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Predictors of referral to pulmonary rehabilitation from UK primary care

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posted on 2020-12-07, 10:26 authored by PW Stone, K Hickman, MC Steiner, CM Roberts, JK Quint, SJ Singh
Background: A large proportion of people with COPD are not referred to pulmonary rehabilitation (PR) despite its proven benefits. No previous studies have examined predictors of referral to PR.
Objective: To determine the characteristics of people with COPD associated with referral to PR.
Methods: Cross-sectional analysis of a primary care cohort of 82,696 Welsh people with COPD generated as part of a UK national audit of COPD care. Data represent care received by patients as of 31/03/2017. Referral to PR was defined as any code in the patient record indicating referral to PR in the last 3 years. Potential predictors of referral to PR were chosen based on clinical judgement and data availability. Independent predictors of PR referral were determined using backward stepwise mixed-effects logistic regression with a random effect for practice. Variables assessed were: age, gender, deprivation, MRC recorded in past year, MRC grade, smoking status recorded in past year, smoking status, number of exacerbations in past year, inhaled therapy prescription, influenza vaccination, and comorbidities of diabetes, hypertension, coronary heart disease, stroke, heart failure, lung cancer, asthma, bronchiectasis, depression, anxiety, severe mental illness, osteoporosis, and painful condition.
Results: A total of 13,297 people (16%) with COPD were referred from primary care for PR. Patients with a comorbidity of bronchiectasis or depression, MRC recorded in the last year, higher MRC grade, more exacerbations in the last year, a greater level of inhaled therapy, an influenza vaccination, or were an ex-smoker had significantly higher odds of referral to PR. Patients that were older, female, more deprived, or had a comorbidity of diabetes, asthma, or painful condition had significantly lower odds of referral to PR.
Conclusion: Generally appropriate patients are being prioritised for PR referral; however, it is concerning that women, current smokers, and more deprived patients appear to have lower odds of referral.

History

Citation

International Journal of Chronic Obstructive Pulmonary Disease, Volume 15, 2020, pp. 2941—2952. https://doi.org/10.2147/COPD.S273336

Author affiliation

Department of Respiratory Sciences, University of Leicester

Version

  • VoR (Version of Record)

Published in

International Journal of COPD

Volume

15

Pagination

2941 - 2952

Publisher

Informa UK Limited

issn

1176-9106

eissn

1178-2005

Acceptance date

2020-09-28

Copyright date

2020

Available date

2020-11-16

Spatial coverage

New Zealand

Language

eng

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