Barriers and outcomes of an evidence-based approach to diagnosis and management of chronic obstructive pulmonary disease (COPD) in Australia: a qualitative study.
Chronic obstructive pulmonary disease (COPD) is commonly managed in primary care but there is poor awareness of evidence-based guidelines and the quality and interpretation of spirometry is suboptimal.



The aims of this qualitative study were to explore how an intervention involving case finding and management of COPD was implemented, and the extent to which the GPs and practice nurses (PNs) worked in partnership to diagnose and manage COPD.



Semi-structured interviews with PNs (n = 7), GPs (n = 4) and patients (n = 26) who had participated in the Primary care EarLy Intervention for Copd mANagement (PELICAN) study. The Theoretical Domains Framework was used to guide the coding and analysis of the interviews with PN and GPs. The patient interviews were analysed thematically.



PNs developed technical skills and understood the requirements for good-quality spirometry. However, many lacked confidence in its interpretation and felt this was not part of their professional role. This was reflected in responses from the GPs. Once COPD was diagnosed, the GPs tended to manage the patients with the PNs less involved. This was in contrast with PNs' active role in managing patients with other chronic diseases such as diabetes. The extent to which the GPs and PNs worked in partnership to manage COPD varied.



PNs improved their skills and confidence in performing spirometry. Beliefs about their professional role, identity and confidence influenced the extent to which PNs were involved in interpretation of the spirometry results and managing the patient in partnership with the GP.
Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia.|Center for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia.
Sarah
S
Dennis
Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.
Helen K
HK
Reddel
Nursing Research Institute, St Vincent's Health Australia, Sydney, New South Wales, Australia.|Australian Catholic University, Sydney, New South Wales, Australia.
Sandy
S
Middleton
Center for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia.
Iqbal
I
Hasan
Center for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia.
Oshana
O
Hermiz
Nursing Research Institute, St Vincent's Health Australia, Sydney, New South Wales, Australia.|Australian Catholic University, Sydney, New South Wales, Australia.
Rosemary
R
Phillips
School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.
Alan J
AJ
Crockett
School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.
Sanjyot
S
Vagholkar
Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.|South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
Guy B
GB
Marks
School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.
Nicholas
N
Zwar
D001315:Australia; D019468:Disease Management; D055317:Evidence-Based Practice / Q000592:standards*; D005260:Female; D058005:General Practitioners; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D024802:Nurse's Role / Q000523:psychology; D011320:Primary Health Care / Q000592:standards; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000628:therapy*; D036301:Qualitative Research
Chronic obstructive pulmonary disease; patient care team; primary health care