Ideal Postdischarge Follow-Up After Severe Pneumonia or Acute Respiratory Failure: A Qualitative Study of Primary Care Clinicians in Diverse Settings

Abstract

Background: Most patients discharged after hospitalization for severe pneumonia or acute respiratory failure receive follow-up care from primary care clinicians, yet guidelines are sparse.

Research question: What do primary care clinicians consider to be ideal follow-up care after hospitalization for severe pneumonia or acute respiratory failure and what do they perceive to be barriers and facilitators to providing ideal follow-up?

Study design and methods: We conducted, via videoconferencing, semistructured interviews of 20 primary care clinicians working in diverse settings from five US states and Washington, DC. Participants described postdischarge visits, ongoing follow-up, and referrals for patients recovering from hospitalizations for pneumonia or respiratory failure bad enough to be hospitalized and to require significant oxygen support or seeking treatment at the ICU. Barriers and facilitators were probed using the capability, opportunity, motivation, behavior framework. Interview summaries and rigorous and accelerated data reduction analysis techniques were used.

Results: Core elements of primary care follow-up after severe pneumonia or acute respiratory failure included safety assessment, medication management, medical specialty follow-up, integrating the hospitalization into the primary care relationship, assessing mental and physical well-being, rehabilitation follow-up, and social context of recovery. Clinicians described specific practices as well as barriers and facilitators at multiple levels to optimal care.

Interpretation: Our findings suggest that at least seven core elements are common in follow-up care after severe pneumonia or acute respiratory failure, and conventional systems include barriers and facilitators to delivering what primary care clinicians consider to be optimal follow-up care. Future research could leverage identified barriers and facilitators to develop implementation tools that enhance the delivery of robust follow-up care for severe pneumonia or acute respiratory failure.

Keywords: aftercare; continuity of patient care; health services research; pneumonia; primary health care.

Figure 1 –

Diagram showing the determinants of ideal follow-up for severe pneumonia or acute respiratory failure. EHR = electronic health record; PCC = primary care clinician.