Scripties UMCG - Rijksuniversiteit Groningen
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Onnodig gebruik van ICS bij COPD : Focusgroeponderzoek naar belemmerende en bevorderende factoren bij deïmplementatie van ICS in de huisartspraktijk

(2018) Graaf-van der Woude, S. de (Sandra)

Background. Chronic obstructive pulmonary disease (COPD) is a progressive lung disease with a high disease burden and is initially treated with bronchodilators. Inhaled corticosteroids (ICS) are indicated in case of a poor lungfunction, more than 2 exacerbations per year or presence of asthma. Thirty percent of the users doesn’t meet the criteria, this results in unnecessary costs and risks. These patients could benefit from deïmplementation of ICS.
Aim. To explore obstructive and favouring factors influencing deïmplementation, reasons to start/not to start and to quit ICS.
Methods. In three focusgroups with general practitioners, pharmacists and specialized nurses three topics have been discussed: to start or not to start ICS, limiting and facilitating factors and approach of the patient. The audio-files are verbatim transcribed and analysed according to grounded theory.
Results. Limiting factors were insufficiënt cooperation from patient or doctor and problems in communication between professionals. Facilitating factors were good collaboration, correct approach and follow-up of the patient en the presence of a specialized nurse. Reasons to start ICS were heavy COPD, presence of asthma and insufficiënt effect of current medication. Reasons not to start were errors in inhalation technique and suboptimal bronchodilation.
Conclusion. ICS are mainly started base don symptoms and presence of asthma and are also indicated when there is no effect of adequate optimal bronchodilation. When ICS are stopped, because of new insights or side-effects is a positive attitude and proper accompainment necessary. The specialized nurse plays an important role in the succes of the deimplementation and a good collaboration between doctor and patient and between professionals is essential for the proces to work well.

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