{
  "abstract": "Objectives Patients living in rural settings are among the least likely to receive care, contributing to excess deaths in rural communities from respiratory conditions. We examine barriers that impede implementation of a care bundle for chronic obstructive pulmonary disease (COPD) management that was widely implemented across rural communities in the USA.Setting 17 rural medical centres implementing the care bundle in the US Department of Veteran Affairs (VA). Medical centres were located across 13 states, with 3 VA medical centres (VAMC) in the Southeast, 4 in the South, 9 in the Midwest and 1 in the Northwest.Participants Clinician participants engaged in programme implementation included pharmacy leaders, hired clinical pharmacists, nurse care managers and pharmacy technicians. Participation was offered to all clinicians engaged in the implementation process and was voluntary.Primary outcome measures This evaluation identifies barriers that impede implementation of a care bundle for COPD management. To guide our analysis, we identified challenges that strongly aligned with work system factors within the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 model.Results Challenges experienced during the implementation of a COPD service in rural settings included (1) limited staff availability, (2) fragmentation of care, (3) technology challenges, (4) limited referral opportunities, (5) competing demands on pharmacist time and (6) clinician apprehension regarding their ability to manage a new disease state.Conclusions This evaluation furthers what is understood regarding barriers to implementing care bundles within rural healthcare contexts. Our findings suggested that clinicians in rural settings felt constrained in their ability to take on new tasks and expand their practice models due to staffing shortages and heavy workload demands. Some clinicians reported approaches they used to address barriers they encountered, such as leveraging relationships with other healthcare practitioners to enhance communication and minimise technology limitations.",
  "authors": [
    {
      "affiliations": [
        "University of Wisconsin-Madison School of Pharmacy, Madison, Wisconsin, USA",
        "William S Middleton Memorial Veterans’ Hospital, Madison, Wisconsin, USA"
      ],
      "name": "Edward Christopher Portillo"
    },
    {
      "affiliations": [
        "University of Wisconsin-Madison School of Pharmacy, Madison, Wisconsin, USA"
      ],
      "name": "Martha Maurer"
    },
    {
      "affiliations": [
        "University of Wisconsin-Madison School of Pharmacy, Madison, Wisconsin, USA"
      ],
      "name": "Steven Do"
    },
    {
      "affiliations": [
        "University of Wisconsin-Madison Institute for Clinical and Translational Research, Madison, Wisconsin, USA",
        "University of Wisconsin-Madison School of Nursing, Madison, Wisconsin, USA"
      ],
      "name": "Nora Jacobson"
    },
    {
      "affiliations": [
        "Social and Administrative Sciences Division, University of Wisconsin-Madison School of Pharmacy, Madison, Wisconsin, USA"
      ],
      "name": "Te-Lien Ku"
    },
    {
      "affiliations": [
        "University of Wisconsin-Madison School of Pharmacy, Madison, Wisconsin, USA"
      ],
      "name": "Tiffany Parham"
    },
    {
      "affiliations": [
        "University of Wisconsin-Madison School of Pharmacy, Madison, Wisconsin, USA"
      ],
      "name": "Dylan Erdelt"
    },
    {
      "affiliations": [
        "University of Wisconsin-Madison School of Pharmacy, Madison, Wisconsin, USA"
      ],
      "name": "Jenna Vande Hey"
    },
    {
      "affiliations": [
        "Clinical Pharmacy Practice, US Department of Veterans Affairs, Washington, District of Columbia, USA"
      ],
      "name": "Sarah Will"
    },
    {
      "affiliations": [
        "Clinical Pharmacy Practice, US Department of Veterans Affairs, Washington, District of Columbia, USA"
      ],
      "name": "Heather Ourth"
    },
    {
      "affiliations": [
        "Clinical Pharmacy Practice, US Department of Veterans Affairs, Washington, District of Columbia, USA"
      ],
      "name": "Michael Shawn McFarland"
    },
    {
      "affiliations": [
        "University of Wisconsin-Madison School of Pharmacy, Madison, Wisconsin, USA"
      ],
      "name": "Sierra Szymanski"
    },
    {
      "affiliations": [
        "University of Wisconsin-Madison School of Pharmacy, Madison, Wisconsin, USA"
      ],
      "name": "Michelle A Chui"
    }
  ],
  "title": "Barriers to implementing a pharmacist-led COPD CARE bundle in rural settings: a qualitative evaluation",
  "uid": "ff08b6a7-d734-52f0-a94d-db9d200abfd1"
}