More than 75% of people with COPD in South America are never diagnosed, leaving them without treatment for the fourth leading cause of death in the region. This project addresses a stark gap: primary care systems in Argentina, Brazil, and Peru lack affordable, accessible pathways to identify and manage the disease, especially for the poor who bear a disproportionate burden. International guidelines fail because they ignore local risk factors, resource limits, and fragmented health systems. The team will co-develop a COPD care pathway tailored to each country, using task-sharing within multi-disciplinary teams. They will test its feasibility in 6–8 clinics per country, model its cost-effectiveness, and assess its potential to reduce health inequalities. If successful, the pathway could become a scalable model for primary care across South America, shifting COPD from a largely invisible killer to a managed condition. The project also builds lasting research capacity—training local leaders, establishing centres of excellence, and creating networks that can sustain future work. This is applied implementation science, not fundamental discovery; its impact depends on uptake by policymakers and clinicians.
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RESEARCH QUESTION How can we effectively implement good primary care pathways for diagnosis & management of COPD in South America and reduce inequities? BACKGROUND South America is the most inequitable region in the world. Three of its largest countries are Argentina (population 45m), Brazil (211m), and Peru (32m). Geographically & ethnically diverse, they experience wide health & social inequalities. COPD is the 4th leading cause of death, with high hospital healthcare & societal burden, disproportionately affecting the poor, but >75% remain undiagnosed, therefore untreated. Good quality, affordable & accessible primary care services for COPD patients are lacking. Diversity of risk factors and health systems with limited human/financial resources require local adaptation of international guidance & implementation using task-sharing within multi-disciplinary teams. AIMS/OBJECTIVES Building on our previous Global Health Group in Brazil, we aim to develop primary care research capacity in South America to improve earlier identification & management of COPD: 1. Develop sustainable research infrastructure/research leaders to deliver high quality COPD research in primary care 2. Develop sustainable engagement with community members, clinical leaders, policy stakeholders to ensure research is rooted in local, national, regional needs with clear pathways to impact on health & healthcare 3. Assess current quality of COPD primary care 4. Develop a set of COPD quality indicators 5. Co-develop/adapt pathway of identification & management of COPD patients in primary care, with locally-appropriate team-based task-sharing implementation 6. Test feasibility of implementation; compare different settings 7. Model preliminary cost-effectiveness of this pathway and potential impact on health inequalities 8. Submit funding applications for full trial METHODS In each country, using qualitative interviews/focus groups, surveys, feasibility studies and economic evaluation: WP1: evaluate quality of COPD care (governance/policy context, foundations, processes, quality, inequities); describe & explore quality of electronic healthcare records (EHR) WP2: co-develop, adapt & test feasibility of a COPD pathway from early diagnosis through management and self-management, implemented by locally-developed task-sharing strategies (6-8 practices per country). Develop COPD quality indicators WP3: conduct preliminary cost-effectiveness analyses with DCEA to model pathways, compare across settings & evaluate potential impact in different segments of society WP4: train & mentor local teams to identify, engage, influence & work with relevant stakeholders to ensure sustainability of impact WP5: build capacity by training individuals on a range of generic, clinical and research skills/methods, engaging with academic/clinical/funding institutions to sustain future research. TIMELINES 0-9m set-up, protocol development, ethics; 9-24m WP1; 18-42m WP2; 33-48m WP3. ANTICIPATED IMPACT/DISSEMINATION • New primary care pathway for COPD • Active, sustainable research networks of academics/primary healthcare professionals trained in primary care research • Centres of excellence for primary care research/education • Pathways to dialogue with funders/policy makers regarding primary care research Dissemination approaches co-developed with community/stakeholder networks & collaborators
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