title: COPD care delivery pathways in five European Union countries: mapping and health care professionals' perceptions.
abstract: BACKGROUND
  COPD is among the leading causes of chronic morbidity and mortality in the European Union with an estimated annual economic burden of €25.1 billion. Various care pathways for COPD exist across Europe leading to different responses to similar problems. Determining these differences and the similarities may improve health and the functioning of health services.
  
  
  OBJECTIVE
  The aim of this study was to compare COPD patients' care pathway in five European Union countries including England, Ireland, the Netherlands, Greece, and Germany and to explore health care professionals' (HCPs) perceptions about the current pathways.
  
  
  METHODS
  HCPs were interviewed in two stages using a qualitative, semistructured email interview and a face-to-face semistructured interview.
  
  
  RESULTS
  Lack of communication among different health care providers managing COPD and comorbidities was a common feature of the studied care pathways. General practitioners/family doctors are responsible for liaising between different teams/services, except in Greece where this is done through pulmonologists. Ireland and the UK are the only countries with services for patients at home to shorten unnecessary hospital stay. HCPs emphasized lack of communication, limited resources, and poor patient engagement as issues in the current pathways. Furthermore, no specified role exists for pharmacists and informal carers.
  
  
  CONCLUSIONS
  Service and professional integration between care settings using a unified system targeting COPD and comorbidities is a priority. Better communication between health care providers, establishing a clear role for informal carers, and enhancing patients' engagement could optimize current care pathways resulting in a better integrated system.
authors.affiliation: Faculty of Science, Engineering and Computing, Kingston University, Kingston-Upon-Thames, UK.
authors.forename: Reem
authors.initials: R
authors.lastname: Kayyali
authors.affiliation: Faculty of Science, Engineering and Computing, Kingston University, Kingston-Upon-Thames, UK.
authors.forename: Bassel
authors.initials: B
authors.lastname: Odeh
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre Schleswig-Holstein, Kiel, Germany.
authors.forename: Inéz
authors.initials: I
authors.lastname: Frerichs
authors.affiliation: Chest Clinic and Research and Development, Croydon University Hospital, Croydon, UK.
authors.forename: Nikki
authors.initials: N
authors.lastname: Davies
authors.affiliation: Pulmonary Clinic, AHEPA University Hospital, Thessaloniki, Greece.
authors.forename: Eleni
authors.initials: E
authors.lastname: Perantoni
authors.affiliation: Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Shona
authors.initials: S
authors.lastname: D'arcy
authors.affiliation: Research and Education, CIRO - Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands.
authors.forename: Anouk W
authors.initials: AW
authors.lastname: Vaes
authors.affiliation: Chest Clinic and Research and Development, Croydon University Hospital, Croydon, UK.
authors.forename: John
authors.initials: J
authors.lastname: Chang
authors.affiliation: Research and Education, CIRO - Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands.
authors.forename: Martijn A
authors.initials: MA
authors.lastname: Spruit
authors.affiliation: COPD Outreach, Beaumont Hospital, Dublin, Ireland.
authors.forename: Brenda
authors.initials: B
authors.lastname: Deering
authors.affiliation: Faculty of Science, Engineering and Computing, Kingston University, Kingston-Upon-Thames, UK.
authors.forename: Nada
authors.initials: N
authors.lastname: Philip
authors.affiliation: Chest Clinic and Research and Development, Croydon University Hospital, Croydon, UK.
authors.forename: Roshan
authors.initials: R
authors.lastname: Siva
authors.affiliation: Medical School, Aristotle University, Thessaloniki.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Kaimakamis
authors.affiliation: Medical School, Aristotle University, Thessaloniki.
authors.forename: Ioanna
authors.initials: I
authors.lastname: Chouvarda
authors.affiliation: Faculty of Science, Engineering and Computing, Kingston University, Kingston-Upon-Thames, UK.
authors.forename: Barbara
authors.initials: B
authors.lastname: Pierscionek
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre Schleswig-Holstein, Kiel, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Weiler
authors.affiliation: Research and Education, CIRO - Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands.
authors.forename: Emiel Fm
authors.initials: EF
authors.lastname: Wouters
authors.affiliation: Research and Development, Exodus Information Technology SA, Athens, Greece.
authors.forename: Andreas
authors.initials: A
authors.lastname: Raptopoulos
authors.affiliation: Faculty of Science, Engineering and Computing, Kingston University, Kingston-Upon-Thames, UK.
authors.forename: Shereen
authors.initials: S
authors.lastname: Nabhani-Gebara
mesh_terms: D001291:Attitude of Health Personnel; D003299:Cooperative Behavior; D019091:Critical Pathways / Q000639:trends; D019033:Delivery of Health Care, Integrated / Q000639:trends; D005060:Europe / Q000453:epidemiology; D005062:European Union; D019538:Health Care Surveys; D054625:Healthcare Disparities / Q000639:trends; D006801:Humans; D033183:Interdisciplinary Communication; D007407:Interviews as Topic; D010348:Patient Care Team / Q000639:trends; D010465:Perception; D010818:Practice Patterns, Physicians' / Q000639:trends; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D036301:Qualitative Research
keywords: COPD; care delivery pathway; comorbidities; comparative analysis