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

Area of Science:

• Healthcare Management
• Rural Health
• Respiratory Medicine

Background:

• Rural populations experience higher mortality from respiratory conditions due to limited access to care.
• Implementing standardized care bundles is essential for managing chronic diseases like COPD.

Purpose of the Study:

• To identify barriers impeding the implementation of a chronic obstructive pulmonary disease (COPD) management care bundle in rural US Department of Veteran Affairs (VA) medical centers.
• To understand clinician perspectives on challenges encountered during the implementation process.

Main Methods:

• Evaluation of 17 rural VA medical centers across 13 states.
• Involved clinicians included pharmacy leaders, pharmacists, nurse care managers, and pharmacy technicians.
• Utilized the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 model to categorize identified barriers.

Main Results:

• Key barriers included limited staff availability, fragmented care, and technology challenges.
• Competing demands on pharmacist time and clinician apprehension about managing new disease states were also significant.
• Limited referral opportunities further complicated implementation.

Conclusions:

• Staffing shortages and heavy workloads constrain rural clinicians' ability to adopt new practice models and tasks.
• Leveraging interprofessional relationships and addressing technology limitations are strategies used by clinicians to overcome barriers.
• Findings enhance understanding of implementation barriers in rural healthcare settings for care bundles.