Aquarius Population Health, London, UK.
Pulmonary Research Institute, LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Schleswig-Holstein, Germany.
Int J Chron Obstruct Pulmon Dis. 2022 Jul 1;17:1507-1521. doi: 10.2147/COPD.S360983. eCollection 2022.
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.
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.
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.
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.
慢性阻塞性肺疾病（COPD）是全球发病率和死亡率的主要原因。为了了解不同医疗体系中 COPD 最佳治疗的常见障碍，需要全面详细地了解从诊断前到急性治疗的 COPD 护理途径。
使用国际建议和国家特定指南为四个高收入国家创建了特定国家的 COPD 护理途径，然后用已发表的流行病学、临床和经济数据填充这些途径。为了完善和验证这些途径，我们与 24 名初级和二级保健呼吸保健专业人员进行了半结构化访谈，使用预先准备的讨论指南和国家特定途径图。然后对访谈记录进行了主题分析。
COPD 护理途径在各国之间具有广泛的一致性。在所有国家中，都确定了与 COPD 管理优化相关的三个关键主题：诊断前的旅程、治疗和 COVID-19 的影响。常见的障碍包括出现晚期 COPD、对 COPD 的考虑不足以及急性和慢性疾病管理不佳。COVID-19 对整个途径的疾病管理产生了负面影响，但为保留虚拟咨询提供了机会。结构因素，如保险和预约时间短，也会影响 COPD 的诊断和管理。
COPD 是一个重要的公共卫生问题，需要紧急优先考虑。决策者使用循证护理途径可以促进基于证据的决策，以改善患者的护理和结果，并减少不必要的资源使用和相关的医疗保健提供者/付款人的成本。
