Promoting COPD diagnosis and treatment, using portable spirometry, in the homeless population

Background: Patients experiencing homelessness are on the edge of marginalized populations. Their access to primary care is limited due to personal and system-based barriers. To promote primary care to these patients, health teams often create outreach solutions such as mobile clinics, pop-up clinics in shelters, and send medical teams to high-risk locations. Previous research has shown that the homeless population has higher rates of respiratory diseases, including asthma and COPD. They are less likely to be diagnosed and treated properly. Most COPD diagnoses on the street are defined by clinical assessment or self-report, without the use of spirometry. Some novel treatments require diagnosis confirmed by spirometry measurements, according to Israeli public health insurance coverage. Lately, with portable easy-to-use spirometry devices, it has become possible to make a more accurate and reliable diagnosis in a street clinical setting. Objective: We aim to discover if promoting early diagnosis and treatment, using a portable spirometer guiding the diagnosis and determining the severity of the disease of COPD, will result in fewer COPD-related ER visits, respiratory exacerbations, and hospitalization for the homeless population. Method: Screening for COPD among 50 rough-sleeper patients and 50 patients in a shelter setting in Tel Aviv, ages 30 and up, using a combination of clinical assessment, CAT-modified score, and spirometry, according to gold criteria for COPD diagnosis and disease severity. Those diagnosed with COPD will receive an explanation about the condition, and be prescribed treatment according to the gold criteria and availability of medicine. ER visits and hospitalization data will be collected the following year from all hospitals in the region. Hypothesis: Those diagnosed with COPD will gain better access to treatment, and therefore suffer fewer respiratory exacerbations, ER visits, and hospitalizations.