A qualitative study of stakeholder views of a community-based anticipatory care service for patients with COPD

Background: The need to consider anticipatory preventive care for people with chronic obstructive pulmonary disease (COPD) has been highlighted in UK guidelines and policy. Aims: To explore stakeholder views of the utility and design of a community-based anticipatory care service (CBACS) for COPD. Methods: This was a qualitative study using focus groups and in-depth interviews in North-East Scotland. Key stakeholders were purposively sampled: GPs (n=7), practice nurses (n=6), community nurses (n=4), district nurses (n=6), physiotherapists (n=6), pharmacists (n=8), COPD Managed Clinical Network members (n=8), NHS managers (n=4), the COPD Early Supported Discharge (ESD) Team (n=7), patients and carers (n=7). Data were analysed using framework analysis. Results: A CBACS for COPD was broadly acceptable to most participants although not all wished direct involvement. Patient education and empowerment, clear roles, effective communication across traditional service boundaries, generic and clinical skills training, ongoing support and a holistic service were seen as crucial. Potential issues included: resources; anticipatory care being in conflict with the 'reactive' ethos of NHS care; and the breadth of clinical knowledge required. Conclusion: A CBACS for COPD requires additional resources and professionals will need to adapt to a new model of service delivery for which they may not be ready.