Sandelowsky Hanna, Hylander Ingrid, Krakau Ingvar, Modin Sonja, Ställberg Björn, Nager Anna
a NVS, Section for Family Medicine, Karolinska Institutet , Huddinge , Stockholm , Sweden ;
b Department of Public Health and Caring Science, Family Medicine and Preventive Medicine , Uppsala University , Uppsala , Sweden.
Scand J Prim Health Care. 2016;34(1):55-65. doi: 10.3109/02813432.2015.1132892. Epub 2016 Feb 5.
To identify factors that hinder discussions regarding chronic obstructive pulmonary disease (COPD) between primary care physicians (PCPs) and their patients in Sweden.
Primary health care centres (PHCCs) in Stockholm, Sweden.
A total of 59 PCPs.
Semi-structured individual and focus-group interviews between 2012 and 2014. Data were analysed inspired by grounded theory methods (GTM).
Time-pressured patient-doctor consultations lead to deprioritization of COPD. During unscheduled visits, deprioritization resulted from focusing only on acute health concerns, while during routine care visits, COPD was deprioritized in multi-morbid patients. The reasons PCPs gave for deprioritizing COPD are: "Not becoming aware of COPD", "Not becoming concerned due to clinical features", "Insufficient local routines for COPD care", "Negative personal attitudes and views about COPD", "Managing diagnoses one at a time", and "Perceiving a patient's motivation as low''.
De-prioritization of COPD was discovered during PCP consultations and several factors were identified associated with time constraints and multi-morbidity. A holistic consultation approach is suggested, plus extended consultation time for multi-morbid patients, and better documentation and local routines.
Under-diagnosis and insufficient management of chronic obstructive pulmonary disease (COPD) are common in primary health care. A patient-doctor consultation offers a key opportunity to identify and provide COPD care. Time pressure, due to either high number of patients or multi-morbidity, leads to omission or deprioritization of COPD during consultation. Deprioritization occurs due to lack of awareness, concern, and local routines, negative personal views, non-holistic consultation approach, and low patient motivation. Better local routines, extended consultation time, and a holistic approach are needed when managing multi-morbid patients with COPD.
确定在瑞典阻碍初级保健医生（PCP）与其患者之间就慢性阻塞性肺疾病（COPD）展开讨论的因素。
瑞典斯德哥尔摩的初级卫生保健中心（PHCC）。
共59名初级保健医生。
2012年至2014年期间进行的半结构化个人访谈和焦点小组访谈。采用扎根理论方法（GTM）对数据进行分析。
患者与医生咨询时时间紧迫导致COPD被置于次要地位。在非预约就诊期间，仅关注急性健康问题导致COPD被置于次要地位，而在常规护理就诊期间，患有多种疾病的患者中COPD被置于次要地位。初级保健医生将COPD置于次要地位的原因有：“未意识到COPD”、“因临床特征未引起关注”、“当地COPD护理常规不足”、“对COPD的个人负面态度和看法”、“一次处理一个诊断”以及“认为患者积极性低”。
在初级保健医生咨询过程中发现了对COPD的重视不足，并且确定了与时间限制和多种疾病相关的几个因素。建议采用整体咨询方法，为患有多种疾病的患者延长咨询时间，并改善记录和当地常规。
慢性阻塞性肺疾病（COPD）的诊断不足和管理不充分在初级卫生保健中很常见。患者与医生的咨询为识别和提供COPD护理提供了关键机会。由于患者数量多或患有多种疾病导致的时间压力，会导致在咨询期间遗漏或忽视COPD。重视不足是由于缺乏认识、关注和当地常规、个人负面看法、非整体咨询方法以及患者积极性低。在管理患有COPD的多种疾病患者时，需要更好的当地常规、延长咨询时间和整体方法。
