Challenges and recommendations for improving access to evidence-based COPD management among rural Veterans: rural primary care provider perspectives

Abstract: Chronic obstructive pulmonary disease (COPD), a leading cause of disability and death in the U.S., disproportionately affects rural residents.1 Rural counties experience more COPD-related exacerbations, hospitalizations, and deaths than urban counties.1,2 Furthermore, isolated rural veterans have a higher risk of mortality following hospitalization for an acute exacerbation compared to urban veterans.3 Rural–urban disparities in COPD outcomes are multifactorial in origin with contributions from factors such as occupational exposures, tobacco use, and socioeconomic status.4,5 Lack of access to resources required to deliver evidence-based COPD management, such as outpatient pulmonary rehabilitation, likely also affects rural disparities in COPD.6 To address this, we aimed to assess barriers to, facilitators of, and recommendations for improving evidence-based COPD management in rural clinics.