title: Time pressured deprioritization of COPD in primary care: a qualitative study.
abstract: OBJECTIVE
  To identify factors that hinder discussions regarding chronic obstructive pulmonary disease (COPD) between primary care physicians (PCPs) and their patients in Sweden.
  
  
  METHODS
  Primary health care centres (PHCCs) in Stockholm, Sweden.
  
  
  METHODS
  A total of 59 PCPs.
  
  
  METHODS
  Semi-structured individual and focus-group interviews between 2012 and 2014. Data were analysed inspired by grounded theory methods (GTM).
  
  
  RESULTS
  Time-pressured patient-doctor consultations lead to deprioritization of COPD. During unscheduled visits, deprioritization resulted from focusing only on acute health concerns, while during routine care visits, COPD was deprioritized in multi-morbid patients. The reasons PCPs gave for deprioritizing COPD are: "Not becoming aware of COPD", "Not becoming concerned due to clinical features", "Insufficient local routines for COPD care", "Negative personal attitudes and views about COPD", "Managing diagnoses one at a time", and "Perceiving a patient's motivation as low''.
  
  
  CONCLUSIONS
  De-prioritization of COPD was discovered during PCP consultations and several factors were identified associated with time constraints and multi-morbidity. A holistic consultation approach is suggested, plus extended consultation time for multi-morbid patients, and better documentation and local routines.
  
  
  CONCLUSIONS
  Under-diagnosis and insufficient management of chronic obstructive pulmonary disease (COPD) are common in primary health care. A patient-doctor consultation offers a key opportunity to identify and provide COPD care. Time pressure, due to either high number of patients or multi-morbidity, leads to omission or deprioritization of COPD during consultation. Deprioritization occurs due to lack of awareness, concern, and local routines, negative personal views, non-holistic consultation approach, and low patient motivation. Better local routines, extended consultation time, and a holistic approach are needed when managing multi-morbid patients with COPD.
authors: a NVS, Section for Family Medicine, Karolinska Institutet , Huddinge , Stockholm , Sweden ;
authors: Hanna
authors: H
authors: Sandelowsky
authors: a NVS, Section for Family Medicine, Karolinska Institutet , Huddinge , Stockholm , Sweden ;
authors: Ingrid
authors: I
authors: Hylander
authors: a NVS, Section for Family Medicine, Karolinska Institutet , Huddinge , Stockholm , Sweden ;
authors: Ingvar
authors: I
authors: Krakau
authors: a NVS, Section for Family Medicine, Karolinska Institutet , Huddinge , Stockholm , Sweden ;
authors: Sonja
authors: S
authors: Modin
authors: b Department of Public Health and Caring Science, Family Medicine and Preventive Medicine , Uppsala University , Uppsala , Sweden.
authors: Björn
authors: B
authors: Ställberg
authors: a NVS, Section for Family Medicine, Karolinska Institutet , Huddinge , Stockholm , Sweden ;
authors: Anna
authors: A
authors: Nager
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D015897:Comorbidity; D005260:Female; D017144:Focus Groups; D006292:Health Priorities; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D010817:Physician-Patient Relations; D058007:Physicians, Primary Care; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D036301:Qualitative Research; D012017:Referral and Consultation; D013548:Sweden; D016526:Workload
keywords: Barriers; COPD; Sweden; general practice; guideline; management; multi-morbidity; primary care; primary care physicians; qualitative study type