McCarron Eamon P, Bailey Melanie, Leonard Breige, McManus Terence E
Division of Respiratory Medicine, Department of Medicine, South West Acute Hospital, Western Health and Social Care Trust, Enniskillen, United Kingdom.
School of Medicine, Dentistry, and Biomedical Sciences, Queen's University, Belfast, United Kingdom.
Clin Respir J. 2019 Oct;13(10):624-629. doi: 10.1111/crj.13068. Epub 2019 Aug 22.
Pulmonary rehabilitation (PR) is a well-established therapeutic management programme for patients with chronic lung disease. Despite good clinical evidence, patient engagement can be poor.
The aim of the study was to determine the number of patients who are referred to PR at a District General Hospital, explore barriers and facilitators to attending and completing and identify strategies for improvement.
All patients invited to attend PR in the calendar year 2016 were included in an analysis (N = 281). A structured questionnaire composed of barriers and facilitators was administered to patients that did not attend (non-attenders, N = 20) and those that attended but did not complete the programme (non-completers/"drop-outs," N = 13). Improvement strategies were identified and implemented followed by analysis of patients invited to attend in 2017 and 2018.
Age, sex and smoking status are factors that affect both attendance and completion rates of patients attending PR. In our analysis, we were able to demonstrate that lack of awareness and low perceived benefits were important barriers for non-attendance. In addition, overall uptake rate was improved but at the expense of completion rate.
Our local non-attendance rate in 2016 was 42%, with strategies aimed at improving patient and physician information, this was reduced to 11% (2018), below the national United Kingdom average. Unexpectedly, there was a worsening of completion rates and this raises questions about both appropriateness of referrals and whether completion rate rather than non-attendance rate should be used as a performance indicator and standard.
肺康复（PR）是针对慢性肺病患者的一项成熟的治疗管理方案。尽管有充分的临床证据，但患者的参与度可能较低。
本研究的目的是确定一家地区综合医院被转诊至肺康复治疗的患者数量，探讨参与并完成治疗的障碍和促进因素，并确定改进策略。
纳入2016日历年所有受邀参加肺康复治疗的患者进行分析（N = 281）。对未参加治疗的患者（未参与者，N = 20）和参加但未完成该方案的患者（未完成者/“退出者”，N = 13）进行了一项由障碍和促进因素组成的结构化问卷调查。确定并实施了改进策略，随后对2017年和2018年受邀参加治疗的患者进行了分析。
年龄、性别和吸烟状况是影响肺康复治疗患者参与率和完成率的因素。在我们的分析中，我们能够证明缺乏认识和较低的感知益处是未参与治疗的重要障碍。此外，总体接受率有所提高，但以完成率为代价。
我们当地2016年的未参与率为42%，通过旨在改善患者和医生信息的策略，该比率降至11%（2018年），低于英国全国平均水平。出乎意料的是，完成率有所下降，这引发了关于转诊是否合适以及是否应将完成率而非未参与率用作绩效指标和标准的问题。
