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

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cam.issuedOnline2018-10-29
dc.contributor.authorEarly, Frances
dc.contributor.authorWellwood, Ian
dc.contributor.authorKuhn, Isla
dc.contributor.authorDeaton, Christi
dc.contributor.authorFuld, Jonathan
dc.contributor.orcidWellwood, Ian [0000-0002-6059-9209]
dc.contributor.orcidKuhn, Isla [0000-0002-2879-4020]
dc.contributor.orcidDeaton, Christi [0000-0003-3209-0752]
dc.contributor.orcidFuld, Jonathan [0000-0003-1847-184X]
dc.date.accessioned2018-12-18T00:31:49Z
dc.date.available2018-12-18T00:31:49Z
dc.date.issued2018
dc.description.abstractPulmonary 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.
dc.format.mediumElectronic-eCollection
dc.identifier.doi10.17863/CAM.34381
dc.identifier.eissn1178-2005
dc.identifier.issn1176-9106
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/287071
dc.languageeng
dc.language.isoeng
dc.publisherInforma UK Limited
dc.publisher.urlhttp://dx.doi.org/10.2147/copd.s172239
dc.rightsAttribution-NonCommercial 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by-nc/4.0/
dc.subjectaccess to healthcare
dc.subjectevidence-based practice
dc.subjecthealth services research
dc.subjectlong-term condition
dc.subjectservice improvement
dc.subjectsupervised exercise
dc.subjectAged
dc.subjectAged, 80 and over
dc.subjectAttitude of Health Personnel
dc.subjectEducation, Medical, Continuing
dc.subjectExercise Therapy
dc.subjectFemale
dc.subjectHealth Services Research
dc.subjectHumans
dc.subjectInservice Training
dc.subjectLung
dc.subjectMale
dc.subjectMiddle Aged
dc.subjectPatient Education as Topic
dc.subjectPhysician Incentive Plans
dc.subjectPractice Patterns, Physicians'
dc.subjectPulmonary Disease, Chronic Obstructive
dc.subjectRecovery of Function
dc.subjectReferral and Consultation
dc.subjectReminder Systems
dc.subjectTreatment Outcome
dc.titleInterventions to increase referral and uptake to pulmonary rehabilitation in people with COPD: a systematic review.
dc.typeArticle
prism.endingPage3586
prism.publicationDate2018
prism.publicationNameInt J Chron Obstruct Pulmon Dis
prism.startingPage3571
prism.volume13
pubs.funder-project-idCambridge University Hospitals NHS Foundation Trust (CUH) (rfpb pb-pg-1215-20034)
rioxxterms.licenseref.startdate2018-01
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserved
rioxxterms.typeJournal Article/Review
rioxxterms.versionVoR
rioxxterms.versionofrecord10.2147/COPD.S172239

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