P94 Improving referral and uptake to pulmonary rehabilitation in primary care: qualitative findings from an online survey in primary care

Abstract

Introduction and objectives Pulmonary rehabilitation (PR) is recommended for people with COPD who are limited by breathlessness yet in 2013/14 only 15% of eligible patients in England and Wales were referred and 10.5% attended assessment. With most PR referral occurring in primary care, we aimed to understand how referral is embedded in GPs’ and practice nurses’ normal practice and how it may be improved. Methods Mixed methods study utilising a 33-item online survey (scales, free text) based on Normalisation Process Theory in a purposive sample of 415 general practices in the East of England between August 2017 and January 2018. We present key findings from free text data, analysed using framework analysis. Results Response rate was 26.9% (112/415). Both GPs and nurses valued PR as beneficial for patients. Nurses were the main referrers as part of routine care; GPs referred at specific moments, e.g. post-discharge or opportunistically. Both wanted regular, prompt feedback from providers about the service and patient outcomes. Nurses valued feedback from service users. Reasons for poor uptake were attributed to patients’ lack of self-confidence and knowledge about PR, patients being unwell or not believing PR would help. Reasons for accepting a referral were attributed to recommendation from a trusted clinician, patients feeling unable to cope, desiring to improve their health and testimony from others who attended. Both GPs and nurses suggested referrals could be increased through improved information about referral criteria, prompts at diagnosis, easy, automated referral processes, better PR promotion and self-referral. GPs suggested prompts at annual reviews, PR as part of the standard approach to exacerbations, patient taster sessions and clinician education sessions. Nurses suggested more time in consultations would help. Both suggested that class times and locations were important and more publicity about classes and benefits might increase uptake. Conclusion While nurses were the main referrers to PR, there was overlap in GPs’ and nurses’ needs to support referral. These spanned knowledge and information to counter misconceptions, support for more effective and efficient referral processes and improved responsiveness from providers. Data suggest combined approaches for both groups to support referral practice could be feasible.