Acceptability and barriers of a GP–physiotherapist partnership in the diagnosis and management of COPD in primary care: A qualitative study
Abstract Introduction Chronic obstructive pulmonary disease (COPD) is commonly diagnosed and managed in primary care but there is evidence that this has been suboptimal, with low confidence expressed in providing interventions requiring behaviour change. The aim of this study was to determine the ac...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2024-02-01
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| Series: | Health Expectations |
| Subjects: | |
| Online Access: | https://doi.org/10.1111/hex.13935 |
| _version_ | 1797296158468472832 |
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| author | Lisa Pagano Zoe McKeough Sally L. Wootton Andrew S. L. Chan Sriram Mahadev Nicholas Zwar Deborah Pallavicini Sarah Dennis |
| author_facet | Lisa Pagano Zoe McKeough Sally L. Wootton Andrew S. L. Chan Sriram Mahadev Nicholas Zwar Deborah Pallavicini Sarah Dennis |
| author_sort | Lisa Pagano |
| collection | DOAJ |
| description | Abstract Introduction Chronic obstructive pulmonary disease (COPD) is commonly diagnosed and managed in primary care but there is evidence that this has been suboptimal, with low confidence expressed in providing interventions requiring behaviour change. The aim of this study was to determine the acceptability of a general practitioner (GP)–physiotherapist partnership in the diagnosis and management of COPD in primary care and to explore the experiences of participants during the implementation of the model. Methods Semi‐structured interviews were conducted with physiotherapists (n = 3), GPs (n = 2), practice nurses (PNs) (n = 2) and patients (n = 12) who had participated in the InNovaTivE Gp‐physiotheRapist pArTnErship for copD (INTEGRATED) trial. We sought to explore participants' views about their experiences and perceived benefits, barriers and facilitators to the implementation of this model of care. Interviews were transcribed, coded and thematically analysed. Synthesis of the data was guided by the Theoretical Domains Framework for clinician interviews and the health belief model for patient interviews. Results All clinicians felt that this integrated model helped to optimise care for patients with COPD by facilitating evidence‐based practice. GPs and PNs valued the physiotherapist's knowledge and skills relating to diagnosis and management, which was reported to complement their own management and improve patient outcomes. Patients reported a sense of empowerment following their appointments and acknowledged improved self‐management skills. However, physiotherapists reported many patients were already engaging in positive health behaviours. Responses were mixed on the effectiveness of the model in facilitating teamwork between clinicians with different perspectives concerning management, communication pathways and logistical issues, such as time and room availability, being cited as barriers. Conclusions An experienced cardiorespiratory physiotherapist embedded into a small number of primary care practices to work in partnership with GPs for COPD diagnosis and management was acceptable and viewed as beneficial for patients. Barriers relating to logistics and resources remain, which must be addressed to optimise implementation. Patient or Public Contribution Patient input was obtained from qualitative feedback from a prior study conducted by two authors and was used to refine the model of care to determine the added value of a physiotherapist integrated into the primary care team. This feedback was also used to refine the interview guides utilised in this study determine the acceptability of this model of care. We had health service involvement from the rehabilitation service of the local health district who were directly involved in determining study aims and establishing the project around the priorities for their chronic disease integration service. For example, this project aimed to engage with a less severe patient population in primary care who would benefit from pulmonary rehabilitation. The findings from this study will be used to further tailor the model of care to the needs of the public and patients. Trial Registration: ACTRN12619001127190 |
| first_indexed | 2024-03-07T21:59:20Z |
| format | Article |
| id | doaj.art-ad0d62ea06314942940605e86e18b82e |
| institution | Directory Open Access Journal |
| issn | 1369-6513 1369-7625 |
| language | English |
| last_indexed | 2024-03-07T21:59:20Z |
| publishDate | 2024-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Health Expectations |
| spelling | doaj.art-ad0d62ea06314942940605e86e18b82e2024-02-24T07:00:38ZengWileyHealth Expectations1369-65131369-76252024-02-01271n/an/a10.1111/hex.13935Acceptability and barriers of a GP–physiotherapist partnership in the diagnosis and management of COPD in primary care: A qualitative studyLisa Pagano0Zoe McKeough1Sally L. Wootton2Andrew S. L. Chan3Sriram Mahadev4Nicholas Zwar5Deborah Pallavicini6Sarah Dennis7Sydney School of Health Sciences, Faculty of Medicine and Health University of Sydney Sydney New South Wales AustraliaSydney School of Health Sciences, Faculty of Medicine and Health University of Sydney Sydney New South Wales AustraliaSydney School of Health Sciences, Faculty of Medicine and Health University of Sydney Sydney New South Wales AustraliaDepartment of Respiratory and Sleep Medicine Royal North Shore Hospital St Leonards New South Wales AustraliaDepartment of Respiratory and Sleep Medicine Royal North Shore Hospital St Leonards New South Wales AustraliaFaculty of Health Sciences and Medicine Bond University Gold Coast Queensland AustraliaSydney North Primary Health Network St Leonards New South Wales AustraliaSydney School of Health Sciences, Faculty of Medicine and Health University of Sydney Sydney New South Wales AustraliaAbstract Introduction Chronic obstructive pulmonary disease (COPD) is commonly diagnosed and managed in primary care but there is evidence that this has been suboptimal, with low confidence expressed in providing interventions requiring behaviour change. The aim of this study was to determine the acceptability of a general practitioner (GP)–physiotherapist partnership in the diagnosis and management of COPD in primary care and to explore the experiences of participants during the implementation of the model. Methods Semi‐structured interviews were conducted with physiotherapists (n = 3), GPs (n = 2), practice nurses (PNs) (n = 2) and patients (n = 12) who had participated in the InNovaTivE Gp‐physiotheRapist pArTnErship for copD (INTEGRATED) trial. We sought to explore participants' views about their experiences and perceived benefits, barriers and facilitators to the implementation of this model of care. Interviews were transcribed, coded and thematically analysed. Synthesis of the data was guided by the Theoretical Domains Framework for clinician interviews and the health belief model for patient interviews. Results All clinicians felt that this integrated model helped to optimise care for patients with COPD by facilitating evidence‐based practice. GPs and PNs valued the physiotherapist's knowledge and skills relating to diagnosis and management, which was reported to complement their own management and improve patient outcomes. Patients reported a sense of empowerment following their appointments and acknowledged improved self‐management skills. However, physiotherapists reported many patients were already engaging in positive health behaviours. Responses were mixed on the effectiveness of the model in facilitating teamwork between clinicians with different perspectives concerning management, communication pathways and logistical issues, such as time and room availability, being cited as barriers. Conclusions An experienced cardiorespiratory physiotherapist embedded into a small number of primary care practices to work in partnership with GPs for COPD diagnosis and management was acceptable and viewed as beneficial for patients. Barriers relating to logistics and resources remain, which must be addressed to optimise implementation. Patient or Public Contribution Patient input was obtained from qualitative feedback from a prior study conducted by two authors and was used to refine the model of care to determine the added value of a physiotherapist integrated into the primary care team. This feedback was also used to refine the interview guides utilised in this study determine the acceptability of this model of care. We had health service involvement from the rehabilitation service of the local health district who were directly involved in determining study aims and establishing the project around the priorities for their chronic disease integration service. For example, this project aimed to engage with a less severe patient population in primary care who would benefit from pulmonary rehabilitation. The findings from this study will be used to further tailor the model of care to the needs of the public and patients. Trial Registration: ACTRN12619001127190https://doi.org/10.1111/hex.13935allied healthCOPDphysiotherapyprimary carequalitative research |
| spellingShingle | Lisa Pagano Zoe McKeough Sally L. Wootton Andrew S. L. Chan Sriram Mahadev Nicholas Zwar Deborah Pallavicini Sarah Dennis Acceptability and barriers of a GP–physiotherapist partnership in the diagnosis and management of COPD in primary care: A qualitative study Health Expectations allied health COPD physiotherapy primary care qualitative research |
| title | Acceptability and barriers of a GP–physiotherapist partnership in the diagnosis and management of COPD in primary care: A qualitative study |
| title_full | Acceptability and barriers of a GP–physiotherapist partnership in the diagnosis and management of COPD in primary care: A qualitative study |
| title_fullStr | Acceptability and barriers of a GP–physiotherapist partnership in the diagnosis and management of COPD in primary care: A qualitative study |
| title_full_unstemmed | Acceptability and barriers of a GP–physiotherapist partnership in the diagnosis and management of COPD in primary care: A qualitative study |
| title_short | Acceptability and barriers of a GP–physiotherapist partnership in the diagnosis and management of COPD in primary care: A qualitative study |
| title_sort | acceptability and barriers of a gp physiotherapist partnership in the diagnosis and management of copd in primary care a qualitative study |
| topic | allied health COPD physiotherapy primary care qualitative research |
| url | https://doi.org/10.1111/hex.13935 |
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