Who is most likely to be referred for COPD pulmonary rehabilitation?

Previous studies have shown that access to public relations programs can improve dyspnea, malaise, quality of life, and athletic performance in COPD patients. PR can also reduce the need for hospital visits. For example, in a previous survey, in the UK, Less than 10% Percentage of COPD patients eligible for PR who have been referred by a doctor.

The author of the current study said in Wales that 50% of eligible patients were referred to the PR program in 2017. This means that half of the PR-eligible COPD population is missing out on potential benefits.

The researchers evaluated the records of 82,696 patients entered in

UK Primary Care COPD Audit Database in the UK Received COPD Care by March 31, 2017 Audit Date

Of interest to researchers is the number of patients referred to the PR during the three years from April 4, 2014 to the audit date.

In the UK, referrals are recommended if COPD worsens frequently, or if the severity of symptoms is moderate or higher, and the Medical Research Council (MRC) grade is 3 or higher, but the PR decision is made by the provider. Is left to

Of the total, 16% (13,297) received PR referrals from primary care providers.

Women were found to be 7% less likely to receive PR referrals than men (odds ratio) [OR], 0.93; 95% CI, 0.89-0.98; P = .0031). Similarly, sensitivity analysis showed that women were 8% less likely to be targeted for PR than men (OR, 0.92; 95% CI, 0.88-0.95; P <.0001). Researchers said there seems to be no obvious reason for these low odds.

“There may be an unconscious bias towards women in the treatment and diagnosis of COPD,” the authors said.

Patients over 70 are less likely to be referred to PR than patients under 60, but are more likely to consider PR and older people are more likely to decline and are inappropriate , Or a PR program that suggests that you may not live nearby (P <.0001).

“Because of the increasing comorbidity and frailty, older people may be less likely to be referred,” the researchers write.

Welsh individuals, who were among the most socio-economically disadvantaged 20%, had lower PR referral odds than 50% of the least disadvantaged patients (P <.0061). Researchers have found that this may be because patients with low SES are more likely to refuse PR, have no access to available PR programs, or are "insufficiently involved" in primary care. Suggested.

Former smokers were found to be 41% more likely to receive PR referrals than current smokers (OR, 1.41; 95% CI, 1.34-1.49; P <.0001). Researchers point out that PR considerations are not significantly different between smokers and former smokers, and current smokers are more likely to reject PR.

“Current smokers can benefit from pulmonary rehabilitation in parallel with smoking cessation treatment, so the discovery that former smokers are more likely to be referred than current smokers or do not smoke at all is potential. I’m worried about it, “the researchers write.

In addition to former smokers, other COPD patients who were more likely to receive PR referrals were bronchiectasis, depression, MRC recorded last year, high MRC grades, and many worsenings last year. Or have been vaccinated against the flu.

“These results are promising because they appear to indicate that people with more severe symptoms are properly prioritized,” the researchers said, but women, smokers, And there is still concern that patients with low SES are less likely to receive PR referrals.

COPD patients who also had diabetes were 10% less likely to receive PR referrals than those who did not have diabetes (OR, 0.90; 95% CI, 0.85–0.95, P <.0001). Patients with other comorbidities including asthma (OR, 0.91; 95% CI, 0.87–0.95; P <.0001) and painful conditions (OR, 0.89; 95% CI, 0.84–0.95; PFor <.0003), referral odds were 9% and 11% lower, respectively.

“It was a pity that we found it unlikely that people with co-existing asthma would be referred,” as evidence has shown that public relations are beneficial to asthmatics. Therefore, referrals need to be encouraged.

reference

Stone PW, Hickman K, Steiner MC, Roberts CM, Quint JK, Singh SJ Predictors of referrals to respiratory rehabilitation from primary care in the UK.. Int J Chron Obstruct Pulmon Dis.. November 16, 2020; 15: 2941-2952. Doi: 10.2147 / COPD.S273336