Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium.
Chron Respir Dis. 2012 Aug;9(3):183-91. doi: 10.1177/1479972312452436.
Patient's attitudes and illness beliefs have shown to be of great importance in chronic obstructive pulmonary disease (COPD). As former qualitative research has mainly focused on patients with end-stage COPD, who are recruited within hospital or pulmonary rehabilitation settings, and excluding patients with disabling comorbidities, this study specifically aims to explore the perspectives of patients with COPD and comorbidities in primary care. This study was designed as a qualitative, explorative study using open patient interviews. The study was conducted at three primary care practices, East Flanders, Belgium. A total number of seven patients, diagnosed with COPD and given a minimum score of 2 on the Charlson Comorbidity Index were included. In-depth interviews were recorded and transcribed verbatim. Thematic analysis was deductive using NVivo software. Researchers' triangulation was performed. Participants show high adaptation capabilities and report quite positively about their functional status, with an emphasis on social participation and partnership. Knowledge of the causes and consequences of COPD appears rather limited, and participants predominantly show an external locus of control in relation to the reported factors influencing the disease and strategies for self-management. Patients with COPD with comorbidity integrate their illness and symptoms into their lives. However, a lack of knowledge and education may leave them more anxious and more dependent on health care than necessary. Our results indicate that health care workers should adopt a positive approach toward patient's functioning and empower and inform their patients. We believe that chronic care for patients with COPD should provide personalized rehabilitation taking into account individual patient characteristics and self-management and coping attitudes. We believe that there is a generic core to be identified, which can tackle both COPD and comorbidities. Further research is mandatory to develop these generic programs focusing on patients with complicated needs. Primary care can provide the setting for exploration.
患者的态度和疾病观念被证明在慢性阻塞性肺疾病（COPD）中非常重要。由于之前的定性研究主要集中在终末期 COPD 患者上，这些患者是在医院或肺康复环境中招募的，且排除了患有致残性合并症的患者，因此本研究特别旨在探讨初级保健中 COPD 合并症患者的观点。本研究设计为定性、探索性研究，采用开放式患者访谈。该研究在比利时东佛兰德的三家初级保健诊所进行。共纳入 7 名患者，这些患者被诊断为 COPD，Charlson 合并症指数得分为 2 分或以上。对深入访谈进行了录音和逐字记录。使用 NVivo 软件进行了基于理论的主题分析。研究者进行了三角验证。参与者表现出很高的适应能力，对他们的功能状态评价相当积极，强调社会参与和伙伴关系。对 COPD 的病因和后果的了解似乎相当有限，参与者主要表现出对影响疾病的报告因素和自我管理策略的外部控制。患有 COPD 合并症的患者将其疾病和症状融入他们的生活。然而，缺乏知识和教育可能会使他们比必要的更焦虑和更依赖医疗保健。我们的研究结果表明，医疗保健工作者应该对患者的功能采取积极的态度，并赋予患者权力和为他们提供信息。我们认为，COPD 患者的慢性护理应该提供个性化的康复，考虑到个体患者的特点以及自我管理和应对态度。我们认为可以确定一个通用核心，该核心可以同时解决 COPD 和合并症。有必要进一步研究以开发这些针对复杂需求患者的通用方案。初级保健可以为探索提供环境。
