An evaluation of factors that influence referral to pulmonary rehabilitation programs among people with COPD
School of Medical and Health Sciences / Exercise Medicine Research Institute
Background: Pulmonary rehabilitation programs (PRP) are important for people with symptomatic COPD. Research Questions: What proportion of people with COPD who are suitable for a PRP go on to be referred? Do clinical or sociodemographic characteristics influence the odds of whether those who are suitable for a PRP go on to be referred? What factors influence people's interest in participating in a pulmonary rehabilitation program? Study Design and Methods: People with COPD who appeared appropriate for a PRP were sequentially recruited from three tertiary hospitals in Australia. Variables such as age, sex, lung function, smoking status, and interest in participating in a PRP were collected through interviews and reviewing the medical records. Referrals to PRPs were prospectively tracked through the electronic referral system, medical records, and discussion with the participant or the physiotherapists responsible for coordinating the PRPs. Results: Six hundred eighty-two people with COPD were approached, 468 consented, and data were available on 391 (No. [%] or mean ± SD; 215 males [55%], age 69 ± 10 years, FEV1 49 ± 19 %predicted). Of the 156 participants deemed suitable for a PRP, 74 (47%, 95% vCI, 40-55) were referred to a PRP. Among participants who were deemed suitable for a PRP, the only variable that separated those who were from those who were not referred was interest in attending a PRP (mean difference in interest on the visual analog scale [VAS]; 22 units, 95% CI, 12-32). Introverted personality traits and feelings of unworthiness reduced interest in attending a PRP. Interpretation: Among people with COPD who were suitable for a PRP, referral from the tertiary hospital setting was suboptimal. Suitable participants who were not referred showed lower interest in attending a PRP. There were novel complex individual barriers that reduced one's interest in participating in a PRP.