Barriers to implementing a pharmacist-led COPD CARE bundle in rural settings: a qualitative evaluation

Patients living in rural settings are among the least likely to receive care, contributing to excess deaths in rural communities from respiratory conditions. We examine barriers that impede implementation of a care bundle for chronic obstructive pulmonary disease (COPD) management that was widely implemented across rural communities in the USA.

17 rural medical centres implementing the care bundle in the US Department of Veteran Affairs (VA). Medical centres were located across 13 states, with 3 VA medical centres (VAMC) in the Southeast, 4 in the South, 9 in the Midwest and 1 in the Northwest.

Clinician participants engaged in programme implementation included pharmacy leaders, hired clinical pharmacists, nurse care managers and pharmacy technicians. Participation was offered to all clinicians engaged in the implementation process and was voluntary.

This evaluation identifies barriers that impede implementation of a care bundle for COPD management. To guide our analysis, we identified challenges that strongly aligned with work system factors within the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 model.

Challenges experienced during the implementation of a COPD service in rural settings included (1) limited staff availability, (2) fragmentation of care, (3) technology challenges, (4) limited referral opportunities, (5) competing demands on pharmacist time and (6) clinician apprehension regarding their ability to manage a new disease state.

This evaluation furthers what is understood regarding barriers to implementing care bundles within rural healthcare contexts. Our findings suggested that clinicians in rural settings felt constrained in their ability to take on new tasks and expand their practice models due to staffing shortages and heavy workload demands. Some clinicians reported approaches they used to address barriers they encountered, such as leveraging relationships with other healthcare practitioners to enhance communication and minimise technology limitations.