Barriers impact COPD management in rural US clinics; tailored interventions may help

NASHVILLE, Tenn. — Primary care providers who care for patients with COPD in rural clinics in the Midwest U.S. identified several barriers to delivering evidence-based care.

“There are rural-urban disparities in COPD outcomes. Previous research has shown that patients in rural vs. urban areas have different outcomes in terms of mortality, hospitalizations and even prevalence of COPD,” Arianne K. Baldomero, MD, MS, assistant professor in pulmonary, allergy, critical care and sleep medicine at the Minneapolis VA Health Care System and University of Minnesota, Minneapolis, told Healio.

Baldomero and fellow researchers interviewed 12 primary care providers, including primary care physicians, nurse practitioners and physician assistants, within the Veterans Health Administration Midwest Health Care Network in four Midwest states who provided care for patients with COPD in rural clinics. The goal was to assess their perspectives on evidence-based COPD management in the rural setting, perceived barriers to care and recommendations for improvement.

Two key barriers to delivering evidence-based COPD management in the rural setting were competing priorities — for example, large patient panels and having to focus management on many issues beyond just COPD — and limited resources, according to the results.

While the primary care providers noted that telemedicine, which increased in use especially during the COVID-19 pandemic, improved access to evidence-based COPD care in rural areas, technological challenges remained.

“Some patients in rural areas may not have access or technical abilities to utilize virtual care,” Baldomero said.

Other challenges cited were frustration in the coordination of care required for non-VA referrals for spirometry and pulmonary care; difficulty applying guidelines in practice; and difficulty maintaining continuity of care.

“Unfortunately, these challenges can lead to fragmented care, on top of the already heavy burden of taking care of a lot of patients cited by the primary care providers we interviewed,” Baldomero said.

The primary care providers identified facilitating factors to delivering evidence-based COPD management, including multidisciplinary clinical support, appointment availability and options for tobacco cessation.

Those interviewed recommended increased access to pulmonary care, such as electronic consultation options. Another recommendation was the development of an electronic health record clinical decision support tool for patients with COPD in rural areas. The primary care providers also noted that a COPD disease management program could improve access to specialty care and boost adherence to evidence-based COPD management.

“Identification of barriers to providing COPD care for rural primary care providers is just the first step to addressing rural-urban disparities in COPD. To improve care delivery for COPD, especially for rural patients, we need to tailor interventions,” Baldomero said.

The researchers have plans to continue this research.

“We would also like to obtain perspectives from the patients and also from health system leadership. We plan to extend the geographic reach to primary care providers who are not just within the VA Midwest Health Care Network. Based on the data we gather, we could eventually develop and pilot an intervention to improve COPD care for patients in rural areas, specifically tailored for rural veterans.”

Reference:

Wilson T, et al. Chest. 2022;doi:10.1016/j.chest.2022.08.1562.