title: Primary and secondary care clinicians' views on self-treatment of COPD exacerbations: a multinational qualitative study.
abstract: OBJECTIVE
  To explore clinicians' views on antibiotic and/or steroid 'rescue packs' used as self-treatment for patients with exacerbations of COPD.
  
  
  METHODS
  21 focus groups conducted in 7 countries--Netherlands, Russia, Norway, China (Hong Kong), Wales, Germany and Poland involving 142 primary care clinicians and pulmonologists.
  
  
  RESULTS
  We found wide variation in reported use of and attitudes to self-treatment among GPs and pulmonologists in the participating countries. Clinicians highlighted the importance of identifying patients who were most likely to benefit (those with more severe disease) and most likely to use the treatment appropriately (demonstrated by previous behaviour), and the importance of adequate patient education and ongoing communication in regard to use of self-treatment packs. Clinicians recognised patient empowerment and facilitating prompt treatment as potential benefits of self-treatment. However, many felt they did not have the time or resources for appropriate patient selection and education.
  
  
  CONCLUSIONS
  Clinicians do not feel it is appropriate to offer self-treatment rescue packs to all patients routinely without careful consideration of patient understanding of their illness and their capacity for self-management.
  
  
  CONCLUSIONS
  Adequate resources and continuity of patient care are required for clinicians to feel confident in the safe and effective implementation of this strategy.
authors.affiliation: Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK. Electronic address: DaviesF9@cf.ac.uk.
authors.forename: Freya
authors.initials: F
authors.lastname: Davies
authors.affiliation: General Practice Research Unit, UiT, The Arctic University of Norway, Tromsø, Norway.
authors.forename: Mette Bech
authors.initials: MB
authors.lastname: Risør
authors.affiliation: General Practice Research Unit, UiT, The Arctic University of Norway, Tromsø, Norway.
authors.forename: Hasse
authors.initials: H
authors.lastname: Melbye
authors.affiliation: Department of Family Medicine, Maastricht University, Maastricht, Netherlands.
authors.forename: Mark
authors.initials: M
authors.lastname: Spigt
authors.affiliation: South East Wales Trials Unit, Cardiff University, Cardiff, UK.
authors.forename: Lucy
authors.initials: L
authors.lastname: Brookes-Howell
authors.affiliation: South East Wales Trials Unit, Cardiff University, Cardiff, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: O'Neill
authors.affiliation: Department of Family and Community Medicine, Medical University of Lodz, Lodz, Poland.
authors.forename: Maciek
authors.initials: M
authors.lastname: Godycki-Cwirko
authors.affiliation: Department of General Practice, University Medical Centre, Rostock, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Wollny
authors.affiliation: Department of Family Medicine, Northern State Medical University, Arkhangelsk, Russia.
authors.forename: Elena
authors.initials: E
authors.lastname: Andreeva
authors.affiliation: Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK; Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Butler
authors.affiliation: Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK.
authors.forename: Nick
authors.initials: N
authors.lastname: Francis
mesh_terms: D001291:Attitude of Health Personnel; D002681:China; D005060:Europe; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D036301:Qualitative Research; D011788:Quality of Life; D063127:Secondary Health Care; D012648:Self Care
keywords: Chronic obstructive pulmonary disease; Rescue packs; Self-management; Self-treatment