A partnership approach to COPD diagnosis and management in general practice
The diagnosis and management of COPD in Australian primary care is suboptimal and indicates low levels of awareness of the national clinical practice guidelines (COPD-X guidelines) (1, 2). The PELICAN study (3) was a randomised controlled trial of an intervention where GPs and practices nurses (PNs) worked in partnership to identify people with COPD and to implement a care plan based on the COPD-X guidelines. The aim of this study was to explore the attitudes to and implementation of the GP-PN team management within their practices.
Semi-structured interviews were conducted with a purposive sample of GPs (n=4) and PNs (n=7) who had taken part in PELICAN. The interviews were digitally recorded and transcribed verbatim. The transcripts were coded in NVivo 10 using the theoretical domains framework (4). The theoretical domains framework has been used in implementation science to understand health professional clinical behaviour change and uptake of evidence based practices and was used to guide the thematic analysis.
The PNs talked about developing skills in spirometry and understanding the requirements for good quality spirometry during the PELICAN study. Several talked about their increased competence in performing spirometry and awareness of the requirements for good quality spirometry. However, many lacked confidence in its interpretation and/or felt that it was not part of their professional role, within their own practice, to interpret the results. This was also reflected in the responses from the GPs. Once COPD was diagnosed, the GPs tended to manage the patients and the PNs had less contact with the patient, unlike their role in managing patients with other chronic diseases such as diabetes. The GPs valued the PNs' increased technical skills and competence in spirometry.
The PNs had gained skills and confidence in spirometry. However, beliefs about professional role, identity and confidence impacted on the extent to which the PN was involved in interpretation of the results and care planning for the patient following diagnosis of COPD. The findings may also reflect the fact that there is not comprehensive post-graduate training for PNs in respiratory disorders in Australia.References 1. Ta M, et al. Management of chronic obstructive pulmonary disease in Australia after the publication of national guidelines. Internal Medicine Journal. 2011;41(3):263-70.2. Abramson M et al. The COPD-X Plan: Australian and New Zealand Guidelines for the management of Chronic Obstructive Pulmonary Disease 2014;V2.38.3. Bunker J, et al. A pragmatic cluster randomized controlled trial of early intervention for chronic obstructive pulmonary disease by practice nurse-general practitioner teams: Study Protocol. Implementation Science. 2012;7(1):83.4. French S, et al. Developing theory-informed behaviour change interventions to implement evidence into practice: a systematic approach using the Theoretical Domains Framework. Implementation Science. 2012;7(1):38.
- Sarah Dennis, Woolcock Medical Research Institute, Sydney, Australia
- Helen Reddel, University of New South Wales, Sydney, Australia
- Sandy Middleton, University of Adelaide, Adelaide, Australia
- Guy Marks, University of New South Wales, Sydney, Australia
- Oshana Hermiz, Australian Catholic University, Sydney, Australia
- Iqbal Hasan, Australian Catholic University, Sydney, Australia
- Sanjyot Vagholkar, Australian Catholic University, Sydney, Australia
- Alan Crockett
- Nick Zwar, Australian Catholic University, Sydney, Australia