title: Improving COPD Care in a Medically Underserved Primary Care Clinic: A Qualitative Study of Patient Perspectives.
abstract: We conducted a focus group study in an urban hospital-based primary care teaching clinic serving an indigent and Hispanic (predominantly Puerto Rican) population in New England in order to learn how patients with Chronic Obstructive Lung Disease (COPD) perceive their disease, how they experience their medical care, and the barriers they face managing their disease and following medical recommendations. The research team included medical doctors, nurses, a medical anthropologist, a clinical pharmacist, a hospital interpreter, and a systems analyst. Four focus groups were conducted in Spanish and English in April and May 2014. The demographic characteristics of the 25 focus group participants closely reflected the demographics of the total COPD clinic patients. The participants were predominantly female (72%) and Hispanic (72%) and had a median age of 63. The major themes expressed in the focus groups included: problems living with COPD; coping with complexities of comorbid illnesses; challenges of quitting smoking and maintaining cessation; dealing with second-hand smoke; beliefs and myths about quitting smoking; difficulty paying for and obtaining medications; positive experiences obtaining and managing medications; difficulties in using sleep machines at home; expressions of disappointment with the departure of their doctors; and overall satisfaction with the clinic health care providers. The study led to the creation of an action plan that addresses the concerns expressed by the focus study participants. The action plan is spearheaded by a designated bilingual and bicultural nurse and is now in operation.
authors.affiliation: a Department of Anthropology , Brown University , Providence , Rhode Island , USA.
authors.forename: Irene
authors.initials: I
authors.lastname: Glasser
authors.affiliation: b School of Pharmacy , Department of Pharmacy Practice, University of Connecticut , Storrs, Connecticut , USA.
authors.forename: Fei
authors.initials: F
authors.lastname: Wang
authors.affiliation: c Adult Primary Care Outpatient Clinic , Hartford Hospital , Hartford, Connecticut, USA.
authors.forename: Jane
authors.initials: J
authors.lastname: Reardon
authors.affiliation: c Adult Primary Care Outpatient Clinic , Hartford Hospital , Hartford, Connecticut, USA.
authors.forename: Cunegundo D
authors.initials: CD
authors.lastname: Vergara
authors.affiliation: c Adult Primary Care Outpatient Clinic , Hartford Hospital , Hartford, Connecticut, USA.
authors.forename: Ralph
authors.initials: R
authors.lastname: Salvietti
authors.affiliation: c Adult Primary Care Outpatient Clinic , Hartford Hospital , Hartford, Connecticut, USA.
authors.forename: Myrtha
authors.initials: M
authors.lastname: Acevedo
authors.affiliation: c Adult Primary Care Outpatient Clinic , Hartford Hospital , Hartford, Connecticut, USA.
authors.forename: Blanca
authors.initials: B
authors.lastname: Santana
authors.affiliation: d Department of Research , Hartford Hospital , Hartford , Connecticut , USA.
authors.forename: Gil
authors.initials: G
authors.lastname: Fortunato
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D045422:Continuous Positive Airway Pressure / Q000009:adverse effects / Q000295:instrumentation; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006630:Hispanic or Latino / Q000523:psychology*; D006801:Humans; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D009511:New England; D017060:Patient Satisfaction; D010465:Perception; D011306:Prescription Fees; D011320:Primary Health Care / Q000592:standards*; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics / Q000523:psychology* / Q000628:therapy; D036301:Qualitative Research; D058996:Quality Improvement; D016540:Smoking Cessation; D014028:Tobacco Smoke Pollution
chemical_list: D014028:Tobacco Smoke Pollution
keywords: Puerto Rican population; barriers; focus group; qualitative research; urban outpatient clinic