Electronic Thesis and Dissertation Repository

Thesis Format



Master of Science




Mitchell, Marc


Background: Primary chronic obstructive pulmonary disease (COPD) care may be worse in rural versus more urban environments.

Purpose: To evaluate the quality of COPD care in a rural Ontario primary care clinic.

Methods: A 12-month retrospective chart review study was conducted between June 2022 and January 2023 at a Goderich, Ontario primary care clinic. Electronic medical records (EMRs) were randomly selected for inclusion. Baseline sociodemographic (e.g., occupation) and health (e.g., smoking status) characteristics were extracted as well as information regarding COPD care received (i.e., Health Quality Ontario [HQO] Quality Standard [QS] indicators; n=33. The primary study outcome was overall proportion of HQO QS indicators met.

Results: Eighty primary care EMRs were accessed (72.3±9.74 years; 39% female). Overall, HQO QS indicators were met 43.2% of the time.

Conclusion: Strengths and opportunities regarding the quality of COPD care delivered in a rural Ontario primary care setting were identified.

Summary for Lay Audience

Chronic obstructive pulmonary disease (COPD) is one of the most prevalent chronic diseases in Canada with nearly 13% of Canadian adults living with the disease. COPD is a complex chronic disease with significant human (e.g., quality of life) and system-level (e.g., costly hospitalization) consequences. High quality COPD management in primary care settings is so important that Health Quality Ontario (HQO), an agency of the Government of Ontario, created a set of quality standards to assess care quality. This retrospective chart review study examined the quality of care provided for adults living with COPD in a rural Ontario area using the HQO standards. Eighty randomly selected patient electronic medical records (EMR) were examined at a primary care clinic in Goderich, Ontario. On average, patients’ received care satisfying less than half (43.2%) of HQO standard indicators. Exploratory analyses revealed that participation in self-management programs, seeing a family physician, being a former or never smoker, and seeing a Respirologist most strongly influenced the QS indicators received. The results of this study may support future Quality Improvement (QI) initiatives in the area. The results also provide rationale for the implementation of a local pulmonary rehabilitation program.