Abstract Rationale Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality in the United States. Rural populations experience a disproportionate burden, which likely reflects a combination of factors, including limited access to evidence-based COPD care. Our aim was to identify barriers, facilitators, and recommendations to improve the quality of COPD care received by rural veterans. Methods We performed a qualitative study of veterans with COPD who lived in rural areas. Participants were drawn from the Minneapolis VA Health Care System and the St. Cloud VA Health Care System. We conducted semi-structured interviews to explore rural veterans’ personal experiences navigating the healthcare system to receive COPD care. Interviews were conducted via telephone and were transcribed using NVIVO software. Transcribed interviews were then coded using content analysis. Results - Participants (N = 27) ranged in age from 59 to 85 years of age, 4 (14.8%) were women, and 24 (88.9%) identified as white. - Most veterans, 12 (44.4%) had an 11 to 30 minute drive to their primary care provider and 13 (48.1%) had a greater than 1 hour drive time to the pulmonologist. - Twenty-four (88.9%) participants had at least one exacerbation in the past 12 months, 10 (41.7%) of which ended up hospitalized. - Elucidative quotes are listed in Table 1, which were used to identify general themes. - General Themes: Barriers Primary care provider turnover and shortages, physical limitations related to chronic medical conditions, discomfort with virtual care, long appointment wait times and limited scheduling flexibility, complex referral processes, transportation challenges, and weather-related difficulties. Facilitators Self-motivation, self-advocacy, support from family and friends, timely scheduling and communication, trust and continuity with healthcare providers, and familiarity with or outside assistance in using technology facilitated access to COPD care. Recommendations Participants suggested improving technology-related education, providing necessary technology equipment, enhancing access to clinic appointments, supporting provider continuity, and fostering timely communication between patients and healthcare teams. Conclusion This study identified several barriers, facilitators, and patient-generated recommendations to improve COPD-related care for rural veterans. Participants described physical limitations, lack of provider continuity, and challenges with technology navigation as key barriers. Facilitating factors included strong family support and a sense of self-sufficiency that motivated engagement in care. Recommendations for improvement emphasized enhanced communication, greater patient education, and additional support for using technology in healthcare delivery. This abstract is funded by: NIH
Hamann et al. (2026) studied this question.