Barriers to, and facilitators for, referral to pulmonary rehabilitation in COPD patients from the perspective of Australian general practitioners: a qualitative study

Johnston, Kylie; Young, Mary; Grimmer, Karen; Antić, R; Frith, Peter

doi:10.4104/pcrj.2013.00062

Cited by 106 publications

(135 citation statements)

References 37 publications

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“…Supporting this, a larger study from Australia [12] found that 10 of 12 general practitioners interviewed had not directly referred a person with COPD for pulmonary rehabilitation, and barriers among the general practitioners were low knowledge of rehabilitation management of people with COPD.…”

Section: Discussionmentioning

confidence: 96%

“…When benefits are so evident and among other things increases functional capacity and individual control, they can lead to a more active daily life with less admission to hospital for exercabation of symptoms [12] and probably less pathological changes in the lungs – and possibly prevent disease progression.…”

Section: Discussionmentioning

confidence: 99%

“…However, in spite of strong evidence, it appears to be very difficult to recruit people with COPD to attend pulmonary rehabilitation [11], and participation in pulmonary rehabilitation is reported to be uniformly low all over the world [12]. A systematic review underlines that physical activity is not widely implemented in clinical practice [13].…”

Section: Introductionmentioning

confidence: 99%

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Barriers and motivational factors towards physical activity in daily life living with COPD – an interview based pilot study

Østergaard

Sritharan

Kristiansen

et al. 2018

European Clinical Respiratory Journal

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Background: In Denmark, few people with Chronic Obstructive Pulmonary Disease (COPD) engage in physical activity although it is evident that pulmonary rehabilitation has positive effects on physical activity, dyspnoea, anxiety, fatigue and quality of life. Objective: The purpose of this pilot study was to explore why people with COPD do not engage in physical activity and to explore motivational factors and barriers towards physical activity. Furthermore, to explore the role general practitioners have in this matter. Design: We conducted fieldwork among five people with COPD and three general practitioners using qualitative semi-structured interviews. We made a thematic analysis and our analytical perspective was based on The Health Belief Model and Self Determination Theory. Results: Findings revealed that people with COPD was not active because they did not receive the necessary information from the general practitioners about the benefits of physical activity neither about the negative consequences of an inactive lifestyle. Motivational factors were knowledge about COPD and benefits of physical activity. Experiencing the benefits on their own bodies, feeling that it was not dangerous to feel breathless and being successful coping with breathlessness were motivational. Functional tests like walking tests were very important and motivational for the participants because they outlined the progress achieved during activity and provided evidence of progress that was easy to comprehend compared with spirometry tests. General practitioners did not inform about the benefits of physical activity because they felt that medication was more important than physical activity and that people with COPD would not be motivated to be active. Conclusions: The main reason for people with COPD not being physically active in our study was lack of sufficient information from their general practitioners. This study described some barriers, enablers and motivational factors for a physically active lifestyle and the general practitioners’ role in this. Thus, it is important that people with COPD receive early information about physical activity - and it should start with the general practitioners, who are the gate keepers in the health care system. We recommend that lung function test results are never used as a single indicator of disease progression and that more focus should be paid to functional tests like The Shuttle Walking Test or The Six Minute Walking Test.Further studies to identify barriers to, and facilitators for referral people with COPD to physical activity in daily life from the perspective of Danish general practitioners are required.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Barriers and motivational factors towards physical activity in daily life living with COPD – an interview based pilot study

Østergaard

Sritharan

Kristiansen

et al. 2018

European Clinical Respiratory Journal

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“…The percentage of frequent exacerbations (16% of patients) and an average of 1.24 hospitalizations per year because of COPD exacerbations suggest that the awareness for these as the main drivers of morbidity and cost has to be increased and that rehabilitation and self-management education need to be proclaimed as effective preventive actions, in analogy to programs established for heart disease (32). A recently published report by Australian GPs identified an awareness barrier, insufficient knowledge of how to refer for pulmonary rehabilitation, anticipated access difficulties for patients and cost benefit issues as major problems (33).…”

Section: Interpretation Of Findings In Relation To Previously Publishmentioning

confidence: 99%

Performance Measures in the Management of Chronic Obstructive Pulmonary Disease in Primary Care – A Retrospective Analysis

Kaufmann

Markun

Hasler

et al. 2015

Praxis

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Leistungsmessgrössen in der Grundversorgung von Patienten mit COPD – eine Analyse Zusammenfassung. Hintergrund: Das Befolgen der Empfehlungen für ein gutes Management der chronisch-obstruktiven Lungenkrankheit (COPD) verbessert wichtige Endpunkte. Leistungsmessgrössen (LM) reflektieren die Qualität der Betreuung, dennoch existieren über die Dokumentation dieser Messgrössen bei COPD für die Grundversorgung kaum Daten. Ziel: Überprüfen der Dokumentation von COPD spezifischen Messgrössen in Grundversorgerpraxen des Kanton Zürich. Methode: Retrospektive Auswertung der Krankengeschichten von Patienten mit ärztlich diagnostizierter COPD, über einen Zeitraum von zwölf Monaten. Die Dokumentation der LM wurde durch Berechnen des Prozentsatzes der dokumentierten Parameter bewertet. Zusätzlich erfolgte ein Vergleich der LM Dokumentation mit einer Praxis, die ein strukturiertes COPD-Programm implementiert hatte. Resultate: Es wurden Daten von 115 Patienten aus 14 Praxen, davon 57% männlich, mit einem Durchschnittsalter von 68 (44–93) Jahren, analysiert. 46% waren aktive Raucher mit 56 (22–150 py) Packyears. Komorbiditäten waren in 73% der Fälle dokumentiert, der Schweregrad mit GOLD-Klassifizierung in 70% (GOLD I 11%, GOLD II 64%, GOLD III 21%, GOLD IV 4%).Gemäss Dokumentation hatten die Patienten durchschnittlich 1,4 Exazerbationen pro Jahr. Die Dokumentation der LM lag zwischen 16% (schriftlicher Aktionsplan im Falle von Exazerbationen) und 95% (Raucherstatus). Eine Dokumentation für eine Rauchstopp-Empfehlung fand sich in 74% der Fälle, für die Grippeimpfung in 49%. Eine adäquate medikamentöse Therapie und Instruktion der Inhalation war für 65 bzw. 57%, für pulmonale Rehabilitation in 27% der Patienten dokumentiert. Angaben zu einer kollaborativen und proaktiven Betreuung fanden sich bei 60 resp. 51%. Die Praxis mit dem laufenden COPD-Programm zeigte eine signifikant bessere Dokumentation (p<0,01) für alle LM ausser für die Grippeimpfung. Schlussfolgerung: In der Schweizer Grundversorgung bestehen Lücken in der Dokumentation hinsichtlich der Empfehlungen für eine nutzbringende COPD-Versorgung. Die Identifikation und Überbrückung dieser Lücken ist zentral für mehr Qualität in der Gesundheitsversorgung.

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“…KOAH alevlenme nedeniyle hastanede yatış sırasında veya hemen akabinde uygulanan PR programlarının çok yararlı ve maliyet etkin olduğu gösterilmiştir [20,23,24]. Ancak, KOAH alevlenme nedeniyle hastanede yatış sonrası PR'a sevk edilme ve uygulama oranları tüm dünyada hala çok düşük seyretmektedir [25][26][27]. Bizim ülkemiz için bildirilen bir oran olmamakla birlikte PR konusunda hizmet veren merkezlerin sayısının oldukça sınırlı olması ve bu konudaki bilgi eksikliği nedeni ile beklenen oran oldukça düşüktür.…”

Section: Bulgularunclassified

The knowledge level of chest physicians about the pulmonary rehabilitation topic

Şen

Hocanlı²,

Abakay³

et al. 2014

J Clin Exp Invest

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Objective: The pulmonary rehabilitation (PR) is multidisciplinary, evidence-based and personalized treatment approach for patients with a symptomatic chronic respiratory disease and reduced daily living activities. In this study, we aimed to determine the knowledge level of chest physicians about PR in our city. Methods:A standardized questionnaire consisting of 10 questions was conducted to a total of 40 chest diseases specialist and assistant doctors who are working at the university hospital, training and research hospital and a private hospital in Diyarbakir city and its purlieus. The questions about the definition of PR, goals, evaluation criteria, patient who candidate for rehabilitation and rehabilitation team, were asked in questionnaire. Ten points was given for each correct answer to closed-ended questions. The knowledge level were identified as low, moderate and high when points were <50, 50-79 and 80-100 respectively. Results:The mean age of participants was 36.1 ± 7.79 and working duration time in chest disease department was 5.57 ± 7.71 years. Seventy-eight point nine percent of university hospital doctors, 57.1% of training and research hospital doctors, 50% of private hospital doctors were answered correctly more than half of the questions. Conclusion:The knowledge of chest physicians about PR is substantially in low and moderate levels in our city. The creation of a curriculum about PR in medical schools, and postgraduate training of physicians in the field will raise awareness about this issue, and might increase the interest of physicians and patients to PR. J Clin Exp Invest 2014; 5 (3): 386-390

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Barriers to, and facilitators for, referral to pulmonary rehabilitation in COPD patients from the perspective of Australian general practitioners: a qualitative study

Abstract: Background: Pulmonary rehabilitation (PR) is recommended in the management of people with chronic obstructive pulmonary disease (COPD), but referral to this service is low.

Cited by 106 publications

References 37 publications

Barriers and motivational factors towards physical activity in daily life living with COPD – an interview based pilot study

Barriers and motivational factors towards physical activity in daily life living with COPD – an interview based pilot study

Performance Measures in the Management of Chronic Obstructive Pulmonary Disease in Primary Care – A Retrospective Analysis

The knowledge level of chest physicians about the pulmonary rehabilitation topic

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