Diaz Del Valle Fernando, Koff Patricia B, Min Sung-Joon, Zakrajsek Jonathan K, Zittleman Linda, Fernald Douglas H, Nederveld Andrea, Nease Donald E, Hunter Alexis R, Moody Eric J, Miller Temple Kay, Niblock Jenny L, Grund Chrysanne, Oser Tamara K, Greiner K Allen, Vandivier R William
Division of Pulmonary Sciences and Critical Care Medicine, Denver Anschutz Medical Campus, University of Colorado, Aurora, Colorado, United States.
Department of Medicine, Division of Healthcare Policy and Research, Denver Anschutz Medical Campus, University of Colorado, Aurora, Colorado, United States.
Chronic Obstr Pulm Dis. 2021 Jul 28;8(3):336-349. doi: 10.15326/jcopdf.2021.0215.
Rural chronic obstructive pulmonary disease (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.
To determine challenges faced by rural primary care providers when caring for COPD patients.
Rural primary care providers in 7 primarily western states were asked about barriers they experienced when caring for COPD patients.
A total of 71 rural primary care medical providers completed the survey, of which 51% were physicians and 49% were advanced practice providers (APPs). A total of 61% used Global Initiative for Chronic Obstructive Lung Disease or American Thoracic Society/European Respiratory Society 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. A total of 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. A total of 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 to pulmonologists (55%) or pulmonary rehabilitation (37%). Subgroup analyses revealed differences based on provider type (APP versus physician) and location (Colorado and Kansas versus other states), but not on population or practice size.
Rural providers face significant challenges when caring for COPD patients that should be targeted in future interventions to improve COPD outcomes.
与城市慢性阻塞性肺疾病（COPD）患者相比，农村患者的治疗结果更差，死亡率更高。这些差异的原因可能包括尚未探讨的医疗服务提供方面的挑战。
确定农村初级保健提供者在照顾COPD患者时面临的挑战。
询问了7个主要位于西部的州的农村初级保健提供者在照顾COPD患者时所遇到的障碍。
共有71名农村初级保健医疗提供者完成了调查，其中51%是医生，49%是高级执业提供者（APP）。共有61%的人将慢性阻塞性肺疾病全球倡议或美国胸科学会/欧洲呼吸学会指南用作评估和治疗资源。多种慢性病的存在以及患者未能识别和报告症状是诊断COPD的最大障碍。共有89%的提供者使用肺活量测定法诊断COPD，但只有62%的人对获得肺活量测定法感到满意。尽管有相关建议，但41%的提供者从未检测α-1抗胰蛋白酶缺乏症。共有87%的人对自己评估症状的能力感到满意，但只有11%的人使用了指南推荐的评估工具。尽管大多数提供者对自己治疗症状和急性加重的能力感到满意，但只有66%的人对自己预防急性加重的能力感到满意。对能够接触到肺科医生（55%）或接受肺康复治疗（37%）感到满意的提供者较少。亚组分析显示，基于提供者类型（APP与医生）和地点（科罗拉多州和堪萨斯州与其他州）存在差异，但在人口或诊所规模方面没有差异。
农村提供者在照顾COPD患者时面临重大挑战，未来的干预措施应针对这些挑战，以改善COPD的治疗结果。
