As COPD cases climb, rural people lack critical access to pulmonology care

Chronic Obstructive Pulmonary Disorder (COPD) is a respiratory disease affecting over 14 million Americans. In recent years, the American Lung Association has asserted that there are likely many more cases of COPD unreported in the United States, given the vast prevalence of patients presenting with symptoms consistent with COPD progression. Prior to the Covid-19 pandemic, over 25 million Americans already suffered from impaired lung function in the form of asthma, and rural patients are at particularly high risk.

Recent data shows that people in rural areas have comparatively less access to care. Pulmonologists are in high demand, as an aging physician population is driving the rise of “care deserts:” geographical areas where patients lack access to a specialty care provider. Fortunately, modern medical technology – including solutions that integrate the power of machine learning and AI – can help bridge gaps and ensure rural patients get access to the care they need.

For COPD, in particular, patient-physician interactions are crucial to providing quality care and improving outcomes. Rural patients suffering from COPD, asthma, or other respiratory illnesses should take proactive steps to ensure they have access to a specialty care provider, using traditional or digital-based services.

The rise of pulmonology “care deserts”

Research shows that rural people frequently lack access to pulmonologists. In the last decade, only 34.5% of people in rural areas had access to a pulmonologist within 10 miles, and that 92% of pulmonologists were located in urban areas, forcing COPD patients with limited access to depend on care provided by primary care physicians. Data published by the Department of Health and Human Services indicates that shortages may be particularly acute in the South and less severe in the Northeast, with the West falling between.

There are several factors that contribute to the spread of these “care deserts.” The primary factor is physician demographics. By 2025, it is estimated that the country will have a deficit of 1,400 pulmonologists, making the specialty care they provide invaluable – and for many patients, inaccessible. Today, just over 70% of pulmonologists are over the age of 55. Many will retire within the decade. Given the number and age of pulmonologists today, there is simply too much ground to cover and too few specialists to cover it.

Economic realities further compound this problem. Many rural hospitals are unable to offer vacation or weekend relief, leading to difficulties recruiting and retaining critical care specialists. This is particularly limiting when about half of pulmonologists are reportedly experiencing burnout, with 37% of them rating their burnout as strong or severe and 6% considering leaving the medical profession entirely. The high rate of burnout is unsurprising. Pulmonologists working in hospital environments were at the forefront of the Covid-19 pandemic, which forced doctors to navigate acute, high-pressure scenarios with patient lives at stake.

The pandemic also created new, steep barriers to patient care that further reduced patient-physician interactions at an already precarious time. Pandemic containment efforts create a significant burden for people with COPD, whose condition puts them at risk if they contract Covid-19. To avoid risk of exposure, many patients must avoid visiting their care provider in person.

These challenges create an urgent problem for people living in rural communities – many of whom will require access to specialized COPD treatment that is increasingly hard to find. As the situation worsens, more patients will progress to the advanced stages of COPD, which makes breathing difficult, significantly diminishes quality of life, and is associated with a 78% and 72% 5-year survival rate in men and women, respectively.

Modern technology may offer an oasis

Advanced remote monitoring and telehealth systems may offer pulmonologists and patients a way to bridge care gaps and create a proverbial oasis within expanding care deserts. Remote monitoring solutions, such as wearables that capture patient biometrics, have made significant progress in recent years, allowing patients to communicate important health data to their care provider, regardless of physical distance. Combined with the development of increasingly sophisticated and user-friendly telehealth platforms, patients now benefit from new ways to access quality care consultations from anywhere with an internet connection.

In pulmonology, this can be leveraged through “yirtual respiratory practices” that uses passive remote monitoring, artificial intelligence and a curated telehealth system to elevate digitally-delivered pulmonology care. A passive, contactless remote monitoring system can capture respiratory biomarkers while a patient sleeps. The software then can use machine learning to identify irregular patterns, flag them as significant, and send them to remote care teams for routine or proactive interventions using the integrated telehealth system.

Although artificial intelligence and machine learning are still in the early stages of medical device integration, this model can offer significant reductions in rescue inhaler use and in ER and hospitalization visits. This means that the burden on patients, caregivers and hospital systems can be meaningfully lowered.

A race against time

The shifting demographics within pulmonology, inability of rural hospitals to match urban hospital incentives, and more recently, justified reluctance of respiratory patients to increase in-person visits have all contributed to the continued growth of pulmonology care deserts within the United States. Accordingly, it is imperative that rural healthcare organizations take steps now to ensure that they provide access to a specialist, through traditional or digital solutions to meet these patient’s critical needs.

Photo: chrupka, Getty Images

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