Enhancing Pulmonary Rehabilitation Enrollment Study (Press Iii)

RATIONALE: Pulmonary rehabilitation (PR) is recommended in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) to reduce the risk of future exacerbations. Previous review in this health region demonstrated 9% of inpatients with AECOPD were being referred to PR following discharge, and 4% were attending, none within 30 days post-discharge. OBJECTIVE: Evaluate referral and attendance rates to PR after implementation of a physician-led recruitment method. MEASUREMENTS AND MAIN RESULTS: All inpatients admitted to medicine wards were systematically screened for AECOPD utilizing a Drug Use Evaluation report for prescribed inhalers/nebulizers. Investigators met with identified eligible patients, delivered education and provided a pre-booked appointment card to attend PR within 4 weeks of discharge. PR attendance and barriers to attendance were documented. A total of 296 patients receiving inhalers/nebulizers were screened: 135 patients did not have clinical COPD. Of the remaining 161 patients, 50 were deemed eligible for the intervention. Reasons for exclusion included significant co-morbid conditions (n = 71), distance (n = 34) and preexisting attendance (n = 6). Of eligible patients, 12 declined referral with the main reason being lack of transportation; 38 patients accepted referral to PR, with 16 attending their first appointment. CONCLUSION: A physician-led referral strategy improved PR referral rates, with 24% of patients admitted with "clinical COPD" being formally referred to PR compared to only 9% with prior clinical practice. Moreover, physician-led recruitment increased PR attendance to 10% from prior 4%. Of the patients with clinical AECOPD, only 31% were eligible for referral to PR, and of those, only 32% attended their first appointment.