Qualitative Validation of COPD Evidenced Care Pathways in Japan, Canada, England, and Germany: Common Barriers to Optimal COPD Care

Abstract

Background Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. A comprehensive and detailed understanding of COPD care pathways from pre-diagnosis to acute care is required to understand the common barriers to optimal COPD care across diverse health systems. Methods Country-specific COPD care pathways were created for four high-income countries using international recommendations and country-specific guidelines, then populated with published epidemiological, clinical, and economic data. To refine and validate the pathways, semi-structured interviews using pre-prepared discussion guides and country-specific pathway maps were held with twenty-four primary and secondary care respiratory healthcare professionals. Thematic analysis was then performed on the interview transcripts. Results The COPD care pathway showed broad consistency across the countries. Three key themes relating to barriers in optimal COPD management were identified across the countries: journey to diagnosis, treatment, and the impact of COVID-19. Common barriers included presentation to healthcare with advanced COPD, low COPD consideration, and sub-optimal acute and chronic disease management. COVID-19 has negatively impacted disease management across the pathway but presents opportunities to retain virtual consultations. Structural factors such as insurance and short duration of appointments also impacted the diagnosis and management of COPD. Conclusion COPD is an important public health issue that needs urgent prioritization. The use of Evidenced Care Pathways with decision-makers can facilitate evidence-based decision making on interventions and policies to improve care and outcomes for patients and reduce unnecessary resource use and associated costs for the healthcare provider/payer.

Mapping the common barriers to optimal COPD care in high and middle-income countries: qualitative perspectives from clinicians

“…Although broadly similar, the theme structure identified in this research differs from the one reported by Meiwald et al (14), where only four HICs were included (Canada, England, Germany and Japan). The key differences are linked to the emergence of two new themes (Themes 6 and 7) that explain how structural issues across healthcare systems affect COPD care.…”

“…The interview data were analysed using deductive and inductive thematic analysis (25). Transcripts were coded using an existing framework (14). Data within each theme was then coded line by line to create sub-categories (inductive component).…”

“…Currently, no well-established and widely recognised method exists for mapping practical aspects of care delivery to identify deviations from the guideline provisions. One approach is reported by Meiwald et al for COPD Evidenced Care Pathways, which collated and illustrated the steps in delivering COPD care across four healthcare settings (14). The Evidenced Care Pathways were developed based on clinical guidelines, peer-reviewed articles, and clinician perspectives, providing a qualitative assessment of differences between clinical practice and guidelines.…”

Patient and Therapeutic Profiles of Pulmonary Hypertension in Chronic Lung Diseases in Japan: A Cohort Study Using a Claims Database

“…Proper training about rare diseases such as group 1 PH and the use of the appropriate diagnostic procedures are required among health professionals, especially general practitioners, so that patients can be appropriately referred to a specialist/cardiologist for RHC [ 26 ]. Poor general awareness regarding these rare diseases, delays in referrals, misdiagnoses, and poor compliance to the treatment guidelines may lead to worse prognoses [ 27 ]. Our analysis suggests that in the clinical practice of respiratory medicine, which mainly treats CLDs, there are still many barriers to the diagnosis and management of patients with PH in CLD, and there is a need to improve the time to referral, diagnosis, and initiation of treatment.…”

Opportunities to improve asthma and COPD prevention and care: insights from the patient journey obtained through focus groups

“…They align with professional expertise and reiterate issues that challenge care for these conditions outside of BC. Worldwide, there is a need to increase awareness of asthma and COPD as priority chronic respiratory diseases,41–43 increase prevention through mitigation of risk factors, address challenges with asthma and COPD diagnosis,44 45 and better leverage integrated care for effective maintenance 39 40. The features that patients affirmed as valuable could be replicated across VCH for more consistent delivery of quality care and promote equitable health outcomes.…”