Johnston Kylie N, Young Mary, Grimmer Karen A, Antic Ral, Frith Peter A
School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.
Prim Care Respir J. 2013 Sep;22(3):319-24. doi: 10.4104/pcrj.2013.00062.
Pulmonary rehabilitation (PR) is recommended in the management of people with chronic obstructive pulmonary disease (COPD), but referral to this service is low.
To identify barriers to, and facilitators for, referral to PR programmes from the perspective of Australian general practitioners.
Semi-structured interviews were conducted with general practitioners involved in the care of people with COPD. Interview questions were informed by a validated behavioural framework and asked about participants' experience of referring people with COPD for PR, and barriers to, or facilitators of, this behaviour. Interviews were audiotaped, transcribed verbatim, and analysed using content analysis.
Twelve general practitioners participated in this study, 10 of whom had never referred a patient to a PR programme. Four major categories relating to barriers to referral were identified: low knowledge of PR for COPD; low knowledge of how to refer; actual or anticipated access difficulties for patients; and questioning the need to do more to promote exercise behaviour change. Awareness of benefit was the only current facilitator. Three major categories of potential facilitators were identified: making PR part of standard COPD care through financial incentive; improving information flow with regard to referrals and services; and informing patients and public.
Significant barriers to referral exist, but opportunities to change the organisation of practice and information management were identified. Behaviour change strategies which directly target these barriers and incorporate facilitators should make up the key components of interventions to improve referral to PR by general practitioners who care for people with COPD.
慢性阻塞性肺疾病（COPD）患者的管理推荐采用肺康复（PR），但该服务的转诊率较低。
从澳大利亚全科医生的角度确定COPD患者转诊至PR项目的障碍及促进因素。
对参与COPD患者护理的全科医生进行半结构式访谈。访谈问题依据经过验证的行为框架提出，询问参与者将COPD患者转诊至PR的经验以及这种行为的障碍或促进因素。访谈进行录音，逐字转录，并采用内容分析法进行分析。
12名全科医生参与了本研究，其中10人从未将患者转诊至PR项目。确定了与转诊障碍相关的四大类因素：对COPD的PR了解不足；对转诊方式了解不足；患者实际或预期的就诊困难；质疑是否需要采取更多措施促进运动行为改变。认识到益处是目前唯一的促进因素。确定了三大类潜在促进因素：通过经济激励使PR成为COPD标准护理的一部分；改善转诊和服务方面的信息流通；向患者及公众宣传。
转诊存在重大障碍，但已确定改变执业组织和信息管理的机会。直接针对这些障碍并纳入促进因素的行为改变策略应成为干预措施的关键组成部分，以改善照顾COPD患者的全科医生对PR的转诊情况。
