How can we improve access to health care for people with severe chronic obstructive pulmonary disease (COPD) in Southern New Zealand? The perspectives of health professional stakeholders and patients.

Problem

Chronic obstructive pulmonary disease (COPD) is a common chronic disease with significant morbidity and mortality which places a large burden on the New Zealand (NZ) health system. People with severe COPD account for most COPD morbidity and mortality. These people have significant symptoms, including breathlessness and fatigue, and impaired quality of life. They also receive suboptimal care, notably in relation to the lack of integration of health services in NZ across primary and secondary care. We undertook a mixed-methods implementation research study in partnership with the Southern District Health Board (DHB) with the aim of delivering better health care to people with severe COPD. We aimed to determine health care utilisation and health care and social support needs of people with severe COPD (reported elsewhere) and the barriers and enablers to the provision of accessible high quality COPD care in NZ’s southern region (reported here).

Approach

Design: Qualitative study using semi-structured interviews with health professional stakeholders and patients. The descriptive categories developed from the patient and stakeholder interviews were organised into themes informed by a conceptual framework for access to health care (Levesque et al, 2013), allowing findings from both sets of interviews to be presented together. Setting: Primary and secondary care in a health region in the lower South Island of NZ (Southern DHB) serving a population of 309,000 dispersed over the largest geographic health region of NZ (62,360 km2).Participants: 11 health professional stakeholders and 23 patients from across the Southern DHB region.

Findings

Health professional stakeholders identified barriers to providing access to health services, in particular: availability (inadequate staffing and resourcing of specialist services and limited geographical availability of pulmonary rehabilitation), affordability (both of regular medication, medication needed for an exacerbation of COPD, and the co-payment charge for seeing a GP) and appropriateness (a shared model of care across primary and secondary care was needed to facilitate better delivery of key interventions such as pulmonary rehabilitation and advance care planning). Patients’ accounts showed variable ability to access services through having a limited understanding of what COPD is, a limited knowledge of services they could access, being unable to attend pulmonary rehabilitation (due to co-morbidities) and direct (medication and GP co-payment charges) and indirect (transport) costs.

Consequences

This is the first NZ-based study to explore barriers to access to health care for people with COPD from the perspectives of both health professional stakeholders and patients. Through the use of a conceptual framework of access to health care we demonstrate how both perspectives interact along the current pathway of COPD care in NZ’s southern region from perception of health needs by patients through to the outcomes arising from health care.