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

Highlights

• Referral rates range from 0% to 85%, even though all patients with chronic obstructive pulmonary disease should be referred.

• Barriers include not knowing what pulmonary rehabilitation is, its benefits, and how to refer.

• Previous experience or training in pulmonary rehabilitation makes health care professionals more likely to refer.

Abstract

Background

Despite pulmonary rehabilitation (PR) being an evidence-based treatment recommended for people with chronic obstructive pulmonary disease (COPD), referral to PR seems to be low. Collating the evidence on referral rates and perceived barriers and enablers may help provide knowledge needed to increase referral.

Objectives

The purpose of this scoping review was to determine 1) the rate of referral of patients with COPD to PR by healthcare professionals (HCPs) and 2) the barriers and enablers to referral perceived by HCPs.

Methods

The JBI scoping review manual was used. Ovid Medline, CINAHL, EMBASE, and ProQuest Dissertations and Theses were searched from inception until July 28, 2017. 245 non-duplicate articles were screened. Included articles reported referral rates and/or HCP perceived barriers and/or enablers to PR referral.

Results

Forty-two studies were included. Twenty-eight observational studies reported referral rates ranging from 0% to 85%. Seven studies looking at the effects of different interventions to improve COPD care reported a range of 2%–56% referral pre-intervention, and 8%–71% post-intervention. Nine studies reported HCP perceived barriers to referral. The two most common barriers were low knowledge of what PR is and its benefits and low knowledge of the referral process. Six studies reported HCP perceived enablers to referral. The most common enabler was training/experience in PR.

Conclusion

The rate of referral to PR is suboptimal, but there are commonly reported barriers and enablers that may help with the creation of actionable changes. HCPs need more knowledge of PR and the benefits it provides.