Identifying Appropriate Delivery of and Referral to Pulmonary Rehabilitation in Uganda: A Survey Study of People Living with Chronic Respiratory Disease and Health Care Workers

Abstract

Introduction Pulmonary rehabilitation (PR) is a low cost, high impact intervention that ameliorates the disability associated with chronic respiratory diseases (CRD). PR is becoming increasingly recognized in low resource settings where the burden of CRD is rapidly increasing. To aid the implementation of PR in Uganda, we conducted a study to assess the attitudes and opinions towards PR among patients with CRD in Uganda and explore barriers faced by health care workers (HCWs) in referring to PR. Methods A cross-sectional study comprising two survey populations: people living with CRD and HCWs regarded as potential PR referrers and PR deliverers. This exploratory study sought initial opinions and thoughts regarding PR, as well as baseline knowledge and potential barriers faced in the referral process. Results Overall, 30 HCWs (53% female, 43% doctors) and 51 adults with CRD (63% female) participated in the survey. Among those with CRD, the majority reported breathlessness as a major problem (86%) and breathlessness affected their ability to do paid and unpaid work (70%). Interest in PR was high amongst adults with CRD (92%) with preference for a hospital-based programme (67%) as opposed to community-based (16%) or home-based (17%). All HCWs considered PR important in lung disease management, but 77% do not refer patients due to a lack of information about PR. HCWs’ free-text responses identified the need for training in PR, patient education and streamlining the referral process as key elements to develop successful PR referral services. Conclusion To successfully set up a PR service for people with CRD in Uganda, there is a great need for appropriately tailored training and education of prospective referrers about CRD and PR programs. Educating patients about the benefits of PR as well as streamlining the referral process is critical in expanding PR services across Uganda to fulfill this unmet need.

The Need for Expanding Pulmonary Rehabilitation Services

“…Referral rates appear to be similar in developing countries. A recent survey of health care professionals and people with COPD in Uganda reported that referral rates to pulmonary rehabilitation were only 23%, despite high interest in the program from 92% of patients surveyed [22]. Referral rates appear to be lowest posthospitalization due to exacerbation of COPD based on a recent audit, with only 1.9% of patients receiving pulmonary rehabilitation within 6 months post-hospitalization and 2.7% within 12 months [23,24].…”

“…In another survey-based study in Sri Lanka, 83% health care professionals were unsure of what made their patients eligible for the program [33]. In Uganda, 77% of health care professionals did not have enough information about the program while 47% identified lack of time to complete the referral process [22]. Referral rates in people after exacerbation of COPD were lower in staff who did not perceive confidence in pulmonary rehabilitation prescription and had poor recall of care recommendations for referral [24].…”

Developing Appropriate Pulmonary Rehabilitation Services in Sri Lanka: Assessment of People Living with COPD and Healthcare Providers in Urban and Semi Urban Areas in Sri Lanka

“… 12 Even though that the similar study conducted in Uganda have given the similar findings as 66% of the participants were preferred in group, supervised, hospital-based programme. 13 This also might be due to the unavailability of resources and different cultural expectations of people same as Sri Lankan setting.…”

The RECHARGE-IPCRG ‘Teach the Teacher’ programme: building capacity for pulmonary rehabilitation in low- and middle-income countries

“…With five project partners in four countries -India (Pune and Delhi), Sri Lanka (Colombo), Kyrgyzstan (Bishkek) and Uganda (Kampala), the project proposes to reduce the disability associated with CRD through context-specific PR and building capacity for research, 9 leadership and service development. 10,11 With NIHR support LMIC partners are exploring how to implement and take account of the cultural, workforce, demographic and health differences. 12 Accordingly, we describe an innovative education programme designed to build sustainable local capacity in PR teaching and delivery in LMIC.…”