Geographic Differences in Availability and Access to Care Services for Asthma and COPD: Case Study of Vancouver Coastal Health, British Columbia

Abstract

Background: With a diverse geographic and sociocultural landscape, Vancouver Coastal Health (VCH) Authority (British Columbia, Canada) encompasses both urban and rural regions, providing a case study to examine the delivery of care services for asthma and chronic obstructive pulmonary disease (COPD). To better understand the landscape of care services within VCH, we aimed to (1) identify asthma and COPD care services availability in urban and rural communities and (2) identify where asthma and COPD quality improvement (QI) initiatives were implemented and their implementation-related characteristics. Methods: An environmental scan was conducted to identify asthma and COPD care services provided in VCH communities. A literature review was conducted to determine where VCH asthma and COPD QI initiatives were implemented and identify their implementation-related characteristics. This case study was analysed descriptively and summarised in tables and figures. Results: The environmental scan analysis revealed that specialty outpatient care, pulmonary rehabilitation, respiratory education and clinical smoking cessation services were limited in urban and unavailable in rural VCH communities. Spirometry services were limited in urban and rural VCH communities. Cross-referencing recommendations from asthma and COPD clinical practice guidelines against prevalence data, we estimated that rural VCH communities could provide 0%-23% of required spirometry while urban could provide 40%-75%. Further, of the 16 asthma and COPD QI initiatives identified within 21 papers, none were conducted at rural VCH healthcare sites. Conclusion: Our findings suggest rural VCH communities have lower access to asthma and COPD care services and the limited urban care services were insufficient to make up for this difference. Past asthma and COPD QI initiatives have not apparently translated to care service improvements in rural regions. Future QI initiatives should focus on overcoming barriers to conducting and participating in QI to improve urban and rural regions' access to asthma and COPD care services.

Figure 1

PRISMA flow diagram for the literature review, which included searches of academic databases, grey literature databases and other sources to identify asthma and chronic obstructive pulmonary disease (COPD) quality improvement initiatives in the Vancouver Coastal Health Authority.

Figure 2

Canadian average wait times for asthma and chronic obstructive pulmonary disease (COPD) care services. Asthma and COPD care services include diagnostic (spirometry), treatment (specialty outpatient care: general respirology; pulmonary rehabilitation; and clinical smoking cessation) and maintenance (respiratory education). Average wait time lengths (in months) were reported at the Canadian national, regional and local Vancouver Coastal Health (VCH) levels [–24]. Canadian Atlantic provinces include New Brunswick, Nova Scotia, Prince Edward Island and Newfoundland and Labrador. Canadian Western provinces Manitoba, Saskatchewan, Alberta and British Columbia. Wait times of less than 3 months for nonurgent referrals from primary to specialty outpatient care in Canada were optimal as they were considered acceptable by patients [21]. VCH hospital locations have abbreviated code names, where ‘U' in front of the name indicates an urban hospital and ‘R' indicates a rural hospital. Urban hospitals include Mount Saint Joseph's Hospital (U-MSJH), St. Paul's Hospital (U-SPH), Vancouver General Hospital (U-VGH), University of British Columbia (U-UBCH), Richmond Hospital (U-RH) and Lions Gate Hospital (U-LGH). Rural hospitals include Squamish Hospital (R-SH), Sechelt Hospital (R-SEH) and qathet General Hospital (R-QGH). COPD spirometry capacities (as percentages) in VCH are reported at the time of inquiry in 2021 [17]. See Table 3 for the COPD spirometry capacity calculation. COPD spirometry capacities were not obtained for regional Canada and U-UBCH. Note there are only diagnostic services available at U-MSJH and U-VGH is the only VCH hospital that provides clinical smoking cessation services. The number of patients seen annually (Pts/yr) for PR in VCH are reported at the time of inquiry in 2021.