Referral to pulmonary rehab program ‘suboptimal’ among suitable patients with COPD

Fewer than half of patients with COPD deemed suitable for pulmonary rehabilitation received a referral to a pulmonary rehabilitation program across three tertiary hospitals in Australia, according to findings published in Chest.

“The implementation of pulmonary rehabilitation programs is problematic with earlier work showing that the proportion of people with COPD who are actually referred to a pulmonary rehabilitation program from primary or tertiary care is as low as 16%,” Sarah Hug, BSc, with the faculty of health sciences at the Curtin School of Allied Health and the department of physiotherapy at Royal Perth Hospital, Australia, and colleagues wrote. “Addressing this implementation gap is recognized as a global priority by international respiratory societies and understanding the reasons for suboptimal referral behaviors is an important first step.”

Researchers recruited 391 adults with COPD (mean age, 69 years; 55% men) who were deemed appropriate candidates for pulmonary rehabilitation programs across three tertiary hospitals in Australia. Researchers collected data on age, gender, lung function, smoking status and interest in participating in a pulmonary rehabilitation program using interviews and medical records. Pulmonary rehabilitation referrals were tracked via electronic referral systems, medical records, and discussion with participants and physiotherapists responsible for coordination.

There were 156 participants suitable for pulmonary rehabilitation and, of these, 47% were referred to a pulmonary rehabilitation program.

“Although suboptimal, the proportion referred in our study was considerably higher than what is reported in earlier work,” the researchers wrote.

Eighty-two participants suitable for rehabilitation were classified as missed referrals, with 11% offered referrals with the health care professional not completing said referral and 18% offered referral by a health care professional but denied the program.

The only variable separating participants who were vs. who were not referred to a pulmonary rehabilitation program was the interest they had in attending a program, with a mean difference in interest on the visual analogue scale of 22 U.

The most frequently reported barriers to not attending a pulmonary rehabilitation program reported by 26% of participants were related to environmental context and resources factors, including problems with travel distance, transport, paring or the inflexibility of programs that led to difficulties fitting it into their schedule.

Researchers noted that attitudes of already doing enough exercise (5%), introverted personality traits (4%) and feelings of unworthiness (1%) reduced a participant’s interest in attending a pulmonary rehabilitation program.

“Collaborations among people with COPD, clinicians and researchers presents a unique opportunity to develop novel strategies to enhance people’s interest and improve referral to pulmonary rehabilitation programs among people with COPD in our tertiary setting,” the researchers wrote.