A motivational intervention for patients with COPD in primary care: qualitative evaluation of a new practitioner role

BMC Family Practice

Research Article

Cara Afzal¹  Peter Salmon²  Susanne Langer³  Cheryl Hunter⁴  Jessica Drinkwater⁵  Kim Keane⁶  Else Guthrie⁷  Carolyn A Chew-Graham⁸ 

[1] CHOICE Programme, Manchester Mental Health and Social Care Trust, M13 9WL, Manchester, UK;Department of Psychological Sciences, University of Liverpool, L69 3GB, Liverpool, UK;Department of Psychology, Manchester Metropolitan University, M13 0JA, Manchester, UK;Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, OX3 7LF, Oxford, UK;Leeds Institute of Health Sciences, University of Leeds, LS2 9LJ, Leeds, UK;Leeds and York Partnership NHS Foundation Trust, LS15 8ZB, Leeds, UK;Manchester Mental Health and Social Care Trust, M13 9WL, Manchester, UK;Research Institute, Primary Care and Health Sciences, Keele University, ST5 5BG, Keele, UK;

关键词: Primary care;    Long-term conditions;    Qualitative research;    Motivational change;    Psychosocial intervention;   

DOI  :  10.1186/1471-2296-15-164

 received in 2014-04-25, accepted in 2014-09-29,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundLong-term conditions such as chronic obstructive pulmonary disease (COPD) are growing challenges for health services. Psychosocial co-morbidity is associated with poorer quality of life and greater use of health care in these patients but is often un-diagnosed or inadequately treated in primary care, where most care for these patients is provided. We developed a brief intervention, delivered by ‘liaison health workers’ (LHWs), to address psychosocial needs in the context of an integrated approach to physical and mental health. We report a qualitative study in which we characterize the intervention through the experience of the patients receiving it and examine how it was incorporated into primary care.MethodsQualitative study using patient and practice staff informants. We audio-recorded interviews with 29 patients offered the intervention (three had declined it or withdrawn) and 13 practice staff (GPs, nurses and administrators). Analysis used a constant comparative approach.ResultsMost patients were enthusiastic about the LHWs, describing the intervention as mobilizing their motivation for self-management. By contrast with other practitioners, patients experienced the LHWs as addressing their needs holistically, being guided by patient needs rather than professional agendas, forming individual relationships with patients and investing in patients and their capacity to change. Practices accommodated and accepted the LHWs, but positioned them as peripheral to and separate from the priority of physical care.ConclusionsDespite being a short-term intervention, patients described it as having enduring motivational benefits. The elements of the intervention that patients described map onto the key features of motivating interventions described by Self-Determination Theory. We suggest that the LHWs motivated patients to self-management by: (i) respecting patients’ competence to decide on needs and priorities; (ii) forming relationships with patients as individuals; and (iii) fostering patients’ sense of autonomy. While truly integrated primary care for patients with long-term conditions such as COPD remains elusive, existing practice staff might adopt elements of the LHWs’ approach to enhance motivational change in patients with long-term conditions such as COPD.

【 授权许可】

Unknown   
© Langer et al.; licensee BioMed Central Ltd. 2014. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.