Abstract

Introduction: Pulmonary rehabilitation (PR) is recommended for people with COPD limited by breathlessness. In 2013/14 only 15% of eligible UK patients were referred and 10.5% attended an assessment. 

Objectives: Most PR referral occurs in primary care. As part of a mixed methods study we surveyed GPs and practice nurses to understand how referral is embedded in normal practice. 

Methods: A 33 item online survey (scales, free text) based on Normalisation Process Theory was sent to 415 general practices in the East of England between August 2017 and January 2018. We present key quantitative results which were analysed descriptively. Chi square was used to compare GP and nurse responses.

Results: Response rate was 26.9% (112/415). 96.4% (108/112) saw value in referring patients to PR. 72.3% (81/112) were highly confident that they understood the eligibility criteria for referral and 72.3% (81/112) could integrate it into their work. Only 38.4% (43/112) believed sufficient training for referral was provided. Nurses (n=68) compared to GPs (n=41) were highly confident in understanding referral criteria (94% v 37.5%, p<.001), felt better prepared to refer (89.7% v 47.5% p<.001), felt it was a normal part of their work (88.2% v 42.5%, p<.001) and that referral was very easy (80.9% v 41.5%, p<.001). More GPs felt insufficient information about PR influenced whether they referred (68.3% v 23.5%, p<.001).

Conclusion: Almost all clinicians responding saw value in making PR referrals. Nurses described greater understanding than GPs of the eligibility and process of PR referral.  Results suggest a need for different strategies for different clinicians to address low PR utilisation.