Mapping COPD care in primary care – professionals’ perspective. A mixed methods study

Abstract

Background: There is a gap between evidence-based interventions and the availability of such interventions for people with chronic obstructive pulmonary disease (COPD). Aim: The aim of this study was to increase the understanding of what shapes the provision of healthcare services to people with COPD in primary care, and what healthcare they are offered and actually receive. Methods: The study was conducted in primary care in Sweden. Mixed methods design was used, where qualitative and quantitative findings were merged into a joint analysis. For the qualitative component interviews were performed with healthcare professionals (n=14) from two primary care centres and analysed with qualitative content analysis. For the quantitative component one questionnaire was answered by professionals (n=18) at two centres and one questionnaire was answered by senior managers/COPD nurses at centres (n=26) in one county council. Descriptive statistical analysis was used. Results: The theme Building COPD care on shaky ground highlights driven and independent professionals that want to build a supportive COPD care with interprofessional collaboration. The shaky organisational ground is represented by a complex disease surrounded with shame, uninformed patients, professionals’ lacking competence, inadequate routines, and lacking resources. Conclusions: The mixed methods design gave a comprehensive picture of the COPD care in primary care and this study could emphasise the gap between evidence and clinical practice. To facilitate implementation of evidence, several actions are needed, such as an improved structure for interprofessional collaboration and patient education, further training for professionals and more resources.