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Chronic obstructive pulmonary disease
Specialty COPD care during COVID-19: patient and clinician perspectives on remote delivery
  1. Frances Wu1,
  2. Jenni Burt1,
  3. Teena Chowdhury2,
  4. Raymond Fitzpatrick3,
  5. Graham Martin1,
  6. Jan W van der Scheer1 and
  7. John R Hurst4
  1. 1The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, Cambridge, Cambridgeshire, UK
  2. 2Audit and Accreditation, Royal College of Physicians, London, UK
  3. 3Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
  4. 4UCL Respiratory, University College London, London, UK
  1. Correspondence to Professor John R Hurst; j.hurst{at}ucl.ac.uk

Abstract

Introduction The COVID-19 pandemic has impacted specialty chronic obstructive pulmonary disease (COPD) care. We examined the degree to which care has moved to remote approaches, eliciting clinician and patient perspectives on what is appropriate for ongoing remote delivery.

Methods Using an online research platform, we conducted a survey and consensus-building process involving clinicians and patients with COPD.

Results Fifty-five clinicians and 19 patients responded. The majority of clinicians felt able to assess symptom severity (n=52, 95%), reinforce smoking cessation (n=46, 84%) and signpost to other healthcare resources (n=44, 80%). Patients reported that assessing COPD severity and starting new medications were being addressed through remote care. Forty-three and 31 respondents participated in the first and second consensus-building rounds, respectively. When asked to rate the appropriateness of using remote delivery for specific care activities, respondents reached consensus on 5 of 14 items: collecting information about COPD and overall health status (77%), providing COPD education and developing a self-management plan (74%), reinforcing smoking cessation (81%), deciding whether patients should seek in-person care (72%) and initiating a rescue pack (76%).

Conclusion Adoption of remote care delivery appears high, with many care activities partially or completely delivered remotely. Our work identifies strengths and limitations of remote care delivery.

  • COPD exacerbations
  • inhaler devices
  • long-term oxygen therapy (LTOT)
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjresp-2020-000817

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    Footnotes

    • Contributors All authors jointly conceived the study, contributed to interpretation and approved the final version of the paper. Data collection was led by FW, with support from JB, TC, RF, GM and JRH. Data analysis was led by FW, with support from JvdS. FW led drafting of the paper, with critical input from all the other authors.

    • Funding This research was supported by the Health Foundation’s grant to the University of Cambridge for The Healthcare Improvement Studies Institute. The Healthcare Improvement Studies Institute is supported by the Health Foundation, an independent charity committed to bringing about better health and healthcare for people in the UK.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The patient survey received approval from the University of Cambridge Psychology Research Ethics Committee. The clinician survey was considered to fall outside the scope of ethical review. Both patients and clinicians were required to provide consent to Thiscovery’s terms and conditions regarding data storage, and both groups were provided with participant information about the survey and consensus-development process. For clinicians, participation in the survey was taken to imply consent; patients were additionally asked to confirm that they understood that participation was voluntary and would not impact the healthcare they received prior to accessing the questionnaire.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data sharing is not applicable as no datasets are generated and/or analysed for this study.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.