[COPD patient care pathways: points of view of hospital personnel]. / Trajectoires de soins des patients ayant une bronchopneumopathie chronique obstructive: points de vue des acteurs hospitaliers.

INTRODUCTION: The aim of this study was to identify, from an hospital point of view, the care pathways of patients with chronic obstructive pulmonary disease (COPD) between the ambulatory and in-hospital settings in two regions to the East of Paris (Val-de-Marne and Seine-et-Marne). METHODS: A qualitative multisite case study was conducted from January to October 2012 with hospital doctors managing patients with COPD. Semi-structured individual interviews were carried out with 46 hospital practitioners from the 25 main hospitals of this area. RESULTS: A marked variability in care pathways was observed between the 25sites studied, but no typology could be established. The care pathways depended on the configuration of the available local medical facilities. The main finding of this study was the global lack of coordination between ambulatory care and in-hospital care of patients before and after hospitalization. DISCUSSION: The care pathways identified concerned the probably most severely ill patients who frequently attend hospital emergency rooms. The lack of pre-hospital coordination for the management of acute exacerbations resulted in a very high hospitalization rate. However, international studies have showed that a better management in an ambulatory care setting reduced significantly the hospitalization rates. The problem ofcoordination between ambulatory and in-hospital carefor optimizing of the care pathways remains unsolved in the territories studied here. This example of COPD care shows that a better management of patients with chronic diseases requires a restructuring of the local health care systems in France.