Ideal Post-Discharge Follow-up after Severe Pneumonia or Acute Respiratory Failure: A Qualitative Study of Primary Care Clinicians in Diverse Settings

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 Identify what primary care clinicians consider ideal follow-up care after hospitalization for severe pneumonia or acute respiratory failure, and their perceived barriers and facilitators to providing ideal follow-up. Study Design and Methods We conducted, via videoconferencing, semi-structured interviews of 20 primary care clinicians working in diverse settings from 5 U.S. states and Washington, D.C. Participants described post-discharge visits, ongoing follow-up, and referrals for “patients recovering from hospitalizations for pneumonia or respiratory failure bad enough to be hospitalized and require a lot of oxygen support or need to go to the ICU.”. Barriers and facilitators were probed using the COM-B (Capability, Opportunity, Motivation, Behavior) framework. Interview summaries and Rigorous and Accelerated Data Reduction (RADaR) 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 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 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.