The aim of this research scholarship is to establish what current opportunities and support for self-care interventions exist within General Practice for patients with Chronic Obstructive Pulmonary Disease (COPD). Following this exploration, further research will aid the development of intervention(s) that will enhance and empower both health care practitioners and COPD patients towards a greater self-care approach, including the promotion and greater utilisation of pulmonary rehabilitation programmes.
This is a 6 year part-time Epidemiology and Public Health PhD that is due to complete in September 2021. This written report reflects the year 1 scholarship support, but also details the subsequent 5 year research plans.
Background
COPD is one of the most common long-term conditions world-wide with a rising prevalence of both diagnosed and undiagnosed disease. It is projected to be the 3rd most common cause of mortality by 2030 (WHO, 2015) and is responsible for significant disability-adjusted life years (DALY). It is the fifth biggest killer in the UK (DoH, 2012).
COPD accounts for high health utilisation and subsequent cost. Hospital admissions for COPD exacerbations are rising year on year (RCP&BTS, 2015), which are reported to be frequent and often unnecessary (King’s Fund, 2012). A strategic approach to the management of long term conditions in primary care is critical, particularly given that 90% of clinical contacts occur in this health care setting (HSCI, 2016). Pulmonary rehabilitation (PR) is an effective evidence-based multidisciplinary intervention that aims to increase patient’s knowledge of COPD, improve physical function and increase the patient’s ability to self-manage the disease (Bolton et al, 2013 ). However, nationwide referral rates are very low. Recently a COPD primary care audit, undertaken in Wales demonstrated that approximately 34% of patients with a COPD diagnosis are referred to PR, but there was wide variation across the 61% of General Practices included within the audit (RCP, 2016).
Methods
As a doctoral degree, there are many layers which require detailed investigation in order to fully understand and answer the research questions. A robust and detailed literature review incorporating the topics COPD, primary care and pulmonary rehabilitation was undertaken, the benefits to this were two fold not only did it identify topic content it also identified varying methodological research approaches. This information has been pivotal in shaping and planning the next steps to ensure the doctoral work is credible and as such has taken a considerable period of time.
The literature review identified a lack of synergy within the published research which identified the benefits of a systematic review within this field. As a result a systematic review will be conducted to answer specific questions related to the implementation and promotion of Pulmonary Rehabilitation (PR) in supporting and managing patients with COPD. The title for the systematic review has been registered with The Cochrane Library and is due for completion at the end of 2017.
Additionally, in order to gain insight into the day to day working experiences of the health care practitioners, a qualitative research study will be undertaken that will seek to understand the barriers and enablers for healthcare staff when discussing and planning self-management interventions, with a particular focus upon PR. Pending Health Research Authority approval, this work will begin early in 2017. One to one semi-structured interviews with a variety of health care practitioners will take place in primary care settings across the West Midlands and Cambridgeshire. The analysis of these results will be mapped to a theoretical framework, which will better inform the areas that may benefit from change in order to enhance the implementation of evidence based interventions. It is anticipated that the results will inform interventions for use in primary care settings which will enhance COPD self-management for the health care practitioner and the patient. This will inform the final part of the PhD.
Results
It is too early yet to specify the specific results of the 6 year research doctorate, however the much of the early work has identified understanding primary care health care practitioners practice within the COPD self-management sphere is poorly investigated. There may be significant barriers and enablers within practice that impeded the transition of evidence based knowledge to practice pertaining to PR specifically. The systematic review will be integral in highlighting global interventions that seek to overcome these barriers and will highlight their effectiveness. The results from the qualitative research however, will highlight the personal experiences of HCP’s in localised practice, this will give valuable insight that will enrich current understanding of self-management practice in primary care setting and will inform the progressive research trajectory.
Conclusion
This has been an exciting and rewarding journey thus far. COPD is a significant global health concern with considerable societal and individual impacts. Identifying how best to support COPD patients and by which investigative research paradigm is both challenging and fulfilling, yet the current and future implications of this work are valuable, not only to those working to support patients with COPD, but also to healthcare organisations and to patients themselves.
Additionally, whilst the specificity of this particular research investigation lies within the respiratory and primary healthcare field, understanding the difficulties relating to the translation and implementation of evidence based practice within clinical working environments is an area of significant growth. Therefore, embedding the research process within practice and adopting the principles of implementation research has important implications for both current and future healthcare research. Furthermore,
as a junior healthcare researcher this is an important personal learning process, but additionally as a lecturer and supervisor to healthcare students the transference of the gained research skills have the potential to be far reaching.