Patient Preference and Adherence (Dec 2022)
Patient and Health Care Provider Perspectives on Potential Preventability of Hospital Admission for Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Qualitative Study
Abstract
Anna Leenders,1 Esther Sportel,1 Elise Poppink,1 Wendy van Beurden,2 Paul van der Valk,2 Marjolein Brusse-Keizer3,4 1Department of Clinical Pharmacy, Medisch Spectrum Twente, Enschede, the Netherlands; 2Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands; 3Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, the Netherlands; 4Medical School Twente, Medisch Spectrum Twente, Enschede, the NetherlandsCorrespondence: Marjolein Brusse-Keizer, Medisch Spectrum Twente, PO Box 50000, Enschede, 7500 KA, the Netherlands, Tel +31 53 487 20 00, Email [email protected]: Chronic obstructive pulmonary disease (COPD) is a highly prevalent chronic disease partly characterised by the occurrence of acute exacerbations (AECOPD). The need for hospital admissions for COPD exacerbations could theoretically be decreased through timely and appropriate outpatient care or self-management. The aim of this study is to explore and compare patients’ and health care providers’ (HCP) perspectives on the potential preventability of COPD hospitalisations and to identify strategies to prevent unnecessary hospitalisations.Patients and Methods: Semi-structured interviews were conducted with patients admitted for an AECOPD (N = 11), HCPs on the respiratory ward (N = 11), and treating pulmonologists (N = 10). Interviews were transcribed verbatim and analysed using thematic content analysis.Results: Patient and HCP perspectives on the potential preventability of hospital admissions for AECOPD often conflict. The kappa coefficients were − 0.18 [95% CI: − 0.46– 0.11] for patients and pulmonologists and − 0.28 [95% CI: − 0.80– 0.21] for patients and HCPs, which indicates poor agreement. The kappa coefficient for pulmonologists and HCPs was 0.14 [95% CI: − 0.13– 0.41], which indicates slight agreement. Patient and HCP factors that could potentially prevent hospitalisation for AECOPD were identified, including timely calling for help, recognizing and acting on symptoms, and receiving instruction about COPD, including treatment and action plans.Conclusion: Patients and their HCPs have different beliefs about the potential preventability of AECOPD hospitalisations. Most patients and HCPs mentioned factors that potentially could have led to a different outcome for the current AECOPD or that could impact the patient’s health status and treatment of AECOPDs in the future. The factors identified in this study indicate that shared decision making is crucial to center the patient’s perspective and individual needs and to provide timely treatment or prevention of AECOPD, thereby potentially decreasing hospital admission rates.Keywords: patient and provider preferences, hospitalisation, COPD exacerbation, prevention
