Access Barriers, Self-reliance Cause Patients With COPD to Avoid Prompt Care

Many patients with chronic obstructive pulmonary disease (COPD) do not believe their cases warrant emergency department care.

Patients experiencing undiagnosed chronic obstructive pulmonary disease (COPD) exacerbations tend to try their own remedies first and only seek medical care when those remedies fail, according to a new report in NPJ Primary Care Respiratory Medicine.

Although early intervention in cases of COPD can lead to earlier resolution of symptoms and a reduction in the need for emergency department (ED) visits, studies show that many patients are slow to seek medical attention. One study found 70% of patients experiencing exacerbations waited more than a day before seeking care, the study authors note.

Corresponding author Emily R. Locke, MPH, US Department of Veterans Affairs’ Puget Sound Health Care System, and colleagues wanted to find out why so many patients avoid seeking care despite the benefits of early intervention. They conducted 60 semistructured interviews with people who had experienced a recent COPD exacerbation, asking them about their experiences and decisions.

The interviewees included 15 untreated patients, 15 who were treated with prednisone and/or antibiotics in an outpatient setting, 16 patients treated in an urgent care or ED setting, and 14 patients who were hospitalized. Most of the respondents were men, and they had a mean age of 69 years.

Locke and colleagues found that attitudes and access issues were major factors in patients’ decisions to delay care. “Participants described avoiding care-seeking because of an attitude of self-reliance and not wanting to ‘bother’ or ‘burden’ others,” they said.

Some patients said they thought seeking care would amount to a hassle, and others said they were open to seeking care but did not think their case constituted a “true emergency” worthy of an ED visit. Others said they developed their own techniques to treat their exacerbations, often without consulting a medical professional. These included using over-the-counter medications or increasing home oxygen levels. Some also took a wait-and-see approach, hoping the exacerbation would prove short lived.

“However, many participants acknowledged that hopes of avoiding care-seeking and the desire to ‘wait it out’ often led them to overestimate the chances that episodes would improve and to ignore or downplay worsening symptoms,” Locke and colleagues said.

The “tipping point” at which patients finally sought medical attention varied from individual to individual. Some sought care when their home remedies proved insufficient or when symptoms worsened, and others had a time limit past which they decided they required medical attention. For still others, intervention by family members was the deciding factor.

Asked what would prompt them to seek care more quickly next time, some respondents pointed to a desire to avoid having to call 911 or to a better understanding of their condition following consultation with their physician.

The investigators suggested several strategies to fix the problem of delaying care. They said clinicians can directly address attitudinal barriers through patient education, adding that health care systems should also consider finding ways to reduce the perceived “hassle” of going to the ED, such as providing virtual care or ED alternatives.

Another strategy is to involve family members.

“Providing education on when and where to seek treatment, and support for family members in their caregiving roles may be beneficial,” they wrote.

Reference

Locke ER, Young JP, Battaglia C, et al. Care-seeking and delay of care during COPD exacerbations. NPJ Prim Care Respir Med. Published online February 15, 2022. doi:10.1038/s41533-022-00269-9