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

The COPD Foundation was 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 2020-21 Learn More Breathe Better campaign. Through this project, the Foundation team, led by Dr. Barbara Yawn and Kristen Willard, MS, is 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 is partnering 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. Millions more may be living with the disease but not yet diagnosed. Those living in rural and remote areas not only have higher rates of COPD than people residing in metropolitan areas, but also account for 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.

To date, the project team has obtained feedback through surveys and focus groups 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 is using that feedback in creating the CIRCLES toolkit, which will include:

  • An interactive game board that patients will use to walk them through the toolkit videos and the app, containing steps toward increased self-management.
  • Videos for both HCPs and patients. The team has created separate introductory videos for each group and then four videos explaining the following topics:
    • Medications
    • Exercise and activity tracking
    • The My COPD Action Plan
    • "For my next visit" tool
  • Paper versions of the My COPD Action Plan, which helps impacted individuals monitor their condition on a daily basis to spot signs of an exacerbation and to take action.

The next stage of the project will include testing toolkit materials with both HCPs and impacted individuals at two rural U.S. clinics. Based upon feedback from these participants. the project team will refine these materials before distributing them for national use. 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.