Challenges Faced by Rural Primary Care Providers When Caring for COPD Patients in the Western United States

Chronic Obstr Pulm Dis. 2021 May 28. doi: 10.15326/jcopdf.2021.0215. Online ahead of print.


RATIONALE: Rural COPD patients have worse outcomes and higher mortality compared with urban patients. Reasons for these disparities likely include challenges to delivery of care that have not been explored.

OBJECTIVE: To determine challenges faced by rural primary care providers when caring for COPD patients.

METHODS: Rural primary care providers in seven, primarily western states were asked about barriers they experienced when caring for COPD patients.

RESULTS: Seventy-one rural primary care medical providers completed the survey, of which 51% were physicians and 49% were advanced practice providers (APPs). 61% used GOLD or ATS/ERS guidelines as an assessment and treatment resource. The presence of multiple chronic conditions and patient failure to recognize and report symptoms were the greatest barriers to diagnose COPD. 89% of providers used spirometry to diagnose COPD, but only 62% were satisfied with access to spirometry. Despite recommendations, 41% of providers never test for alpha-1 antitrypsin deficiency. 87% were comfortable with their ability to assess symptoms, but only 11% used a guideline-recommended assessment tool. Although most providers were satisfied with their ability to treat symptoms and exacerbations, only 66% were content with their ability to prevent exacerbations. Fewer providers were happy with their access pulmonologists (55%) or pulmonary rehabilitation (37%). Subgroup analyses revealed differences based on provider type (APP vs. physician) and location (Colorado and Kansas vs. other states), but not on population or practice size.

CONCLUSIONS: Rural providers face significant challenges when caring for COPD patients that should be targeted in future interventions to improve COPD outcomes.

PMID:34048644 | DOI:10.15326/jcopdf.2021.0215