Lundell Sara, Pesola Ulla-Maija, Nyberg André, Wadell Karin
Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, 901 87, Umeå, Sweden.
Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, 901 87, Umeå, Sweden.
BMC Health Serv Res. 2020 Nov 10;20(1):1025. doi: 10.1186/s12913-020-05875-2.
Chronic obstructive pulmonary disease (COPD) is one of the most common and deadliest chronic diseases worldwide. Since COPD is a chronic and progressive disease, treatment is necessary throughout life. For people with COPD who cannot live independently, long-term care facilities are often required. However, knowledge is very limited about aspects of importance for effective COPD management in these settings in accordance with current treatment guidelines. The aim of this study was to explore aspects of importance in long-term care facilities for providing interventions according to treatment guidelines for people with COPD, from the perspective of healthcare professionals, in an effort to prove novel knowledge that could be used to facilitate implementation of treatment guidelines in these settings.
A qualitative study was performed in northern Sweden. In Sweden, municipalities are responsible for providing long-term care. Interviews with 36 healthcare professionals (nurses, physiotherapists, occupational therapists and dieticians) in municipal healthcare were conducted and analysed using qualitative content analysis with triangulation by the authors.
The overarching theme that emerged from the analysis was Groping around in the dark for adequate COPD management. This represents healthcare professionals' experiences of working with a complex diagnosis somewhat overlooked in the municipal healthcare, an underdog in the healthcare system. The groping around in the dark theme further represents the healthcare professionals' lack of COPD-related competence, lack of interprofessional collaboration, and insufficient communication with the county council. The fragile group of people with COPD and their relatives were considered in need of support adapted to their context, but routines and resources for COPD management were limited. This lack of routines and resources also resulted in professionals being pragmatic and adopting short-term solutions without focusing on specific needs related to the diagnosis.
The COPD management in long-term care settings showed several insufficiencies, indicating a large gap between clinical practice and treatment guidelines for COPD. It is crucial to improve COPD management in long-term care settings. Consequently, several actions are needed, such as increasing professional competence, establishing new routines, acknowledging and making COPD a higher priority, as well as adapting treatment guidelines to the context.
慢性阻塞性肺疾病（COPD）是全球最常见、最致命的慢性病之一。由于COPD是一种慢性进行性疾病，需要终身治疗。对于无法独立生活的COPD患者，通常需要长期护理机构。然而，根据当前治疗指南，在这些机构中，对于有效管理COPD至关重要的方面，人们的了解非常有限。本研究的目的是从医疗保健专业人员的角度，探索长期护理机构中根据COPD治疗指南提供干预措施的重要方面，以证明可用于促进这些机构实施治疗指南的新知识。
在瑞典北部进行了一项定性研究。在瑞典，市政当局负责提供长期护理。对36名市政医疗保健专业人员（护士、物理治疗师、职业治疗师和营养师）进行了访谈，并由作者使用定性内容分析法进行分析，并进行了三角互证。
分析得出的总体主题是“在黑暗中摸索以实现充分的COPD管理”。这代表了医疗保健专业人员在处理市政医疗保健中某种程度上被忽视的复杂诊断时的经历，COPD在医疗保健系统中处于劣势。黑暗中摸索这一主题还代表了医疗保健专业人员缺乏与COPD相关的能力、缺乏跨专业协作以及与郡议会的沟通不足。脆弱的COPD患者群体及其亲属被认为需要适合其情况的支持，但COPD管理的常规做法和资源有限。这种常规做法和资源的缺乏也导致专业人员采取务实态度并采用短期解决方案，而不关注与该诊断相关的特定需求。
长期护理机构中的COPD管理存在若干不足，表明COPD的临床实践与治疗指南之间存在很大差距。改善长期护理机构中的COPD管理至关重要。因此，需要采取若干行动，例如提高专业能力、建立新的常规做法、认识到COPD并将其列为更高优先事项，以及使治疗指南适应当地情况。
