CIRCLES: Clinicians Improving the Rural COPD Landscape through Education in Self-care Goals

The COPD Foundation is pleased to announce that in 2020 we are one of three organizations across the nation to be awarded a contract from the National Heart, Lung, and Blood Institute (NHLBI) as part of their Learn More Breathe Better campaign. Through this award, the Foundation team, led by Dr. Barbara Yawn and Kristen Willard, MS, will be working to improve the ability of rural health care professionals (HCPs) to help their patients engage in effective self-management using the COPD Pocket Consultant Guide (PCG) app. The Foundation will partner with Rural Medical Education Collaborative, experts in rural clinician education and engagement, on this project.


More than 16 million Americans, including more than two million people who reside in rural and remote areas of the United States, live with COPD. Those living in rural and remote areas not only have higher rates of COPD than people residing in metropolitan areas, they also have a disproportionate amount of all COPD-related deaths, hospitalizations and emergency department visits. Additionally, people in rural communities often have completed less schooling and live with greater financial stress, which can lead to limited access to health care and COPD-related resources such as specialty care and pulmonary rehabilitation.

Approximately 60 million Americans live in areas defined as rural and rates of COPD are significantly higher in these parts of the country (8.2%) compared to metropolitan areas (4.7%). Many factors contribute to this higher prevalence, including higher smoking rates and increased occupational exposures. In the U.S., 80% of people with COPD receive at least some of their care from primary care clinicians, with higher rates in rural and remote areas. Often that care is not optimal and rarely involves enhanced patient education or support, such as support and tools for self-management.

Project Approach

The COPD Foundation has developed a unique self-management support tool, the COPD Pocket Consultant Guide (PCG) mobile app, to address the limited support and awareness that many people with COPD experience, particularly those in rural locations. The PCG app includes both patient/caregiver and health care professional tracks. The tool is available for free download from either the Apple AppStore or Google Play. Awareness of the tool is limited among rural clinicians and individuals living with COPD with little focus on the opportunity to use it to support and guide patient self-care or self-management.

This project will obtain both impacted individual and HCP feedback on what is needed in the rural primary care space to help people better self-manage their COPD and to improve communication between HCPs and those with COPD. The project team will use that feedback in creating the CIRCLES Toolkit, which will include:

  • HCP outreach and education materials. These will be designed to educate clinicians in teaching self-management skills to their patients with a particular focus on the COPD PCG app.
  • Materials for the clinicians to use directly with their patients. These may include visuals that mirror the PCG app features and provide step-by-step instructions on key self-care steps, videos on self-care, wall posters, tear-off pads or other tools.

We will then work with HCPs in the field to pilot test CIRCLES materials with their patients with COPD. Based upon feedback from these participants. the project team will refine Toolkit materials before distributing these for national use through web posting as well as webinar events.

This project is in its kickoff stage; we will add more information as it progresses. Stay tuned to learn more about the rural CIRCLES project and how you may become involved.

More on this project and the work being done by other awardees can be found on the National Heart, Lung, and Blood Institue (NHLBI) website.