Increasing capacity and capability of general practitioners to provide COPD management in primary care
Creators: name: Daken, Kirstie
Publisher: name: University of Southern Queensland
Year: 2022
Subjects: Chronic Obstructive Pulmonary Disease, COPD, clinical guidelines, guideline adherence, primary care, COPD management

description: Chronic Obstructive Pulmonary Disease (COPD) places a large financial and resource burden on the primary healthcare system and is currently the fifth leading cause of death in Australia. Patients experience hospitalisation due to exacerbations that could have been prevented in primary health care settings. Research indicates that use of the guidelines by general practice doctors is generally poor. Three research questions were explored in this thesis which aimed to investigate the needs of general practitioners (GPs) within a specific health region, identify what evidence-based interventions are available for behaviour change targeting GPs according to the COPD guidelines and current best practice guidelines, and using these, develop an appropriate intervention. The overall aim of this project was to improve adherence to clinical guidelines by GPs in order to manage the condition more effectively in the primary healthcare setting, thereby reducing the burden on tertiary health. The thesis (and studies within) utilised theories of behaviour change, specifically the established ‘gold standard’ components for intervention development: Theoretical Domains Framework (TDF) and the COM-B model. Study One: The first study consisted of a mixed-methods (quantitative with some qualitative open responses) survey involving 36 GPs from the health region. This aim of this study was to identify the knowledge, confidence, and skills of GPs in managing COPD in the primary healthcare setting. Barriers identified to guideline adherence included lack of familiarity, time restraints, resources restraints, and a reported gap in knowledge, confidence and skills to follow the recommendations. Study Two: Study two consisted of a systematic quantitative literature review (SQLR) of published literature with the aim of compiling evidence-based interventions targeted at behaviour change for GPs for COPD guideline adherence within primary healthcare settings. The results yielded seven studies, from which four primary types of interventions were identified being educational programs, disease management plans, patient feedback and technology guidance. Study Three: Study three aimed to develop an intervention utilising the steps described in the literature and integrating the findings from study one, information from the additional qualitative interviews of seven GPs conducted by the research team for study three, one respiratory physiologist and one hospital respiratory specialist, as well as the SQLR from study two. The findings identified key recommendations for intervention behaviour change techniques within six intervention functions including goal setting, action planning, monitoring of behaviour and supports. This project faced challenges due to the nature of GP-focused research, including poor engagement heightened with the restrictions of the COVID-19 pandemic. Implications from this project aim to inform policy, practice in research particularly for improving health outcomes and health service optimisation for GPs.