Challenges and Strategies for Improving COPD Primary Care Services in Quebec: Results of the Experience of the COMPAS+ Quality Improvement Collaborative.

Introduction: Management of chronic obstructive pulmonary disease (COPD) remains a challenge in primary care and multiple barriers can limit implementation of COPD guidelines. Since 2016, a quality improvement (QI) collaborative, called COMPAS+, has been implemented across the province of Quebec (Canada) to support improvement of chronic disease management in primary care. The aim of this study was to describe the main COPD quality problems reported by participating teams and the strategies they proposed and implemented to improve COPD primary care services in Quebec.
Methods: Sixteen sites in four different regions of Quebec were engaged in the COMPAS+ intervention to improve primary care services delivered to people living with COPD. A total of 14 workshop reports, 31 QI action plans and 4 regional final reports underwent content analysis. Key COPD quality problems were first identified and, for each of them, root causes were classified according to the domains and constructs of the Consolidated Framework for Implementation Research. Proposed strategies were organized according to the intervention function types described in the Behavior Change Wheel.
Results: Four key COPD quality problems were identified: 1) lack of organization/coordination of COPD services, 2) lack of screening services coordination, 3) lack of interprofessional communication and collaboration and 4) lack of treatment adherence. Main root causes explaining these quality gaps were 1) lack of awareness of COPD, 2) lack of professional knowledge, 3) lack of definition of professional roles, 4) lack of resources and tools for COPD prevention, diagnosis, and follow-up, 5) lack of communication tools, 6) lack of integration of the patient-as-partner approach, and 7) lack of adaptation of patient education to their specific needs. Multiple strategies were proposed to improve healthcare professionals' education and interprofessional collaboration and communication.
Conclusion: QI collaborative activities can support achieving understanding of QI challenges healthcare organizations face to improve COPD services.
Competing Interests: Dr Jean Bourbeau reports grants from CIHR, grants from FRQS, Foundation of the McGill University Health Centre and Distinguished Scientist Award of McGill University. He reports grants, articipating in speaking activities and advisory board for AstraZeneca Canada Ltd, Boehringer Ingelheim Canada Ltd, GlaxoSmithKline Canada Ltd and Global, Pfizer Canada Ltd and Trudell Canada Ltd. He reports being a member of Formulary or similar Committee for INESS (province of Quebec), Provincial Lung Associations (Quebec and Ontario), Canadian Thoracic Society (CTS) and Global Initiative of Obstructive Lung Disease (GOLD) outside the submitted work. The authors report no other conflicts of interest in this work.
(© 2022 Vachon et al.)