Rural COPD patients face higher death rates; the first step to helping these patients is understanding why these disparities exist.

By Lisa Spear


An inflammatory lung disease that leads to obstructed airflow in the lungs, chronic pulmonary obstructive disease (COPD) is difficult for patients to navigate under the best circumstances, but patients who live in rural settings are more likely to face barriers to care. They are more likely to land in the emergency room due to the disease, and are less likely to visit a physician’s office during the latest stages of their illness.1-2

The percentage of adults in rural areas who have a COPD diagnosis is nearly double the percentage in large metropolitan areas, according to data in CDC’s Morbidity and Mortality Weekly Report (MMWR).3

“What we know from prior published research is that rural patients have more hospitalizations and deaths related to COPD than their urban counterparts, but we don’t fully know why these disparities exist,” said Arianne Baldomero, MD, MS, assistant professor in pulmonary, allergy, critical care and sleep medicine at the University of Minnesota, Minneapolis.

The first step to helping rural COPD patients is understanding why these disparities exist. A new research paper, published in the journal CHEST, aims to investigate the problem. Presented at the October CHEST annual meeting in Nashville, the paper looked at the potential barriers to delivering evidence-based COPD care in rural populations.4

Baldomero and a team of researchers at the University of Minnesota, Minneapolis, interviewed 12 primary care providers, including physicians, nurses and physician assistants, within the Veterans Health Administration Midwest Health Care Network in four Midwest states who work with rural COPD patients. They found that fragmented care and limited resources are potential drivers of poor outcomes in these rural COPD populations.

“The primary care providers reported that they have many competing priorities that they manage, they have large patient panels, making it really challenging to focus on just COPD management alone,” said Baldomero, who is also a staff physician in the Minneapolis VA Health Care System.

Why Are There Poor Outcomes in Rural COPD Populations?

The primary care clinicians surveyed said that limited resources were a noteworthy problem. “What surprised me was that some of these providers said, ‘I have no access to care. I have no access to an X-ray. I have to send patients to the emergency room to get them some of the tests,” she said. “They are saying how isolated it is and they are the only ones providing the care there.” 

Also, many patients do not have access to or the ability to use virtual technology. For example, a lot of rural patients have no broadband connection access. 

To make matters more difficult, if a COPD patient needs a pulmonologist or other specialist, the primary care provider may have to refer the patient outside of the medical system, which can be challenging for patients to navigate and lead to fragmented care.

Additionally, COPD patients in rural areas are often exposed to environmental factors that might not impact people in more urban regions, including agriculture, woodburning stoves, coal, and other factors, says Baldomero.

Solutions to Barriers to Care in Rural COPD Patient Populations

The researchers’ hope is that by investigating the challenges that COPD patients in rural areas face, they may be able to develop solutions. One recommendation that surfaced during the primary care interviews was the potential to rely more heavily on pharmacists to reach these COPD patients. 

Pharmacists are often at the heart of a community, where patients can lean on them to answer questions about inhaler therapies or other treatments. They could help patients learn about therapy options, teach them how to use therapeutic devices, educate them on airway clearance, or be a resource for looking up treatment guidelines. 

“Pharmacists are very knowledgeable and are greatly embedded in the center of things,” said Baldomero.

Overall, Baldomero said, innovative solutions are needed to reach COPD patients in rural locations and testing those solutions should be part of the process of ensuring these patients get the care they need. 

“We really need to continue this important work by continuing to seek perspectives also from patients and healthcare leaders,” she said. “To improve healthcare delivery for COPD care for rural patients, we especially, need to tailor interventions for rural COPD patients using the input that we have gotten from patients, primary care providers, clinic providers, and health care leadership.”


RT

Lisa Spear is associated editor of RT magazine. For more information, contact [email protected]


References

1. Croft JB, Wheaton AG, Liu Y, Xu F, Lu H, Matthews KA, Cunningham TJ, Wang Y, Holt JB. Urban-rural county and state differences in chronic obstructive pulmonary disease – United States, 2015. Morbidity and Mortality Weekly Report. 2018 Feb 23;67(7):205-211.

2. Goodridge D, Lawson J, Rennie D, Marciniuk D. Rural/urban differences in health care utilization and place of death for persons with respiratory illness in the last year of life. Rural Remote Health. 2010 Apr-Jun;10(2):1349. 

3. Croft JB, Wheaton AG, Liu Y, Xu F, Lu H, Matthews KA, Cunningham TJ, Wang Y, Holt JB. Urban-rural county and state differences in chronic obstructive pulmonary disease – United States, 2015. Morbidity and Mortality Weekly Report. 2018 Feb 23;67(7):205-211.

4. Wilson T, et al. Chest. Rural primary care provider perspectives on barriers and facilitators to evidence-based management of COPD among veterans. 2022;doi:10.1016/j.chest.2022.08.1562.