Barriers and Facilitators to Practitioner Identification and Treatment of Patients with Chronic Obstructive Pulmonary Disease (COPD): A Systematic Search and Narrative Synthesis

Chronic Obstructive Pulmonary Disease (COPD) remains underdiagnosed and undertreated despite the availability of clinical guidelines. Variability in care delivery suggests that factors beyond clinical knowledge influence how care is implemented in practice. Understanding the barriers and facilitators shaping healthcare professionals' behaviour is essential to improving COPD identification and management. This review aimed to synthesise evidence on the barriers and facilitators influencing healthcare professionals' ability to identify and manage COPD. A systematic search of CINAHL, MEDLINE, PsycINFO, and the Cochrane Database of Systematic Reviews was conducted to identify studies published between 2015 and 2025. Studies examining healthcare professionals' experiences of COPD identification and management were included. Data were extracted and analysed using narrative synthesis, with barriers and facilitators coded and grouped across stages of care. Sixty-one studies across 28 countries were included. Barriers were reported more frequently than facilitators and were shaped by interacting system, practitioner and patient-level factors. Key barriers included limited time, restricted access to diagnostic and treatment resources, unclear professional roles, and gaps in knowledge and confidence. Facilitators included access to training, supportive organisational structures, multidisciplinary collaboration and clear care pathways. Barriers were often interdependent, with system constraints influencing practitioner behaviour and patient engagement. Barriers to COPD care are multi-level and interconnected, suggesting that single-component interventions are unlikely to be effective. Improving care requires coordinated approaches that address system constraints, support practitioner confidence and role clarity, and strengthen patient engagement. These findings provide a framework for designing interventions responsive to the complexity of real-world COPD care.