PCPs fall short on making rehab referrals for COPD patients

Less than 10 percent of patients with chronic obstructive pulmonary disease (COPD) that were eligible for pulmonary rehabilitation programs received referrals for them, according to a new study from the United Kingdom.

The study, published in Chest, analyzed the medical records of more than 62,000 patients with COPD, and found that just 9.3% were referred to or completed a rehab program. An equal number of patients were eligible for such programs but were never referred, according to the report, and 0.9% were referred but declined participation, according to the report.

This shows that patients who are eligible and referred to rehab may comply with orders, but that primary care physicians are falling short in their referrals of these patients.

“We need to take every opportunity to assess a patient’s suitability and refer them when appropriate,” said lead author Jennifer K. Quint, MSc, PhD, clinical senior lecturer on respiratory epidemiology at Imperial College of London. “We also need to be better about coding completion rates so that we can carry out more research on this at the highest quality possible.”

It isn’t clear from the current study why patients aren’t being referred to rehab programs, she said. Of course, some patients are too frail for rehab, and others with multiple comorbidities may not be suitable, she said, but the study accounted for these situations.

While the study indicated a need for more referrals to rehab programs, it did not provide evidence to support their efficacy. The research team notes that patients had slightly more COPD exacerbations after participation in pulmonary rehabilitation programs, and that participation in these programs had no impact on hospital length of stay for COPD patients.

The study authors say these results don’t exactly match with other studies on the benefits of rehabilitation, noting that clinicians need to do a better job at measuring participation and outcomes in rehab programs in order to complete a more accurate analysis. The study also notes that, outside of decreasing exacerbations and hospital length of stay, pulmonary rehabilitation has been shown to improve overall quality of life, exercise tolerance, breathlessness, and activity limitations.

Primary care providers need to increase the frequency of asking patients about attending rehab, making referrals, and coding their attendance and progress, Quint said. She said she hopes her study will encourage clinicians to take these steps, and that follow-up studies will be better able to uncover some of the barriers patients face in getting referred to pulmonary rehab programs.