Understanding the factors affecting self-management of COPD from the perspectives of healthcare practitioners: a qualitative study

Abstract

Self-management is recognised as an essential criteria for the provision of high quality care for chronic obstructive pulmonary disease (COPD). The management of COPD is usually delivered by a wide range of healthcare practitioners. This study aimed to understand the factors affecting self-management of COPD from the perspectives of the different multidisciplinary healthcare teams involved in COPD care. Semi-structured interviews were conducted with participants from primary care, specialist respiratory and pulmonary rehabilitation (PR) teams. Purposive sampling and snowballing were employed in participant recruitment. All interviews were audio-recorded and transcribed verbatim and data were analysed thematically. A total of 20 participants (eight primary care practitioners, seven respiratory specialists and five PR practitioners) were interviewed until data saturation was reached. Participants identified a range of complex and interrelated factors affecting COPD self-management that were grouped into three broad categories—patient, practitioner and organisational/system-level factors. Patient-level factors were predominantly considered as barriers, with COPD knowledge and understanding, and the individual patients’ life circumstances/context being the most prominent issues. Practitioner-level factors identified were practitioners’ speciality, interest and experience in respiratory conditions as the overarching factor that influenced how self-management was understood and practiced. A number of organisational/system-level factors were identified by all practitioners, including inconsistency of referral pathways and the wide variations of different self-management planning tools. Factors affecting self-management of COPD across these three levels need to be tackled equally in order to improve the effectiveness of interventions and to embed and integrate self-management support approaches into routine practice.

Exploring transitions in care from pulmonary rehabilitation to home for persons with chronic obstructive pulmonary disease: A descriptive qualitative study

“…Social support, such as having a caregiver at home, was identified in our study as an important facilitator of transitions. The benefits of social support to facilitate transitions (eg, reduce anxiety and fear) and self‐management are supported by previous studies . DiNicola and colleagues examined social support and the impact on anxiety for patients with COPD.…”

“…Our study also identified that the physical and mental health status of patients (eg, arthritis, anxiety and depression) affected their overall care transitions and ability to self‐management. Previous studies have also shown psychological issues (eg, frustration, guilt, anxiety, and depression), as well as other comorbid conditions, to be barriers for self‐management . Specifically, patient anxiety and breathlessness were identified in a systematic review as common factors affecting patients' ability to self‐manage .…”

“…Unfortunately, the current literature suggests that patients with COPD often have difficulties applying self‐management strategies, even after following pulmonary rehabilitation, with minimal research on why. A 2017 qualitative study reported that health‐care providers in England identified several factors that affected self‐management for persons with COPD . These factors were complex and interrelated, including provider (knowledge, communication skills, interprofessional teams, ability to normalize self‐management into routine practice), patient (knowledge, motivation, emotional/psychological state, self‐management skills), and system‐level (service fragmentation, inconsistent pathways) factors …”

“…15 Self-management programmes have been demonstrated to improve outcomes, including decreased hospitalization admissions, among persons with COPD. 17,18 Unfortunately, the current literature suggests that patients with COPD often have difficulties applying self-management strategies, 19,20 even after following pulmonary rehabilitation, 13,21 with minimal research on why. A 2017 qualitative study reported that health-care providers in England identified several factors that affected self-management for persons with COPD.…”

“…19 These factors were complex and interrelated, including provider (knowledge, communication skills, interprofessional teams, ability to normalize self-management into routine practice), patient (knowledge, motivation, emotional/psychological state, self-management skills), and system-level (service fragmentation, inconsistent pathways) factors. 19 Prior research has focused largely on compliance to home exercise programmes post-discharge from rehabilitation, [21][22][23] or to transitions from acute care to the community. 8,9 To our knowledge, no studies have sought perspectives from health-care professionals and persons with COPD during transition from rehabilitation to home.…”