Working with primary care clinicians and patients to introduce strategies for increasing referrals for pulmonary rehabilitation

Abstract

Background: Pulmonary rehabilitation (PR), a programme of exercise, education and psycho-social support, is recommended for patients with chronic obstructive pulmonary disease but referral rates are relatively low compared with need. Aim: Working with primary care clinicians (GPs and practice nurses) from eight practices, this project developed strategies for influencing clinician and patient behaviours as a means of increasing referral rates for PR. Methods: A participatory action research design was employed. Semi-structured questionnaires captured clinicians' baseline knowledge of PR and their ideas for increasing referrals. Actionable changes were then recommended. Audits (at baseline, mid-point and end of project) were used to assess and initiate improvements in the quality of practice data about PR referrals. The impacts of these changes were explored via further clinician surveys (free text questionnaire). Semi-structured questionnaires, posted to patients eligible for PR, assessed their characteristics, and, where applicable, their views on PR referral processes and reasons for not wanting PR. Findings: The baseline survey of clinicians (n = 22) revealed inadequate knowledge about PR, particularly among GPs. Actionable changes recommended included in-house education sessions, changes to practice protocols, and 'pop-ups' and memory aids (mugs and coasters) to prompt clinician/patient discussions about PR. Audit findings resulted in changes to improve the quality and availability of coded information about patients eligible for PR. These changes, supported by clinicians (n = 9) in the follow-up survey, aimed to facilitate and increase the quality of patient/ clinician discussions about PR. Findings from the patient survey (n = 126, response rate 25.7%) indicate that such changes will increase the uptake of PR as patients who accepted a referral for PR provided more positive feedback about their discussions with clinicians. Conclusions: The strategies introduced were relatively easy to implement and the anticipated advantage is more patients accessing the health and quality of life benefits that PR offers.

Rate of, and barriers and enablers to, pulmonary rehabilitation referral in COPD: A systematic scoping review

“…Thirty-five studies reported on referral rates [3,7,; 28 of these were observational studies [3,7,[12][13][14][16][17][18][19][20][21][22][23][25][26][27][28][29][30][31][34][35][36][37][40][41][42]44], while the remaining seven assessed the effect of an intervention on COPD care (and measured referral rates at baseline and post-intervention) [15,24,32,33,38,39,43]. Nine studies reported on HCP perceived barriers to PR referral [23,26,[45][46][47][48][49][50][51], and seven of these also reported on enablers [23,26,45,…”

A Review of Non-Pharmacological Pulmonary Rehabilitation for Patients Receiving Palliative Care

“…Patients are frequently not being referred to these services 12,21,26,47,50,55 and even if they are, there are considerable barriers that must be overcome in order for the patients to be able to attend pulmonary rehabilitation. Healthcare providers need to be educated about pulmonary rehabilitation and the evidence that supports its benefits in patients with a wide degree of chronic as well as malignant conditions.…”

“…11 Another studied indicated that poor communication among health care professionals and with patients as to what pulmonary rehabilitation is and how it can benefit patients, frequently occurs. 12,26 Patients complained that health care providers were not taking the time to explain their condition and offer solutions. Contributing to this problem was that some patients felt their general practitioners had lim-pulmonary Research and respiratory medicinE ISSN 2377ISSN -1658 Pulm Res Respir Med Open J ited knowledge about pulmonary rehabilitation and they were therefore not told of the benefits of rehabilitation or simply not referred to these programs at all.…”

“…Contributing to this problem was that some patients felt their general practitioners had lim-pulmonary Research and respiratory medicinE ISSN 2377ISSN -1658 Pulm Res Respir Med Open J ited knowledge about pulmonary rehabilitation and they were therefore not told of the benefits of rehabilitation or simply not referred to these programs at all. 12,21,26 One study found only 3-16% of eligible patients were referred for pulmonary rehabilitation. 12 Even the referring physician's attitude toward pulmonary rehabilitation influences whether a patient will attend or not.…”

“…12,21,26 One study found only 3-16% of eligible patients were referred for pulmonary rehabilitation. 12 Even the referring physician's attitude toward pulmonary rehabilitation influences whether a patient will attend or not. 21 Healthcare professionals need to improve tailoring of education to meet the individual needs of their patients regarding COPD and its trajectory, referring patients to and discussing benefits of pulmonary rehabilitation, and involving palliative care early on in their patient's treatments so that patients can derive maximum benefit.…”