Geographic Differences in Availability and Access to Care Services for Asthma and COPD: Case Study of Vancouver Coastal Health, British Columbia.

Background: With a diverse geographic and sociocultural landscape, Vancouver Coastal Health (VCH) Authority (British Columbia, Canada) encompasses both urban and rural regions, providing a case study to examine the delivery of care services for asthma and chronic obstructive pulmonary disease (COPD). To better understand the landscape of care services within VCH, we aimed to (1) identify asthma and COPD care services availability in urban and rural communities and (2) identify where asthma and COPD quality improvement (QI) initiatives were implemented and their implementation-related characteristics. Methods: An environmental scan was conducted to identify asthma and COPD care services provided in VCH communities. A literature review was conducted to determine where VCH asthma and COPD QI initiatives were implemented and identify their implementation-related characteristics. This case study was analysed descriptively and summarised in tables and figures. Results: The environmental scan analysis revealed that specialty outpatient care, pulmonary rehabilitation, respiratory education and clinical smoking cessation services were limited in urban and unavailable in rural VCH communities. Spirometry services were limited in urban and rural VCH communities. Cross-referencing recommendations from asthma and COPD clinical practice guidelines against prevalence data, we estimated that rural VCH communities could provide 0%-23% of required spirometry while urban could provide 40%-75%. Further, of the 16 asthma and COPD QI initiatives identified within 21 papers, none were conducted at rural VCH healthcare sites. Conclusion: Our findings suggest rural VCH communities have lower access to asthma and COPD care services and the limited urban care services were insufficient to make up for this difference. Past asthma and COPD QI initiatives have not apparently translated to care service improvements in rural regions. Future QI initiatives should focus on overcoming barriers to conducting and participating in QI to improve urban and rural regions' access to asthma and COPD care services.