Health Services Management Centre, School of Social Policy and Society, University of Birmingham, Birmingham, UK.
Independent Patient/Public Co-analyst, Birmingham, UK.
NPJ Prim Care Respir Med. 2024 Nov 30;34(1):41. doi: 10.1038/s41533-024-00398-3.
Half of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are caused by bacterial infection, but self-management plans (SMPs) generally advocate use of antibiotics and steroids for all events. We report findings from a qualitative study exploring the acceptability of a sputum colour chart and SMP to guide patient use of antibiotics and steroids (commonly termed a 'rescue pack'). Qualitative interviews were conducted with healthcare professionals (HCPs) and patients from the Colour COPD trial - a randomised controlled trial of usual care (SMP alone) versus usual care plus sputum colour chart to manage AECOPD across England and sampled to promote maximum variation. Interviews were audio-recorded, transcribed clean verbatim, then analysed thematically, using an adapted Framework approach. Expert patients contributed to the patient data analysis. Fourteen HCPs and 39 patients were interviewed from primary and secondary care. Three overarching themes were identified. (1) Handling tensions: the tension between stewardship of antimicrobials and need to reduce risk of serious illness. (2) Clinical and embodied legacies: established clinical practices of infection control and patient's own experiences of managing their condition over time have focused on early intervention for AECOPD. (3) Changing self-management practices: opportunities for changing practices through negotiating change between HCP and patient. In conclusion, while, in principle, the assessment of sputum colour using a chart to manage AECOPD was acceptable to both patients and HCPs, in practice, it is unlikely to have significant impact on well-established clinical practices for infection control and patient habits of self-management.
慢性阻塞性肺疾病（COPD）急性加重（AECOPD）的一半是由细菌感染引起的，但自我管理计划（SMP）通常主张对所有事件使用抗生素和类固醇。我们报告了一项定性研究的结果，该研究探讨了痰液颜色图表和 SMP 用于指导患者使用抗生素和类固醇（通常称为“救援包”）的可接受性。这项定性研究在 Colour COPD 试验中对医疗保健专业人员（HCP）和患者进行了访谈，该试验是一项针对英格兰 AECOPD 的常规护理（单独使用 SMP）与常规护理加痰液颜色图表的随机对照试验，并进行了抽样以促进最大变化。访谈进行了录音，并逐字转录为干净的文字，然后使用改编的框架方法进行主题分析。经验丰富的患者为患者数据分析做出了贡献。共对来自初级和二级保健的 14 名 HCP 和 39 名患者进行了访谈。确定了三个总体主题。（1）处理紧张局势：对抗生素管理和减少严重疾病风险的需求之间的紧张关系。（2）临床和体现的遗产：感染控制的既定临床实践和患者自己随着时间的推移管理病情的经验，都集中在早期干预 AECOPD。（3）改变自我管理实践：通过在 HCP 和患者之间协商改变来改变实践的机会。总之，虽然原则上使用图表评估痰液颜色来管理 AECOPD 对患者和 HCP 都是可以接受的，但实际上，它不太可能对感染控制的既定临床实践和患者自我管理习惯产生重大影响。
