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Abstract：
UNASSIGNED: Chronic obstructive pulmonary disease (COPD) poses a significant global health burden despite being largely preventable and treatable. Despite the availability of guidelines, COPD care remains suboptimal in many settings, including high-income countries (HICs) and upper-middle-income countries (UMICs), with varied approaches to diagnosis and management. This study aimed to identify common and unique barriers to COPD care across six countries (Australia, Spain, Taiwan, Argentina, Mexico, and Russia) to inform global policy initiatives for improved care.
UNASSIGNED: COPD care pathways were mapped for each country and supplemented with epidemiological, health-economic, and clinical data from a targeted literature review. Semi-structured interviews with 17 respiratory care clinicians were used to further validate the pathways and identify key barriers. Thematic content analysis was used to generate the themes.
UNASSIGNED: Six themes were common in most HICs and UMICs: \"Challenges in COPD diagnosis\", \"Strengthening the role of primary care\", \"Fragmented healthcare systems and coordination challenges\", \"Inadequate management of COPD exacerbations\", \"Limited access to specialized care\" and, \"Impact of underfinanced and overloaded healthcare systems\". One theme, \"Insurance coverage and reimbursement challenges\", was more relevant for UMICs. HICs and UMICs differ in patient and healthcare provider awareness, primary care involvement, spirometry access, and availability of specialized care. Both face issues with healthcare fragmentation, guideline adherence, and COPD exacerbation management. In addition, UMICs also grapple with resource limitations and healthcare infrastructure challenges.
UNASSIGNED: Many challenges to COPD care are the same in both HICs and UMICs, underscoring the pervasive nature of these issues. While country-specific issues require customized solutions, there are untapped possibilities for implementing global respiratory strategies that support countries to manage COPD effectively. In addition to healthcare system-level initiatives, there is a crucial need for political prioritization of COPD to allocate the essential resources it requires.
UNASSIGNED: COPD care pathways were mapped for each country and supplemented with epidemiological, health-economic, and clinical data from a targeted literature review. Semi-structured interviews with 17 respiratory care clinicians were used to further validate the pathways and identify key barriers. Thematic content analysis was used to generate the themes.
UNASSIGNED: Six themes were common in most HICs and UMICs: \"Challenges in COPD diagnosis\", \"Strengthening the role of primary care\", \"Fragmented healthcare systems and coordination challenges\", \"Inadequate management of COPD exacerbations\", \"Limited access to specialized care\" and, \"Impact of underfinanced and overloaded healthcare systems\". One theme, \"Insurance coverage and reimbursement challenges\", was more relevant for UMICs. HICs and UMICs differ in patient and healthcare provider awareness, primary care involvement, spirometry access, and availability of specialized care. Both face issues with healthcare fragmentation, guideline adherence, and COPD exacerbation management. In addition, UMICs also grapple with resource limitations and healthcare infrastructure challenges.
UNASSIGNED: Many challenges to COPD care are the same in both HICs and UMICs, underscoring the pervasive nature of these issues. While country-specific issues require customized solutions, there are untapped possibilities for implementing global respiratory strategies that support countries to manage COPD effectively. In addition to healthcare system-level initiatives, there is a crucial need for political prioritization of COPD to allocate the essential resources it requires.
摘要：
慢性阻塞性肺疾病(COPD)构成了巨大的全球健康负担，尽管在很大程度上是可以预防和治疗的。尽管有指南，COPD护理在许多情况下仍然欠佳，包括高收入国家（HIC）和中上收入国家（UMICs），具有多种诊断和管理方法。这项研究旨在确定六个国家(澳大利亚，西班牙,台湾,阿根廷,墨西哥,和俄罗斯）为改善护理的全球政策举措提供信息。
■为每个国家绘制了COPD护理路径，并补充了流行病学，健康-经济,和临床数据来自有针对性的文献综述。对17名呼吸护理临床医生进行了半结构化访谈，以进一步验证路径并确定关键障碍。主题内容分析用于生成主题。
■六个主题在大多数HIC和UMIC中很常见：“COPD诊断的挑战”，“加强初级保健的作用”，“支离破碎的医疗系统和协调挑战”，“COPD急性加重的管理不足”，“获得专门护理的机会有限”和，“资金不足和过载的医疗保健系统的影响”。一个主题,“保险范围和报销挑战”，与UMICs更相关。HIC和UMIC在患者和医疗保健提供者的意识方面有所不同，初级保健参与，肺活量测定接入，和专业护理的可用性。两者都面临着医疗保健碎片化的问题，指导方针坚持，和COPD急性加重管理。此外,UMICs还努力应对资源限制和医疗保健基础设施挑战。
■COPD护理的许多挑战在HIC和UMIC中都是相同的，强调了这些问题的普遍性。虽然特定国家的问题需要定制的解决方案，实施支持各国有效管理COPD的全球呼吸策略还有尚未开发的可能性.除了医疗保健系统级别的举措，迫切需要对COPD进行政治优先排序,以分配其所需的基本资源.
■为每个国家绘制了COPD护理路径，并补充了流行病学，健康-经济,和临床数据来自有针对性的文献综述。对17名呼吸护理临床医生进行了半结构化访谈，以进一步验证路径并确定关键障碍。主题内容分析用于生成主题。
■六个主题在大多数HIC和UMIC中很常见：“COPD诊断的挑战”，“加强初级保健的作用”，“支离破碎的医疗系统和协调挑战”，“COPD急性加重的管理不足”，“获得专门护理的机会有限”和，“资金不足和过载的医疗保健系统的影响”。一个主题,“保险范围和报销挑战”，与UMICs更相关。HIC和UMIC在患者和医疗保健提供者的意识方面有所不同，初级保健参与，肺活量测定接入，和专业护理的可用性。两者都面临着医疗保健碎片化的问题，指导方针坚持，和COPD急性加重管理。此外,UMICs还努力应对资源限制和医疗保健基础设施挑战。
■COPD护理的许多挑战在HIC和UMIC中都是相同的，强调了这些问题的普遍性。虽然特定国家的问题需要定制的解决方案，实施支持各国有效管理COPD的全球呼吸策略还有尚未开发的可能性.除了医疗保健系统级别的举措，迫切需要对COPD进行政治优先排序,以分配其所需的基本资源.
