Scripties UMCG - Rijksuniversiteit Groningen
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Belangrijke factoren bij de deïmplementatie van inhalatiecorticosteroïden bij patiënten met : Gezien vanuit het patiënten perspectief

(2018) Jong, B. de

Background: Chronic obstructive pulmonary disease (COPD) is characterized by persistent respiratory symptoms and airflow limitation. Patients are mostly treated with bronchodilatation and inhaled corticosteroids (ICS). According to new guidelines a lot of COPD patients use ICS without a proper indication. The aim of this study is identifying the facilitators and barriers in withdrawing ICS in patients with COPD without a proper indication.
Methods: This is a qualitative study using the focus group methodology. A focus group is a semi structured group interview with a moderator using a standardized protocol. There have been 3 focus groups. Data was analyzed using the software of Nvivo.
Results: Patient are glad about reduced medication. Facilitators: reduction in related side effects, healthcare costs savings, individualized care, whether or not with a personalized ‘action plan’ and good support from specialized nurses. Also, patients are satisfied with new scientific development. Participants prefer to be approached by the pulmonologist. It is important that the withdrawing of ICS is well argued and the practitioner takes sufficient time for this. A good patient-doctor relationship makes a positive contribution to the decision making. Some participants would like to taper the ICS and some participant want to have some extra consideration time before stopping.
Barriers are the fear of worsening of condition, medication reliance, disappointment about the long-term unnecessary use of ICS and switching to a different inhaler. Also, some people are a bit sceptical about the possibility that they can safely withdraw ICS.
Conclusion: Withdrawing the use of ICS gives advantages and disadvantages. Also, it is important that there is a well-structured process of withdrawing, therefore a good communication is essential. All factors together can facilitate the process of withdrawing ICS in COPD patients without a proper indication for the health professionals and patients.

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