Time pressured deprioritization of COPD in primary care: a qualitative study

Figures & data

Table 1. Characteristics of the primary care physicians (PCPs) who participated in the interviews concerning discussions about COPD in patient consultations (n = 59).

Characteristic	Number Mean Median	%
Gender, n = 59
Men	30	51
Women	29	49
Educational degree, number n = 59
Specialist in Family Medicine	40	68
Non-specialist in Family Medicine	19	32
Age, mean (SD)	45.5 (10.5)
Age, median (range)	44 (28–68)
n = 54 (missing data n = 5)
Years in profession, mean (SD)	14.0 (10.2)
Years in profession, median (range)	12.5 (1–39)
n = 43 (missing data n = 16)
1–5 years	10	22
6–10 years	8	18
11–20 years	14	31
21–30 years	7	16
> 31 years	5	11
Working at PHCC with nurse based asthma/COPD clinic, number n = 59
Yes	45	76
No	14	24

No compatible routine data for PCPs in Stockholm is available.

Table 2. The gradually developed interview guides in chronologic order (I–VI) for the semi-structured interviews (A–K) for exploring the factors that influence PCPs’ level of prioritizing of COPD in a consultation.

I Initial interview guide, focus group interviews A–B
	1. Opening question: Clinical situations of COPD  Tell me about one of your COPD patients you particularly remember.
	2. Further questions: Clinical situations of COPD  How would you describe a typical patient with COPD?  When do you suspect COPD?  Tell me about difficulties or dilemmas you face when managing patients with COPD.  Tell me about a case where you felt you provided successful COPD care.
	3. COPD guidelines  What are your views on current guidelines?
II Further developed interview guide, focus group interviews B–C
	4. As 1–3 above
	5. Factors possibly connected with poor adherence with COPD guidelines according to interviews A-B  Detection of COPD   What factors are important for you to proceed with further examination when you suspect COPD?   How does a previous knowledge of COPD affect your management?  COPD medications   What do you think when choosing a medication for treating COPD?  Patient motivation for COPD care   How do you think COPD affects the patient’s everyday life?   What do you think is the patient’s view of COPD?   How do you work together with the patient towards a better adherence to treatment?  Type of patient visit   How do you manage COPD if the patient comes on a regular or routine care visit, i.e. “yearly COPD check-up”?   How do you manage COPD if the patient comes on a regular or routine care visit, i.e. “yearly general check-up”?   How do you manage COPD if the patient comes on an urgent or unscheduled care visit due to acute airway problems?  Local structure for COPD care   What routines do you have for COPD at your PHCC?   How do the routines (or lack thereof) affect your management of COPD?
III Further developed interview guide, focus group interviews D–E + individual interview F
	6. As 4–5 above
	7. Difficulties in patient–doctor encounter considering COPD  How do you discuss smoking with a patient with COPD?  Tell me about what can happen in an encounter with a patient who disagrees with the treatments you suggest.  What kind of personal views do you have on COPD and smoking?  What other difficulties or obstacles are there for discussing COPD?
	8. The role of other care providers in COPD care  When do you refer to secondary care?  Who is responsible for a COPD patient that, in addition to you, is in contact with a pulmonary specialist or other care providers?
	9. Follow-up of given COPD care  How do you keep in touch with your patient?  What makes you arrange a follow-up visit?
IV Further developed interview guide, individual interviews G–I
	10. Opening question: Clinical situations of COPD involving multi- and comorbidity  Try to think of yourself meeting with a patient with multiple conditions, of which COPD is one of them. Tell me about how you manage a patient like that.
	11. Multi-morbidity  What do you think about COPD in relation to other morbidities?  How do you prioritize different diseases during an encounter with a patient?  What is important and/or difficult about COPD in a multi-morbid patient?
	12. Local structure for COPD care  As in 5 above
	13. Attitudes and views regarding COPD and patients with COPD  What is your personal attitude towards smoking and COPD?  How do you think society’s view on smoking and COPD as a self-inflicted disease affects the COPD care you provide?
	14. Patient motivation for COPD care  How does the patient’s motivation to receive COPD care affect you?  How do you handle a situation in which you and your patient have clearly different views and goals about COPD care?
V Further developed interview guide, focus group interview J
	15. As 10–11 above
	16. Consultation technique as a factor in managing COPD  Holistic vs. disease-oriented approach   Tell me what happens during a consultation with a COPD patient who also has other medical conditions, e.g. a multi-morbid patient?   How do you balance the interests of your patient and yourself?   How do you handle a patient who is unmotivated to quit smoking or disagrees with the treatment you suggest?
	17. Early detection of COPD  The effect of a patient’s age   How does the age of the patient affect your managing of COPD?
	18. The role of other care providers in COPD care  “My patients vs. other doctor’s patients”   How do you plan for further care and follow-up for patients that normally see you, and for those who normally see some other doctor?   What is the role of pulmonary specialists in the care of your COPD patients?
VI. Further developed interview guide, focus group interview K
	19. Discussion on a presentation of a preliminary model of the study results

The main themes are listed as 1–19, including examples of intended questions in italics. The open discussion contributed to several follow-up questions that are not included in this table.

Figure 1. The theoretical model describing the process of deprioritization of COPD in a primary care patient–doctor consultation.