GB-COH-RC000631-GB-EDU-133784-BWSA University College London This research programme addresses the problem of poor and inequitable access to quality primary healthcare for chronic obstructive pulmonary disease (COPD) patients in South America. COPD is the fourth leading cause of death in the continent, with high a hospital healthcare and societal burden, disproportionately affecting the poor. More than 75% of cases remain undiagnosed, therefore untreated. Building on a previous Global Health Group in Brazil, the aim of the programme is to develop primary care research capacity in South America (specifically Argentina, Brazil and Peru) to improve earlier identification and management of COPD. It is co-led by the University of Birmingham (UoB) and the Universidad Cientifica del Sur (UCSUR) in partnership with CRONICAS Centre of Excellence in Chronic Diseases in Peru. The co-leads work in an equitable partnership with the Institute for Clinical Effectiveness and Health Policy (IECS) in Argentina, the University of São Paulo (USP) in Brazil, the International Primary Care Respiratory Group (IPCRG) and University College London (UCL). The three South American partner Institutions (‘hubs’) will work with and build capacity amongst colleagues from 2-3 less-experienced institutions (‘spokes’), situated in contrasting geographical/economic areas which include the most disadvantaged populations. Over four years, starting in July 2024, Breathe Well partners will develop a set of COPD quality indicators, and an identification pathway for COPD patients in primary care. They will test the feasibility of these in different settings, and model the preliminary cost-effectiveness of the pathway and its potential impact on health inequalities. Based on the outcomes of the work, partners will then submit funding applications for full trials of the developed interventions. At University College London, John Hurst, Professor of respiratory medicine, will advise on the clinical aspects of the study, working with local respiratory doctors from each country. Building on a previous Global Health Group in Brazil, the aim of this programme is to develop primary care research capacity in South America (specifically Argentina, Brazil and Peru), to improve earlier identification and management of chronic obstructive pulmonary disease (COPD). The programme’s objectives are as follows. • Develop sustainable research infrastructure and research leaders, in order to deliver high quality COPD research in primary care in South America. This will involve training individuals on a range of generic, clinical and research skills and methods, and engaging with academic, clinical and funding institutions to sustain future research. • Develop sustainable engagement with community members, clinical leaders and policy stakeholders, to ensure research is rooted in local, national and regional needs with clear pathways to impact on health and healthcare. The core project partners will provide training and mentoring for local teams to identify, engage, influence and work with relevant stakeholders, in order to ensure sustainability of impact. • Assess the current quality of COPD primary care in Argentina, Brazil and Peru. This assessment will cover governance and the policy context, foundations, processes, quality and inequities, as well as the quality of electronic healthcare records (EHR). • Develop a set of COPD quality indicators. These indicators will be used to monitor and improve the quality of care. • Co-develop/adapt a pathway of identification and management of COPD patients in primary care, from early diagnosis through management and self-management. The pathway will be based on locally-appropriate, team-based, task-sharing implementation. • Test feasibility of implementation. The pathway will be tested, including a comparison of different settings to evaluate its potential impact in different segments of society. • Model preliminary cost-effectiveness of the pathway and potential impact on health inequalities. The pathway will be assessed using exploratory decision model-based health economic analyses from both healthcare and societal perspectives. • Submit funding applications for full trials of the developed interventions. Institute for Clinical Effectiveness and Health Policy International Primary Care Respiratory Group (IPCRG) Universidad Cientifica del Sur (UCSUR) University College London University of Sao Paulo 4666.73 4666.73 4666.73 4679.53 1334.27 1334.26 1334.27 1334.26 1334.27 1334.26