Mapping and comparing COPD Care Pathways across 10 countries to understand barriers to optimal care

Clinical Research Results Abstract Background: Although predominantly preventable and treatable, chronic obstructive pulmonary disease (COPD) is a leading cause of death globally. Guidelines for managing the condition are widely available, yet, COPD care remains suboptimal in many settings, including high and middle-income countries. Several approaches are used to diagnose and manage COPD, resulting in substantial variation in its care pathways.This study aimed to assess how barriers to optimal COPD care vary across high and middle-income countries, by mapping and comparing 10 country-specific COPD care pathways.Methods: Based on GOLD recommendations and national guidelines, we mapped COPD care pathways for Argentina, Australia, Canada, England, Germany, Japan, Mexico, Spain, Russia and Taiwan. Country-specific pathways were populated with published epidemiological, health economic, and clinical data identified through a pragmatic literature review. Semi-structured interviews with 41 respiratory care clinicians further informed and validated the pathways, data inputs, and key issues arising in each country. A qualitative comparative approach was used to analyse common barriers across countries.Results: Despite important differences across healthcare systems, the main issues in current COPD care were broadly similar. Ten common themes emerged, eight of which were shared by all countries. The most frequent issues in both primary and secondary care were linked to “Difficulties in getting a diagnosis” and “Poor adherence to treatment guidelines”. In all countries, poor management of exacerbations drives up costs, healthcare utilisation, morbidity and mortality.Conclusion: This analysis of COPD pathway data showed that barriers to optimal COPD care are similar across countries with heterogeneous healthcare systems and GDP/capita levels. This highlights that, in addition to country-specific policies, there are opportunities for unified global policy initiatives to improve COPD diagnosis and management, which should be part of the broader efforts to build more sustainable and resilient healthcare systems. Research Idea Abstract Service Development & Evaluation Abstract Declaration of Interest At the time of the study, all authors were employed by Aquarius Population Health which was funded by AstraZeneca to carry out this research. The study design, data gathering, data analysis, results and interpretation were carried out independently by the authors who declare that the source of funding has not led to any competing or conflicting interests. AstraZeneca reviewed the manuscript once, for medical and scientific accuracy. The authors confirm they had full access to all the data in this study and take complete responsibility for the integrity and accuracy of the analysis. References and Clinical Trial Registry Information