Referral of patients with chronic obstructive pulmonary disease to pulmonary rehabilitation from primary care: A local survey of GPs and practice nurses

Aim To gain an understanding of the referral practices of local general practitioners (GPs) and practice nurses (PNs) to a local pulmonary rehabilitation (PR) programme in order to improve referral rates of patients with chronic obstructive pulmonary disease (COPD). Methods The study involved a cross-sectional survey of local GP and PNs from 16 GP practices within a local health and social care trust. The survey was distributed electronically and in hard copy form to GP practices and a 1-month period was provided to complete the survey. Inclusion/exclusion criteria GPs and PNs who review patients with COPD were eligible to complete the survey. Outcome measures The study reports on descriptive statistics for perceived referral rates to PR, knowledge of PR referral process within the local area, service user barriers, referral barriers and strategies to improve referral. Inferential statistics were used to determine if differences existed between GPs and PNs with regards MRC questioning and PR education. Results The survey was distributed to a total of 70 people, with responses received from 13 general practitioners (GPs) and 11 practice nurses. The overall response rate for the survey was 34%, with a GP response rate of 23% versus a PN response rate of 79%. 83% percent (n = 20) of respondents estimated they referred <50% and 17% (n = 4) did not refer any COPD patients to PR. The number of PNs who reported that they question service-users around exertional breathlessness and educate around the benefits of PR was significantly higher than participating GPs (p <0.05). 63% (n = 15) of respondents felt that the principal barrier to PR referral was patient unwillingness/refusal to attend. 29% (n = 7) of respondents felt that information leaflets/posters would improve referral rates to PR. Conclusions In this local survey referral from primary care to PR in the COPD population was underutilised by clinicians. PNs reported that they were more likely than GPs to explore patient’s exertional breathlessness and to educate patients regarding the benefits of PR. Respondents perceived that patient unwillingness to attend PR was the primary barrier however practitioner referral barriers in the form of time constraints were also cited. Respondents also cited a perceived lack of patient understanding of the benefits of PR as a factor affecting PR attendance.