Department of General Practice, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Prahran, Victoria, Australia.
Department of Sociology, School of Social Sciences, Faculty of Arts, Monash University, Prahran, Victoria, Australia.
PLoS One. 2023 Jun 23;18(6):e0287518. doi: 10.1371/journal.pone.0287518. eCollection 2023.
Studies of the lived experience of chronic obstructive pulmonary disease (COPD) reveal a number of challenges patients face when interacting with healthcare providers that may be exacerbated by unwillingness or inability to quit smoking. However, none have explored, in-depth, primary care experiences among patients with COPD in community healthcare settings.
AIMS/ OBJECTIVE: The study investigated healthcare experiences of patients living independently in the community with COPD who smoked or had recently quit (at most within the last 5 years), seeking care in primary care settings.
An Interpretative Phenomenological Analysis (IPA) involving thirteen participants purposively recruited from social media posts in COPD and carer support groups, general community groups, community noticeboards and paid adverts on social media. In-depth interviews were held between February and April 2022 by phone or Zoom™ and explored patient experience of primary care, focusing on how smoking patterns, addiction and stigma impact upon and shape these experiences.
Participants were aged between 45 to 75 years. Nine were female and two thirds were current smokers. Problematic experiences including time-constrained consultations, having to self-advocate for care "…go digging myself and then go and see him and say, can we do this, can we do that type of thing?" and guilt about smoking were common. Positive care experiences described non-judgemental interpersonal interactions with doctors, timely referral, proactive care and trust "I have an actual great trust for my GP… they're awesome, they'll look after you". Participants described how their care experience shifted as primary care adapted care delivery during COVID-19.
Pro-active, empathetic care from general practitioners is desired from patients living with COPD. Stigma and fear of judgement was an important underlying driver of negative care experiences contributing to delayed help seeking from general practitioners.
对慢性阻塞性肺疾病（COPD）患者生活体验的研究揭示了患者在与医疗保健提供者互动时面临的许多挑战，这些挑战可能因不愿意或无法戒烟而加剧。然而，目前还没有深入研究社区医疗保健环境中 COPD 患者的初级保健体验。
目的/目标：本研究调查了在社区中独立生活、吸烟或最近戒烟（最多在过去 5 年内）的 COPD 患者在初级保健环境中寻求医疗护理时的医疗保健体验。
采用解释现象学分析（IPA）方法，从 COPD 和护理人员支持小组、普通社区小组、社区布告栏和社交媒体付费广告中通过社交媒体帖子有目的地招募了 13 名参与者。2022 年 2 月至 4 月期间，通过电话或 Zoom™进行了深入访谈，探讨了患者对初级保健的体验，重点关注吸烟模式、成瘾和污名如何影响和塑造这些体验。
参与者年龄在 45 至 75 岁之间，9 名女性，三分之二的参与者目前吸烟。常见的不良体验包括时间受限的咨询、不得不为护理“……自己去挖掘，然后去找他，问他我们能不能做这件事，能不能做那件事”而自我主张，以及对吸烟的内疚感。积极的护理体验描述了医生之间没有评判的人际互动、及时转诊、主动护理和信任“我对我的全科医生有真正的信任……他们很棒，他们会照顾你”。参与者描述了在 COVID-19 期间，初级保健如何调整护理交付方式，从而改变了他们的护理体验。
患有 COPD 的患者希望从全科医生那里获得积极主动、富有同理心的护理。污名化和对评判的恐惧是导致患者延迟向全科医生寻求帮助的负面护理体验的重要潜在驱动因素。
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