Abstract
Background: Studies show evidence of vast under-diagnosis and poor adherence to COPD guidelines in primary care in Sweden.
Aim: To identify factors that explain the process in patient-doctor encounter determining primary care physicians´ (PCPs´) level of activity in further COPD care.
Method: Grounded theory method. Data were collected in 2013-2014 through semi-structured individual (4) and focus group (10) interviews including in all 54 PCPs in Stockholm County, Sweden.
Results: PCPs experienced they typically met patients with COPD at short urgent primary care appointments or planned, time-limited check-ups of patients with multiple morbidities, including COPD. PCP's consultation strategy was central for the outcome: whether a holistic or disease-oriented approach was used, and whether the patient's agenda or the PCP's medical assessment dictated the terms of the consultation. In addition, PCPs' ways of coping with time pressure and complexity of multiple morbidities was important. Activity in further COPD care was also influenced by PCPs' expectations of the patients´ adherence to treatment, PCPs' attitudes towards smoking and whether COPD was considered a self-inflected disease. Important patient-related factors were the clinical severity of COPD, if the COPD diagnosis was previously known, and the level of patient's motivation for COPD care.
Conclusions: In a primary care patient-doctor encounter, the PCP's consulting strategy, attitudes towards COPD and coping with complexity of multiple morbidities together with severity of the patient's COPD and patient's motivation were the main factors determining the actions taken by the PCP in further COPD care.
- © 2014 ERS
