Reem Kayyali, Bassel Odeh, Inéz Frerichs, Nikki Davies, Eleni Perantoni, Shona D’arcy, Anouk W Vaes, John Chang, Martijn A Spruit, Brenda Deering, Nada Philip, Roshan Siva, Evangelos Kaimakamis, Ioanna Chouvarda, Barbara Pierscionek, Norbert Weiler, Emiel FM Wouters, Andreas Raptopoulos, Shereen Nabhani-Gebara

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. 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. HCPs were interviewed in two stages using a qualitative, semistructured email interview and a face-to-face semistructured interview. 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. 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.