Abstract

Background
Pulmonary rehabilitation (PR) is an effective treatment for patients with COPD. However, referral, uptake and adherence to PR is persistently low.

Objective
to determine the effectiveness of interventions to increase referral, uptake, and adherence to pulmonary rehabilitation programmes for patients with COPD.

Methods
A broad range of study designs were sought and included if the population targeted was either healthcare professionals caring for COPD patients in any setting, adults with a primary diagnosis of COPD or partners/caregivers/family/friends of COPD patients, and the intervention/s were implemented in order to increase referral to, uptake of or adherence to any type of face to face PR programme.
Two authors independently screened titles, abstracts and full texts, extracted data and critically appraised each study. Risk of bias was assessed. Narrative synthesis was undertaken, due to substantial heterogeneity.
Results
30 studies fulfilled inclusion criteria, testing interventions across primary and secondary care, focused on patients (n=13), healthcare professionals (HCP - n=14) or both (n=3 studies).
Primary care interventions including screen prompts and/or staff education increased referral rates by 3-39%. Most interventions in secondary care focused on increasing HCP education and awareness of PR, use of checklists and discharge bundles, reporting increases in referral rates ranging from 5%-54%.
Seven studies, reported PR uptake as an outcome. Two cluster RCTs in primary care had mixed results; one involving COPD nurse home visits and individualised care plan increased uptake to 31% ,whereas one educational intervention was not effective. Secondary care, two RCTs had no effect.
Seven studies reported PR adherence, one RCT of CBT alongside PR for people with anxiety or depression increased adherence.
Conclusions
Interventions that incorporated partnership working between patients and HCPs appeared to increase referral, uptake and adherence rates with greater effectiveness than singular populations. Well-designed trials of interventions to increase referral are needed.