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Improving access to health care for people with severe chronic obstructive pulmonary disease (COPD) in Southern New Zealand: qualitative study of the views of health professional stakeholders and patients

Stokes, Tim, Tumilty, Emma, Latu, Anna Tiatia Fa'atoese, Doolan-Noble, Fiona, Baxter, Jo, McAuley, Kathryn, Hannah, Debbie, Donlevy, Simon and Dummer, Jack 2019, Improving access to health care for people with severe chronic obstructive pulmonary disease (COPD) in Southern New Zealand: qualitative study of the views of health professional stakeholders and patients, BMJ open, vol. 9, no. 11, pp. 1-11, doi: 10.1136/bmjopen-2019-033524.

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Title Improving access to health care for people with severe chronic obstructive pulmonary disease (COPD) in Southern New Zealand: qualitative study of the views of health professional stakeholders and patients
Author(s) Stokes, Tim
Tumilty, EmmaORCID iD for Tumilty, Emma orcid.org/0000-0002-4132-6467
Latu, Anna Tiatia Fa'atoese
Doolan-Noble, Fiona
Baxter, Jo
McAuley, Kathryn
Hannah, Debbie
Donlevy, Simon
Dummer, Jack
Journal name BMJ open
Volume number 9
Issue number 11
Start page 1
End page 11
Total pages 11
Publisher BMJ Open
Place of publication London, Eng.
Publication date 2019
ISSN 2044-6055
Keyword(s) Access to health care
Chronic Obstructive Pulmonary Disease (COPD)
HEALTH SERVICES ADMINISTRATION & MANAGEMENT
Summary Objectives Chronic obstructive pulmonary disease (COPD) is a common chronic disease with significant morbidity and mortality, particularly for Ma ori, which places a large burden on the New Zealand (NZ) health system. We undertook a qualitative study as part of a mixed-methods implementation research project which aimed to determine the barriers and enablers to the provision of accessible high-quality COPD care. Setting Southern Health Region of NZ (Otago and Southland). Participants Thirteen health professional stakeholders and 23 patients with severe COPD (including one Ma ori and one Pasifika participant). Methods Semistructured interviews were undertaken. A thematic analysis using the Levesque conceptual framework for access to healthcare was conducted. Results Health professional stakeholders identified barriers to providing access to health services, in particular: availability (inadequate staffing and resourcing of specialist services and limited geographical availability of pulmonary rehabilitation), affordability (both of regular medication, medication needed for an exacerbation of COPD and the copayment charge for seeing a general practitioner) and appropriateness (a shared model of care across primary and secondary care was needed to facilitate better delivery of key interventions such as pulmonary rehabilitation and advance care planning (ACP). Ma ori stakeholders highlighted the importance of communication and relationships and the role of wha nau (extended family) for support. Patients' accounts showed variable ability to access services through having a limited understanding of what COPD is, a limited knowledge of services they could access, being unable to attend pulmonary rehabilitation (due to comorbidities) and direct (medication and copayment charges) and indirect (transport) costs. Conclusions People with severe COPD experience multilevel barriers to accessing healthcare in the NZ health system along the pathway of care from diagnosis to ACP. These need to be addressed by local health services if this group of patients are to receive high-quality care.
Language eng
DOI 10.1136/bmjopen-2019-033524
Indigenous content off
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2019, Author(s)
Free to Read? Yes
Persistent URL http://hdl.handle.net/10536/DRO/DU:30132585

Document type: Journal Article
Collections: Faculty of Health
School of Medicine
Open Access Collection
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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.