Enhancing potential impact of hospital discharge interventions for patients with COPD: a qualitative systematic review

Abstract

Background: Patients with chronic obstructive pulmonary disease (COPD) are frequently readmitted to hospital resulting in avoidable healthcare costs. Many different interventions designed to reduce hospital readmissions are reported with limited evidence for effectiveness. Greater insight into how interventions could be better designed to improve patient outcomes has been recommended.

Aim: To identify areas for optimisation within previously reported interventions provided to reduce COPD rehospitalisation to improve future intervention development.

Methods: A systematic review was conducted by searching Medline, Embase, CINAHL, PsycINFO, and CENTRAL in June 2022. Inclusion criteria were interventions provided to patients with COPD in the transition from hospital to home or community. Exclusion criteria were lack of empirical qualitative results, reviews, drug trials, and protocols. Study quality was assessed using the Critical Appraisal Skills Programme tool and results were synthesised thematically.

Results: A total of 2,962 studies were screened and nine studies included. Patients with COPD experience difficulties when transitioning from hospital to home. It is therefore important for interventions to facilitate a smooth transition process and give appropriate follow-up post-discharge. Additionally, interventions should be tailored for each patient, especially regarding information provided.

Conclusion: Very few studies specifically consider processes underpinning COPD discharge intervention implementation. There is a need to recognise that the transition itself creates problems, which require addressing, before introducing any new intervention. Patients report a preference for interventions to be individually adapted-in particular the provision of patient information. Whilst many intervention aspects were well received, feasibility testing may have enhanced acceptability. Patient and public involvement may address many of these concerns and greater use of process evaluations should enable researchers to learn from each other's experiences.

Trial registration: The review was registered in PROSPERO with registration number CRD42022339523.

Keywords: Chronic obstructive pulmonary disease; Health services; Implementation science; Qualitative research; Systematic review.

Fig. 1

Identification and screening process of the systematic search based on the PRISMA-2020 diagram [24]

Fig. 2

Descriptive and analytical themes from the thematic synthesis. Items with rounded corners are descriptive themes and items with sharp corners are analytical themes