Since many people with COPD avoid going to the ED due to factors like time spent waiting to be seen, it’s important to develop other outpatient care options.

Research has shown that earlier treatment of COPD exacerbations can lead to more rapid recovery and fewer ED visits and hospitalizations. “However, many people with COPD either do not seek care or delay care for their exacerbations,” says Vincent S. Fan, MD, MPH, a VA Puget Sound Health Care System investigator. A better understanding of why some patients delay treatment for exacerbations, he adds, may improve COPD self-management programs and could help efforts to develop more effective telemonitoring programs.

Searching for Ways to Increase Care-Seeking Behavior

Dr. Fan and colleagues published a qualitative analysis in NPJ Primary Care Respiratory Medicine that sought to understand how patients with COPD perceived and managed their breathing symptoms. They also explored barriers and facilitators that led to seeking or delaying care for acute exacerbations. “We interviewed 60 patients following a COPD exacerbation to better understand how they make decisions about seeking care for exacerbations,” Dr. Fan says. “Our goal was to find ways to help clinicians support and encourage earlier care seeking for COPD exacerbations.”

Of total participants in the study, 15 went untreated, 15 received treatment with outpatient prednisone and/or antibiotics, 16 were treated in an urgent care or ED setting, and 14 were hospitalized. “We identified four themes from the qualitative interviews in our study,” says Dr. Fan (Table). “First, there were several reasons patients were reluctant to seek care for an exacerbation. These included wanting to preserve self-reliance, not wanting to burden their family or physicians, and reports that seeking care can be a hassle or inconvenient. Additionally, patients typically wanted to wait before seeking care for an exacerbation to see if symptoms resolved on their own over time or to use a home treatment approach they developed based on their prior experience with exacerbations.”

Support Needed to Encourage Patients to Seek Care Sooner

Dr. Fan says another key theme was that patients who sought care did so because they reached a critical tipping point. “For patients who sought care, we found that their symptoms did not resolve with home treatment approaches, they developed worrisome symptoms, their exacerbation continued longer than expected, or they were encouraged by family to seek care,” he says. “We also found that while many patients delayed care, others reported changing their care-seeking behavior because of a prior episode when they called 9-1-1 or were hospitalized for a severe exacerbation. Some patients reported that clinicians encouraged them to seek care earlier.”

According to Dr. Fan, clinicians need to acknowledge prior experiences of patients with COPD exacerbations and recognize that some people may develop their own strategies to manage symptoms at home. “Incorporating the past experiences of patients can help clinicians work with them to develop strategies to seek care sooner,” he says. “Furthermore, self-reliance and wanting to avoid being a burden to family or healthcare teams may play an important role in patients’ decisions to seek care. Motivational interviewing might be an effective approach to help patients address these factors.”

Care-Seeking Programs Will Need to Acknowledge Previous Experiences

Even though patients reported they did not want to burden their family members, interviews with caregivers of patients with COPD found that the caregivers typically wanted patients to seek care sooner. “Providing education and support for both patients and family members may help encourage early care seeking,” Dr. Fan says. “In addition, since many people with COPD wanted to avoid going to the ED because of factors like time spent waiting to be seen, it’s important to develop other outpatient care options, such as virtual care, to help encourage earlier care seeking for exacerbations.”

For future research, Dr. Fan says it is important to gain a better understanding on how to address specific patient characteristics, such as self-reliance and not wanting to burden others, to encourage earlier care-seeking behavior. “Programs aiming to encourage earlier care seeking will need to acknowledge the previous experiences of patients living with COPD and the approaches they used for home care for their exacerbations. Given that patients prefer to be treated for exacerbations in an outpatient setting, it’s important to develop new options for treatment.”

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