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How do general practitioners implement decision-making regarding COPD patients with exacerbations? An international focus group study

Overview of attention for article published in International Journal of Chronic Obstructive Pulmonary Disease, December 2016
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2 tweeters

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70 Mendeley
Title
How do general practitioners implement decision-making regarding COPD patients with exacerbations? An international focus group study
Published in
International Journal of Chronic Obstructive Pulmonary Disease, December 2016
DOI 10.2147/copd.s118856
Pubmed ID
Authors

Johanna Laue, Hasse Melbye, Peder Halvorsen, Elena Andreeva, Maciek Godycki-Cwirko, Anja Wollny, Nick Francis, Mark Spigt, Kenny Kung, Mette Risør

Abstract

To explore the decision-making of general practitioners (GPs) concerning treatment with antibiotics and/or oral corticosteroids and hospitalization for COPD patients with exacerbations. Thematic analysis of seven focus groups with 53 GPs from urban and rural areas in Norway, Germany, Wales, Poland, Russia, the Netherlands, and Hong Kong. Four main themes were identified. 1) Dealing with medical uncertainty: the GPs aimed to make clear medical decisions and avoid unnecessary prescriptions and hospitalizations, yet this was challenged by uncertainty regarding the severity of the exacerbations and concerns about overlooking comorbidities. 2) Knowing the patient: contextual knowledge about the individual patient provided a supplementary framework to biomedical knowledge, allowing for more differentiated decision-making. 3) Balancing the patients' perspective: the GPs considered patients' experiential knowledge about their own body and illness as valuable in assisting their decision-making, yet felt that dealing with disagreements between their own and their patients' perceptions concerning the need for treatment or hospitalization could be difficult. 4) Outpatient support and collaboration: both formal and informal caregivers and organizational aspects of the health systems influenced the decision-making, particularly in terms of mitigating potentially severe consequences of "wrong decisions" and concerning the negotiation of responsibilities. Fear of overlooking severe comorbidity and of further deteriorating symptoms emerged as a main driver of GPs' management decisions. GPs consider a holistic understanding of illness and the patients' own judgment crucial to making reasonable decisions under medical uncertainty. Moreover, GPs' decisions depend on the availability and reliability of other formal and informal carers, and the health care systems' organizational and cultural code of conduct. Strengthening the collaboration between GPs, other outpatient care facilities and the patients' social network can ensure ongoing monitoring and prompt intervention if necessary and may help to improve primary care for COPD patients with exacerbations.

Twitter Demographics

The data shown below were collected from the profiles of 2 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 70 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 70 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 14 20%
Student > Ph. D. Student 11 16%
Researcher 9 13%
Student > Bachelor 7 10%
Student > Doctoral Student 5 7%
Other 11 16%
Unknown 13 19%
Readers by discipline Count As %
Medicine and Dentistry 22 31%
Social Sciences 8 11%
Psychology 7 10%
Nursing and Health Professions 5 7%
Business, Management and Accounting 4 6%
Other 8 11%
Unknown 16 23%

Attention Score in Context

This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 10 August 2017.
All research outputs
#8,913,267
of 11,595,461 outputs
Outputs from International Journal of Chronic Obstructive Pulmonary Disease
#973
of 1,355 outputs
Outputs of similar age
#207,574
of 323,848 outputs
Outputs of similar age from International Journal of Chronic Obstructive Pulmonary Disease
#77
of 92 outputs
Altmetric has tracked 11,595,461 research outputs across all sources so far. This one is in the 20th percentile – i.e., 20% of other outputs scored the same or lower than it.
So far Altmetric has tracked 1,355 research outputs from this source. They receive a mean Attention Score of 4.7. This one is in the 21st percentile – i.e., 21% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 323,848 tracked outputs that were published within six weeks on either side of this one in any source. This one is in the 31st percentile – i.e., 31% of its contemporaries scored the same or lower than it.
We're also able to compare this research output to 92 others from the same source and published within six weeks on either side of this one. This one is in the 14th percentile – i.e., 14% of its contemporaries scored the same or lower than it.