‘The evidence is out there…’: perspectives of healthcare providers on improving asthma and COPD prevention and care within a major health authority region of British Columbia, Canada
Tina Afshar, Aneisha Collins-Fairclough, Pat Camp, Karen Rideout, Erin Shellington, Nardia Strydom, J Mark FitzGerald, Sian Hoe Cheong, Mary-Frances Ceccato, John Fleetham, Carmen Rempel, Phalgun Joshi, Christopher CarlstenIntroduction
Asthma and chronic obstructive pulmonary disease (COPD) impose substantial morbidity and health system burden in Canada. Within Vancouver Coastal Health (VCH), a large and geographically diverse health authority in British Columbia, variation in service availability, access and care coordination creates barriers to prevention and high-quality chronic respiratory disease management. This project sought to document healthcare professionals’ (HCPs’) experiences and recommendations to inform a regional strategy to improve asthma and COPD care.
Methods
We conducted a qualitative quality improvement project using occupation-specific virtual focus groups (March to September 2021) with HCPs involved in asthma and COPD prevention and care across VCH. Purposive sampling targeted diversity in profession, practice setting and geography (urban, suburban, rural and remote). Results were analysed thematically in NVivo using iterative coding and team-based refinement.
Results
54 HCPs participated across 10 focus groups, including respiratory physicians (n=9), respiratory therapists (n=19), family physicians (n=11), nurse practitioners (n=2), nurses (n=7), pharmacists (n=6) and one registered dietitian (n=1). Themes aligned with a socio-ecological framework and spanned (1) patient-level barriers (financial insecurity, language barriers, comorbid mental health and substance use, medication beliefs and adherence, smoking and vaping), (2) health system barriers (limited access to spirometry and pulmonary rehabilitation, fragmented transitions and unlinked electronic records, workforce and resource constraints) and (3) environmental barriers (medication coverage and formulary restrictions, poor air quality as an exacerbation trigger). HCPs recommended expanding community-based services (including mobile diagnostics and rehabilitation), strengthening prevention and cessation supports, improving medication access and inhaler education, and building integrated pathways and information systems to support continuity across settings.
Conclusions
Frontline HCP perspectives identify actionable, system-level opportunities to improve asthma and COPD prevention and care within a complex health authority. This work provides implementation-oriented insights to inform regional strategy and offers a replicable approach for engaging HCPs to strengthen chronic respiratory care.