Interventions to increase referral and uptake to pulmonary rehabilitation in people with COPD : A systematic review

Journal article


Early, Frances, Wellwood, Ian, Kuhn, Isla, Deaton, Christi and Fuld, Jonathan. (2018). Interventions to increase referral and uptake to pulmonary rehabilitation in people with COPD : A systematic review. The International Journal of Chronic Obstructive Pulmonary Disease. 13, pp. 3571-3586. https://doi.org/10.2147/COPD.S172239
AuthorsEarly, Frances, Wellwood, Ian, Kuhn, Isla, Deaton, Christi and Fuld, Jonathan
Abstract

Pulmonary rehabilitation (PR) reduces the number and duration of hospital admissions and readmissions, and improves health-related quality of life in patients with COPD. Despite clinical guideline recommendations, under-referral and limited uptake to PR contribute to poor treatment access. We reviewed published literature on the effectiveness of interventions to improve referral to and uptake of PR in patients with COPD when compared to standard care, alternative interventions, or no intervention. The review followed recognized methods. Search terms included “pulmonary rehabilitation” AND “referral” OR “uptake” applied to MEDLINE, EMBASE, CINAHL, PsycINFO, ASSIA, BNI, Web of Science, and Cochrane Library up to January 2018. Titles, abstracts, and full papers were reviewed independently and quality appraised. The protocol was registered (PROSPERO # 2016:CRD42016043762). We screened 5,328 references. Fourteen papers met the inclusion criteria. Ten assessed referral and five assessed uptake (46,146 patients, 409 clinicians, 82 hospital departments, 122 general practices). One was a systematic review which assessed uptake. Designs, interventions, and scope of studies were diverse, often part of multifaceted evidence-based management of COPD. Examples included computer-based prompts at practice nurse review, patient information, clinician education, and financial incentives. Four studies reported statistically significant improvements in referral (range 3.5%–36%). Two studies reported statistically significant increases in uptake (range 18%–21.5%). Most studies had methodological and reporting limitations. Meta-analysis was not conducted due to heterogeneity of study designs. This review demonstrates the range of approaches aimed at increasing referral and uptake to PR but identifies limited evidence of effectiveness due to the heterogeneity and limitations of study designs. Research using robust methods with clear descriptions of intervention, setting, and target population is required to optimize access to PR across a range of settings.

Keywordshealth services research; service improvement; access to healthcare; evidence-based practice; long-term condition; supervised exercise
Year2018
JournalThe International Journal of Chronic Obstructive Pulmonary Disease
Journal citation13, pp. 3571-3586
PublisherDove Medical Press Ltd.
ISSN1176-9106
Digital Object Identifier (DOI)https://doi.org/10.2147/COPD.S172239
PubMed ID30464439
Scopus EID2-s2.0-85056969645
PubMed Central IDPMC6214582
Open accessPublished as ‘gold’ (paid) open access
Research or scholarlyResearch
Page range3571-3586
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online29 Oct 2018
Publication process dates
Accepted01 Aug 2018
Deposited24 Aug 2022
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