Centre for Self Management Support, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Centre for Health Services Studies, University of Kent, Canterbury, UK.
BMJ Open. 2019 Jan 21;9(1):e024806. doi: 10.1136/bmjopen-2018-024806.
Chronic obstructive pulmonary disease (COPD) is a progressive lung disease associated with breathlessness, inability to exercise, frequent infections, hospitalisation and reduced quality of life. Pulmonary rehabilitation (PR), providing supervised exercise and education, is an effective and cost-effective treatment for COPD but is significantly underused. Interventions to improve referral and uptake have been tested and some positive results reported. However, interventions are diverse and no clear recommendations for practice can be made. This study aims to understand the challenges to referral and uptake in primary care, where most referrals originate, and to develop a flexible toolkit of resources to support referral and uptake to PR in primary care in the UK.
This is a mixed methods study informed by normalisation process theory and burden of treatment theory. In the first phase, general practitioners, practice nurses and PR providers will be invited to complete an online survey to inform a broad exploration of the topic areas. In phase 2 interviews and focus groups will be conducted with patients, healthcare professionals (HCP) in primary care, PR providers and commissioners to gain an in-depth understanding of the issues and needs. Toolkit development in phase 3 will draw together the learning from phases 1 and 2 and employ an iterative development process to build the toolkit jointly with patients and HCPs. It will be tested in primary care for usability and acceptability.
The study has ethical and Health Research Authority approval (Research Ethics Committee reference number 17/EE/0136). It is registered with the International Standard Registered Clinical/Social Study Number (ISRCTN) registry (trial ID: ISRCTN20669629, assignment date 20 March 2018, trial start date 1 April 2016). Dissemination will be aimed at patients, carers/families, service providers, commissioners and national interest groups. Methods will include conferences, presentations, academic publications and plain English reports and will be supported by the British Lung Foundation.
ISRCTN20669629 ; Pre-results.
慢性阻塞性肺疾病（COPD）是一种与呼吸困难、无法运动、频繁感染、住院和生活质量下降有关的进行性肺部疾病。提供监督运动和教育的肺康复（PR）是 COPD 的有效且具有成本效益的治疗方法，但使用率明显较低。已经测试了一些旨在改善转诊和参与度的干预措施，并报告了一些积极的结果。然而，干预措施多种多样，无法针对实践提出明确的建议。本研究旨在了解初级保健中最常见的转诊来源所面临的挑战，并开发一个灵活的资源工具包，以支持英国初级保健中的 PR 转诊和参与度。
这是一项混合方法研究，受正常化过程理论和治疗负担理论的指导。在第一阶段，将邀请全科医生、执业护士和 PR 提供者填写在线调查，以广泛了解各个主题领域。在第二阶段，将对患者、初级保健中的医疗保健专业人员（HCP）、PR 提供者和决策者进行访谈和焦点小组讨论，以深入了解问题和需求。在第三阶段的工具包开发中，将从第一阶段和第二阶段的学习中吸取经验，并采用迭代开发过程，与患者和 HCP 共同构建工具包。它将在初级保健中进行可用性和可接受性测试。
该研究已获得伦理和英国健康研究管理局的批准（研究伦理委员会参考号 17/EE/0136）。它在国际标准注册临床试验/社会研究编号（ISRCTN）注册处注册（试验 ID：ISRCTN20669629，分配日期 2018 年 3 月 20 日，试验开始日期 2016 年 4 月 1 日）。传播将针对患者、照顾者/家属、服务提供者、决策者和国家利益集团进行。方法将包括会议、演讲、学术出版物和通俗易懂的报告，并将得到英国肺脏基金会的支持。
ISRCTN20669629；预结果。
