School of Nursing, University of Northern British Columbia, British Columbia, 3333 University Way, Prince George, V2N 4Z9, Canada.
Centre for Technology Adoption for Aging in the North, University of Northern British Columbia, Prince George, British Columbia, Canada.
BMC Pulm Med. 2023 Oct 20;23(1):399. doi: 10.1186/s12890-023-02683-2.
The prevalence of COPD continues to rise. To address the challenges to provide high quality COPD care in rural and northern communities, leaders in one rural and northern community in Western Canada sought to change the culture of COPD screening and care. Recognizing effective assessment, diagnosis, and treatment for patients with COPD are crucial to improve outcomes, a program was developed between 2012 and 2021 to enhance primary care for COPD patients.
A process evaluation was undertaken to assess program development, implementation, mechanisms of impact, and context of COPD program. Qualitative thematic analysis of stakeholder interviews (n = 11) and a document review (n = 60; ~ 500 pages) of key clinic documents was conducted.
We describe five phases of the COPD program's development (Survive; Reorganize and Stabilize; Assess and Respond; Build and Refine; and Sustain and Share), highlighting areas of innovation. Outreach and localizing resources improved access to the program. Acquiring secured physician compensation, capturing quality data, and improving patient and provider self-efficacy built the capacity of the system and stakeholders within it. Finally, relationships were forged through building an integrated facility, collaborative networking, and patient engagement. Key elements of program implementation included the resources (infrastructure, software, operational) required to ensure operation.
Team-based care and service integration enhanced care capacity and the health network. Focused use of infrastructure and resources supported the people in the care system. Upholding a shared value of relationship is critical to deliver robust and sustainable rural healthcare. Quality improvement requires investment in rural community healthcare resources.
COPD 的患病率持续上升。为了解决在农村和北部社区提供高质量 COPD 护理的挑战，加拿大西部一个农村和北部社区的领导人试图改变 COPD 筛查和护理的文化。认识到对 COPD 患者进行有效评估、诊断和治疗对于改善预后至关重要，因此在 2012 年至 2021 年间制定了一项计划，以加强 COPD 患者的初级保健。
进行了过程评估，以评估 COPD 计划的制定、实施、影响机制和背景。对利益相关者访谈（n=11）和关键诊所文件的文件审查（n=60；~500 页）进行了定性主题分析。
我们描述了 COPD 计划发展的五个阶段（生存；重组和稳定；评估和响应；建立和完善；和持续和共享），突出了创新领域。扩大宣传和本地化资源改善了对该计划的获取。获得有保障的医生薪酬、捕获高质量数据以及提高患者和提供者的自我效能感，增强了系统和其中利益相关者的能力。最后，通过建立一个综合设施、协作网络和患者参与建立了关系。计划实施的关键要素包括确保运营所需的资源（基础设施、软件、运营）。
基于团队的护理和服务整合增强了护理能力和健康网络。基础设施和资源的集中使用支持了护理系统中的人员。坚持关系的共同价值观对于提供强大和可持续的农村医疗保健至关重要。质量改进需要投资于农村社区医疗保健资源。
