title: General practitioners' perceptions of COPD treatment: thematic analysis of qualitative interviews.
abstract: BACKGROUND
  In Denmark, the treatment of COPD is mainly managed by general practitioners (GPs). Pulmonary rehabilitation (PR) is available to patients with COPD in the local community by GP referral, but in practice, many patients do not participate in rehabilitation. The aim of our study was to explore 1) GPs' perceptions of their role and responsibility in the rehabilitation of patients with COPD, and 2) GPs' perceptions of how patients manage their COPD.
  
  
  METHODS
  The study was based on a qualitative design with semi-structured key-informant interviews with GPs. Investigator triangulation was applied during data generation, and analysis was done using thematic analysis methodology.
  
  
  RESULTS
  Our main findings were that GPs relied on patients themselves to take the initiative to make clinic appointments and on professionals at health centers to provide the PR including consultations on lifestyle changes. The GPs experienced that patients chose to come to the clinic when they were in distress and that patients either declined or had poor adherence to rehabilitation when offered. The GPs were relieved that the health centers had taken over the responsibility of rehabilitation as GPs lacked the resources to discuss rehabilitation and follow up on individual plans.
  
  
  CONCLUSIONS
  Our study suggested a potential self-reinforcing problem with the treatment of COPD being mainly focused on medication rather than on PR. Neither GPs nor patients used a proactive approach. Further, GPs were not fully committed to discuss non-pharmacological treatment and perceived the patients as unmotivated for PR. As such, there is a need for optimizing non-pharmacological treatment of COPD and in particular the referral process to PR.
authors: CopenRehab, Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors: Katrine Rutkær
authors: KR
authors: Molin
authors: Department of Neuroanaesthesiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors: Ingrid
authors: I
authors: Egerod
authors: CopenRehab, Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors: Laura Staun
authors: LS
authors: Valentiner
authors: Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors: Peter
authors: P
authors: Lange
authors: CopenRehab, Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors: Henning
authors: H
authors: Langberg
mesh_terms: D001291:Attitude of Health Personnel; D003142:Communication; D019033:Delivery of Health Care, Integrated; D003718:Denmark; D005260:Female; D058006:General Practice; D058005:General Practitioners / Q000523:psychology*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010349:Patient Compliance; D010465:Perception; D010819:Physician's Role; D010817:Physician-Patient Relations; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D036301:Qualitative Research; D012138:Respiratory Therapy
keywords: motivation theory; non-pharmacological treatment; primary care; pulmonary rehabilitation; qualitative research; treatment approach