Assessing Compliance With the American Thoracic Society COPD Guidelines in the Internal Medicine and Family Medicine Residency Clinics

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,…”

“…Seven studies included an intervention designed to improve COPD care, with rate of referral to PR included as an outcome measure [15,24,32,33,38,39,43]. All 7 studies saw an improvement in referral rates post-intervention [15,24,32,33,38,39,43], although one included conference abstract did not explicitly state the actual improvement in referral rate post-intervention [15]. Four of the interventions involved HCP education [15,32,33,43], one introduced a discharge care bundle [39], and the other introduced a care package with financial incentives for the network of hospitals involved [24].…”

“…All 7 studies saw an improvement in referral rates post-intervention [15,24,32,33,38,39,43], although one included conference abstract did not explicitly state the actual improvement in referral rate post-intervention [15]. Four of the interventions involved HCP education [15,32,33,43], one introduced a discharge care bundle [39], and the other introduced a care package with financial incentives for the network of hospitals involved [24]. Details of the interventions and their effects can be seen in Table 3.…”

“…One study saw an 85% referral rate in a hospital with a Living Well with COPD program compared to a referral rate of only 12% in a hospital without one [30], supporting the idea that having close access and a way of systematically referring patients is important for increasing referral rates. The implementation of both discharge care bundles [39] and educational programs for hospital staff [15,32,33,39,43] saw a concomitant increase in referral rates. Instituting these strategies alongside an organized referral system could further improve rates of referral.…”

“…This highlights the urgent need for potential referrers to receive specific PR training, as PR is strongly evidenced for increasing exercise tolerance, improving health related quality of life and reducing symptoms in COPD patients [53]. As evidenced by the four studies which implemented specific HCP education regarding COPD care, this has the potential to contribute to a positive effect on referrals [15,32,33,43]. The other most frequently cited barrier to referral was low knowledge of the referral process.…”