Exploring factors contributing to Chronic Obstructive Pulmonary Disease (COPD) guideline non-adherence and potential solutions in the emergency department: interdisciplinary staff perspective

Article


Issac, Hancy, Taylor, Melissa, Moloney, Clint and Lea, Jackie. 2021. "Exploring factors contributing to Chronic Obstructive Pulmonary Disease (COPD) guideline non-adherence and potential solutions in the emergency department: interdisciplinary staff perspective." Journal of Multidisciplinary Healthcare. 14, pp. 767-785. https://doi.org/10.2147/JMDH.S276702
Article Title

Exploring factors contributing to Chronic Obstructive Pulmonary Disease (COPD) guideline non-adherence and potential solutions in the emergency department: interdisciplinary staff perspective

ERA Journal ID123846
Article CategoryArticle
AuthorsIssac, Hancy (Author), Taylor, Melissa (Author), Moloney, Clint (Author) and Lea, Jackie (Author)
Journal TitleJournal of Multidisciplinary Healthcare
Journal Citation14, pp. 767-785
Number of Pages19
Year2021
Place of PublicationUnited Kingdom
ISSN1178-2390
Digital Object Identifier (DOI)https://doi.org/10.2147/JMDH.S276702
Web Address (URL)https://www.dovepress.com/exploring-factors-contributing-to-chronic-obstructive-pulmonary-diseas-peer-reviewed-fulltext-article-JMDH
Abstract

Purpose: Acute exacerbations of chronic obstructive pulmonary disease (COPD) have a significant and prolonged impact on health-related quality of life, patient outcomes, and escalation of pulmonary function decline. COPD-X guidelines published in 2003 subsist to facilitate a shift from the emphasis on pharmacological treatment to a more holistic multi-disciplinary interventions approach. Despite the existing comprehensive recommendations, readmission rates have increased in the last decade. Evidence to date has reported sub-optimal COPD guidelines adherence in emergency departments. This qualitative study explored contributing factors to interdisciplinary staff non-adherence and utilisation of COPD-X guidelines in a major Southern Queensland Emergency Department.

Methods: Semi-structured qualitative interviews with interdisciplinary staff were conducted in an emergency department. A purposive sample of doctors, nurses, physiotherapists, pharmacist and a social worker were recruited. Interviews were digitally recorded, de-identified and transcribed verbatim. Data analysis followed a coding process against the Theoretical Domains Framework (TDF) to examine implementation barriers and potential solutions. Identified factors affecting non-adherence and underutilisation of guidelines were then mapped to the capability, opportunity, motivation, behaviour model (COM-B) and behaviour change wheel (BCW) to inform future implementation recommendations.

Results: Prominent barriers influencing the clinical uptake of COPD guidelines were identified using TDF analysis and included knowledge, professional role clarity, clinical behaviour regulation, memory, attention, and decision process, beliefs about departmental capabilities, environmental context and resources. Potential interventions included education, training, staffing, funding and time-efficient digitalised referrals and systems management reminders to prevent COPD readmissions, remissions and improve patient health-related quality of life.

Conclusion: Implementation strategies such as electronic interdisciplinary COPD proforma that facilitates a multimodal approach with appropriate patient/staff resources and referrals prior to discharge from an ED require further exploration. Greater clarity around which components of the COPD X guidelines must be applied in ED settings needs to stem from future research

KeywordsAECOPD management, COPD guidelines adherence, theoretical domains framework, multidisciplinary, COM-B, behaviour change wheel, behaviour change techniques taxonomy
ANZSRC Field of Research 2020420501. Acute care
Byline AffiliationsSchool of Nursing and Midwifery
Institution of OriginUniversity of Southern Queensland
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Moloney, Clint. 2011. Behavioural intention and user acceptance of research evidence for Queensland nurses: provision of solutions from the clinician. PhD Thesis Doctor of Philosophy. University of Southern Queensland.
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Scott, Annette, Gururajan, Raj, Moloney, Clint and Gururajan, Vijaya. 2006. "A qualitative evaluation of the effectiveness of videoconferencing to support the training of orthopaedic registrars." Journal of Telemedicine and Telecare. 12 (3 (Supplement)), pp. 69-70. https://doi.org/10.1258/135763306779379969
The role of wireless technology in addressing sleeping disorders in aged care
Moloney, Clint. 2010. "The role of wireless technology in addressing sleeping disorders in aged care." Pease, Wayne, Cooper, Malcolm and Gururajan, Raj (ed.) Biomedical knowledge management: infrastructures and processes for e-health systems. Hershey, PA. United States. IGI Global. pp. 279-288
Perceived facilitators and inhibitors for the use of personal digital assistants (PDAs) by nurses: a systematic review
Moloney, Clint and Beccaria, Lisa Mara. 2009. "Perceived facilitators and inhibitors for the use of personal digital assistants (PDAs) by nurses: a systematic review." JBI Library of Systematic Reviews. 7 (33), pp. 1430-1491. https://doi.org/10.11124/01938924-200907330-00001
A systematic review of psychometric evidence and expert opinion regarding the assessment of faecal incontinence in older community-dwelling adults
Fallon, Anthony Bruce, Westaway, Julie and Moloney, Clint. 2008. "A systematic review of psychometric evidence and expert opinion regarding the assessment of faecal incontinence in older community-dwelling adults." International Journal of Evidence-Based Healthcare. 6 (2), pp. 225-259.
A discussion on the legal barriers in addressing sleeping disorders in aged care using wireless technology
Moloney, Clint and Gururajan, Raj. 2004. "A discussion on the legal barriers in addressing sleeping disorders in aged care using wireless technology." Conrick, Moya and Soar, Jeffrey (ed.) 1st Australian Aged and Community Care Informatics Conference (ACCIC'04). Brisbane, Australia 24 - 25 Aug 2004 Brunswick East, Australia.
Implementation of oral health recommendations into two residential aged care facilities in a regional Australian city
Fallon, Tony, Buikstra, Elizabeth, Cameron, Michelle, Hegney, Desley, Mackenzie, Debra, March, Judith, Moloney, Clint and Pitt, Jacinta. 2006. "Implementation of oral health recommendations into two residential aged care facilities in a regional Australian city." International Journal of Evidence-Based Healthcare. 4 (3), pp. 162-179. https://doi.org/10.1111/j.1479-6988.2006.00040.x
To what extent will the annual number of episodes of acute confusion within a medical unit be reduced following the introduction of high risk indicators and early intervention strategies
Moloney, Clint. 2005. To what extent will the annual number of episodes of acute confusion within a medical unit be reduced following the introduction of high risk indicators and early intervention strategies. Masters Thesis Master of Health Science. University of Southern Queensland.
Challenges for implementing wireless hand-held technology in health care: views from selected Queensland nurses
Gururajan, Raj, Moloney, Clint and Soar, Jeffrey. 2005. "Challenges for implementing wireless hand-held technology in health care: views from selected Queensland nurses." Journal of Telemedicine and Telecare. 11 (2 (Supplement)), pp. 37-38. https://doi.org/10.1258/135763305775124849
Out patient orthopaedic consultations via telehealth: a qualitative study
Gururajan, Raj, Gururajan, Vijaya, Moloney, Clint and Scott, Annette. 2005. "Out patient orthopaedic consultations via telehealth: a qualitative study." Beekhuyzen, Jenine, Von Hellens, Lisa, Guest, Karen, Morley, Morley and Collier, Toni (ed.) 2005 QualIT Challenges for Qualitative Research. Brisbane, Australia 23 - 25 Nov 2005 Brisbane, Australia.
Facilitators and inhibitors for wireless handheld technology: views from Queensland nurses
Gururajan, Raj and Moloney, Clint. 2005. "Facilitators and inhibitors for wireless handheld technology: views from Queensland nurses." Beekhuyzen, Jenine, Von Hellens, Lisa, Guest, Karen, Morley, Morley and Collier, Toni (ed.) 2005 QualIT Challenges for Qualitative Research. Brisbane, Australia 23 - 25 Nov 2005 Brisbane, Australia.
Adoption of wireless handheld technology: a case of Queensland healthcare
Gururajan, Raj, Hafeez-Baig, Abdul and Moloney, Clint. 2005. "Adoption of wireless handheld technology: a case of Queensland healthcare." Yeung, Jeff (ed.) 5th International Conference on Electronic Business: Enhancing Logistics & Supply Chain Competence Through E-Business (ICEB 2005). Hong Kong, China 05 - 09 Dec 2005 Hong Kong, China.
Drivers for wireless handheld technology: views from Queensland nurses
Gururajan, Raj, Moloney, Clint and Kerr, Don. 2005. "Drivers for wireless handheld technology: views from Queensland nurses." Shehadie, Elias (ed.) Australasian Business and Behavioural Sciences Association Conference 2005 (ABBSA 2005). Cairns, Australia 05 - 07 Aug 2005 Australia.
An investigation into the factors of adoption of wireless applications for data management by nurses
Gururajan, Raj, Kerr, Don, Moloney, Clint and Houghton, Luke. 2005. "An investigation into the factors of adoption of wireless applications for data management by nurses." Eldon, Li (ed.) APDSI 2005. Taipei, Taiwan 28 Jun - 02 Jul 2005 Taipei, Taiwan.