Understanding referral to Pulmonary Rehabilitation for COPD patients by Primary Health Care staff - a qualitative study using the Theoretical Domains Framework.

Abstract

Introduction: Pulmonary Rehabilitation (PR) is a cost-effective, internationally recommended intervention for COPD patients suffering breathlessness and/or functional limitation. Referral is largely health care practitioner led, but referral & patient uptake remains poor worldwide. Aim: To use behavioural theory to explore the reported practice of primary health care practitioners (PHPs) in the referral of COPD patients to PR. Methods: Semi-structured interviews were conducted with PHPs in General Practices across Cambridgeshire & West Midlands, UK. Interviews were completed to theme saturation, audio recorded & transcribed verbatim. Content & thematic analysis was mapped to the Theoretical Domains Framework (TDF) s a 14 domain behavioural framework used to diagnose & solve behavioural barriers to implementation problems. Results: PHPs reported referral to PR is low. Barriers: Lack of awareness of PR & its benefits (knowledge), uncertainty about referral process (skills), limited consultation time (environmental context and resources), other priorities (goals), uncertain patients will attend (belief about consequences) or don’t want to go (social influences). Enablers: COPD Annual review (behavioural regulation), stable disease (beliefs about capabilities), template prompts (memory, attention & decision processes), financial reward (reinforcement), believing benefits (belief about consequences) & peer support/engagement, including from PR providers (social influences). Recommendations: These results aim to inform behaviour change interventions that seek to increase PR referral numbers.