title: Case finding for COPD in primary care: a qualitative study of the views of health professionals.
abstract: BACKGROUND
  Chronic obstructive pulmonary disease (COPD) is common but largely underdiagnosed. Case-finding initiatives have been evaluated in primary care, but few studies have explored the views of service providers on implementing them in practice.
  
  
  OBJECTIVE
  To explore the views of primary health care providers on case finding for COPD.
  
  
  METHODS
  A total of 20 semi-structured interviews were conducted from March 2014 to September 2014 among general practitioners, nurses, and managers from practices participating in a large COPD case-finding trial based in primary care in the West Midlands, UK. Participants' views were sought to explore perceived benefits, harms, barriers, and facilitators to implementing COPD case finding in practice. Interviews were transcribed and analyzed using the framework method.
  
  
  RESULTS
  Participants felt that case finding improves patient care but also acknowledged potential harms to providers (increase in workload) and to patients (overdiagnosis). Insufficient resources, poor knowledge of COPD, and limited access to diagnostic services were viewed as barriers to diagnosis, while provision of community respiratory services, including COPD specialist nurses, and support from secondary care were thought to be facilitators. Participants also expressed a need for more education on COPD for both patients and clinicians.
  
  
  CONCLUSIONS
  Care providers believe that early detection of COPD improves patient care but also has accompanying harms. Barriers to diagnosing COPD, such as insufficient expertise in primary care and limited access to diagnostic services in the community, should be explored and addressed. The knowledge and attitudes of the public about COPD and its symptoms should also be investigated to inform future education and awareness-raising strategies.
authors.affiliation: School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK.
authors.forename: Shamil
authors.initials: S
authors.lastname: Haroon
authors.affiliation: School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK.
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Jordan
authors.affiliation: School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK.
authors.forename: David A
authors.initials: DA
authors.lastname: Fitzmaurice
authors.affiliation: School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK.
authors.forename: Peymane
authors.initials: P
authors.lastname: Adab
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D042241:Early Diagnosis; D004739:England / Q000453:epidemiology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D007318:Inservice Training; D007407:Interviews as Topic; D008297:Male; D000069342:Medical Overuse; D008875:Middle Aged; D010348:Patient Care Team; D010353:Patient Education as Topic; D011237:Predictive Value of Tests; D011320:Primary Health Care / Q000592:standards; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D036301:Qualitative Research; D058996:Quality Improvement; D016526:Workload
keywords: chronic obstructive pulmonary disease; diagnosis; primary care; qualitative research