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 worked 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 and other tools developed for this project. The Foundation partnered with Rural Medical Education Collaborative, experts in rural clinician education and engagement, on this project.


Webinars

The COPD Foundation hosted two webinars to update community members about the status of our CIRCLES initiative and what we learned. One webinar was for those impacted by COPD and caregivers. The second was for health care professionals.

CIRCLES update for those living with COPD

Effective COPD self-management and better communication with your health care team is essential. Learn more about our CIRCLES initiative and what we learned about improving care in rural communities

CIRCLES update for health care professionals

How can you work with patients to encourage them to engage in better self-care and also improve communication? Learn more about our CIRCLIS initiative and how we are working to address the challenges facing patients and HCPs in rural America.


Toolkit Items


Background

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.

For this project, the team also created a toolkit designed to help people better self-manage their COPD and to improve communication between HCPs and those with COPD. The toolkit includes the following:

  • An interactive game board that patients used to walk them through the toolkit videos and the app, containing steps toward increased self-management.
  • Videos for both HCPs and patients. The team 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 included testing toolkit materials with both HCPs and impacted individuals at two rural clinics in Colorado and New Mexico. Those who were selected to participate received instructions on using the different parts of the toolkit so they could integrate the toolkit into their daily routine. After several weeks of use, these participants provided feedback on the different components of the toolkit and whether they found the material to be helpful. We conducted follow-up conversations with a small group of individuals living with COPD and one health care professional to gain their perceptions on the toolkit and what worked or did not work.

Response to the toolkit from those we spoke with was positive. Participants especially liked the “My COPD Journey” gameboard and the ability to use different toolkit components to monitor and record any activity. One common theme was that while participants liked the COPD PCG app, they also expressed a desire for a more “low tech” alternative. As the project moves forward, we will devise an approach for those who may not be comfortable using a smart phone or live in an area with limited access to Wi-Fi.

Response to the toolkit from those we spoke with was positive. Participants especially liked the “My COPD Journey” gameboard and the ability to use different toolkit components to monitor and record any activity. One common theme was that while participants liked the COPD PCG app, they also expressed a desire for a more “low tech” alternative. As the project moves forward, we will devise an approach for those who may not be comfortable using a smart phone or live in an area with limited access to Wi-Fi.