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dc.contributor.authorLaue, Johanna
dc.contributor.authorMelbye, Hasse
dc.contributor.authorHalvorsen, Peder Andreas
dc.contributor.authorAndreeva, Elena
dc.contributor.authorGodycki-Cwirko, Maciek
dc.contributor.authorWollny, Anja
dc.contributor.authorFrancis, Nick
dc.contributor.authorSpigt, Mark
dc.contributor.authorKung, Kenny
dc.contributor.authorRisør, Mette Bech
dc.date.accessioned2017-01-31T09:56:28Z
dc.date.available2017-01-31T09:56:28Z
dc.date.issued2016-12-08
dc.description.abstract<b>Purpose:</b> To explore the decision-making of general practitioners (GPs) concerning treatment with antibiotics and/or oral corticosteroids and hospitalization for COPD patients with exacerbations.<br> <b>Methods:</b> Thematic analysis of seven focus groups with 53 GPs from urban and rural areas in Norway, Germany, Wales, Poland, Russia, the Netherlands, and Hong Kong.<br> <b>Results:</b> Four main themes were identified. 1) Dealing with medical uncertainty: the GPs aimed to make clear medical decisions and avoid unnecessary prescriptions and hospitalizations, yet this was challenged by uncertainty regarding the severity of the exacerbations and concerns about overlooking comorbidities. 2) Knowing the patient: contextual knowledge about the individual patient provided a supplementary framework to biomedical knowledge, allowing for more differentiated decision-making. 3) Balancing the patients’ perspective: the GPs considered patients’ experiential knowledge about their own body and illness as valuable in assisting their decision-making, yet felt that dealing with disagreements between their own and their patients’ perceptions concerning the need for treatment or hospitalization could be difficult. 4) Outpatient support and collaboration: both formal and informal caregivers and organizational aspects of the health systems influenced the decision-making, particularly in terms of mitigating potentially severe consequences of “wrong decisions” and concerning the negotiation of responsibilities.<br> <b>Conclusion:</b> Fear of overlooking severe comorbidity and of further deteriorating symptoms emerged as a main driver of GPs’ management decisions. GPs consider a holistic understanding of illness and the patients’ own judgment crucial to making reasonable decisions under medical uncertainty. Moreover, GPs’ decisions depend on the availability and reliability of other formal and informal carers, and the health care systems’ organizational and cultural code of conduct. Strengthening the collaboration between GPs, other outpatient care facilities and the patients’ social network can ensure ongoing monitoring and prompt intervention if necessary and may help to improve primary care for COPD patients with exacerbations.en_US
dc.descriptionThis article is distributed under the terms of the <a href="http://creativecommons.org/licenses/by-nc/3.0/"> the Creative Commons Attribution – Non Commercial (unported, v3.0) License</a>.<br> This article is also available via DOI:<a href="http://dx.doi.org/ 10.2147/COPD.S118856"> 10.2147/COPD.S118856</a>en_US
dc.identifier.citationLaue J, Melbye H, Halvorsen PA, Andreeva E, Godycki-Cwirko M, Wollny A, Francis N, Spigt M, Kung K, Risør MB. How do general practitioners implement decision-making regarding COPD patients with exacerbations? An international focus group study. The International Journal of Chronic Obstructive Pulmonary Disease. 2016;11(1):3109-3119en_US
dc.identifier.cristinIDFRIDAID 1410656
dc.identifier.doi10.2147/COPD.S118856
dc.identifier.issn1176-9106
dc.identifier.issn1178-2005
dc.identifier.urihttps://hdl.handle.net/10037/10246
dc.language.isoengen_US
dc.publisherDove Medical Pressen_US
dc.relation.journalThe International Journal of Chronic Obstructive Pulmonary Disease
dc.rights.accessRightsopenAccessen_US
dc.subjectCOPD exacerbationen_US
dc.subjectantibioticsen_US
dc.subjectoral corticosteroidsen_US
dc.subjecthospitalizationen_US
dc.subjectprimary careen_US
dc.subjectdecision-makingen_US
dc.subjectVDP::Medisinske Fag: 700::Klinisk medisinske fag: 750::Allmennmedisin: 751en_US
dc.subjectVDP::Medical disciplines: 700::Clinical medical disciplines: 750::Family practice: 751en_US
dc.titleHow do general practitioners implement decision-making regarding COPD patients with exacerbations? An international focus group studyen_US
dc.typeJournal articleen_US
dc.typeTidsskriftartikkelen_US
dc.typePeer revieweden_US


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