitación respiratoria (RR) es un tratamiento clave en la enfermedad pulmonar obstructiva crónica, pero aun estando disponible, los pacientes no siempre acceden a ella.Objetivo. Identificar los factores que pueden limitar el acceso a la RR y que se relacionan con los pacientes, los médicos y los fisioterapeutas.Materiales y métodos. Se realizó una revisión de artículos publicados en inglés y español entre 2006 y 2018. Se usaron los términos “COPD”, “chronic obstructive pulmonary disease”, “COLD”, “chronic obstructive lung disease”, “physical therapy modalities”, “rehabilitation”, “health services accessibility” y “patient” en las bases de datos PubMed, PEDro, Scielo e IBECS.Resultados. Se seleccionaron 11 publicaciones. Entre las barreras que afectan a los pacientes destacan el transporte, la condición ambiental, las situaciones personales y algunos factores sociales y contextuales. El conocimiento de los profesionales, sus condiciones de trabajo y sus expectativas sobre beneficio de los protocolos de RR también son factores que condicionan el acceso de los pacientes.Conclusiones. La formación interprofesional de médicos y fisioterapeutas, la implantación de protocolos flexibles a las condiciones de los pacientes y las medidas organizativas e intersectoriales del sistema sanitario pueden facilitar la accesibilidad a la RR de los pacientes.

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Pulmonary rehabilitation in COPD – available resources and utilization in Swedish primary and secondary care

Cited by 17 publications

References 33 publications

Groping around in the dark for adequate COPD management: a qualitative study on experiences in long-term care

Groping around in the dark for adequate COPD management: a qualitative study on experiences in long-term care

Changes in smoking prevalence and cessation support, and factors associated with successful smoking cessation in Swedish patients with asthma and COPD

¿Por qué la rehabilitación respiratoria no llega a todos los pacientes de enfermedad pulmonar obstructiva crónica que lo necesitan? Revisión de la literatura

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