将慢性阻塞性肺疾病患者转介至肺康复治疗：对初级保健医生的障碍和促进因素的定性研究。
Referral of patients with chronic obstructive pulmonary disease to pulmonary rehabilitation: a qualitative study of barriers and enablers for primary healthcare practitioners.
机构信息
Faculty of Health, Medicine, Education & Social Care, Anglia Ruskin University, Cambridge; Institute of Applied Health, University of Birmingham.
Institute of Applied Health, University of Birmingham.
出版信息
Br J Gen Pract. 2020 Mar 26;70(693):e274-e284. doi: 10.3399/bjgp20X708101. Print 2020 Apr.
BACKGROUND
Pulmonary rehabilitation (PR) is a cost-effective, internationally recommended intervention for patients with chronic obstructive pulmonary disease (COPD). Referral is predominately led by primary healthcare practitioners (PHCPs), but referral and patient uptake is poor.
AIM
To understand barriers and enablers for PHCPs when considering patient referral to PR, to explore the influence of patient characteristics, and to understand how referral rates may be increased.
DESIGN AND SETTING
PHCPs who care for and refer patients with COPD to PR were purposively selected from general practices across Cambridgeshire and Peterborough, and the West Midlands.
METHOD
A qualitative study. Semi-structured interviews were undertaken to theme saturation, exploring PR referral. Images depicting patients with varying COPD severity were used to stimulate memory and associative recall. Interviews were recorded, transcribed verbatim, and analysed using rapid qualitative analysis.
RESULTS
A total of 19 PHCPs were interviewed. Barriers to PR referral included limited awareness of the clinical benefits, little knowledge of local PR providers, consultation time constraints, and presumed low patient motivation. While practice nurses had the greatest knowledge, they still described difficulty in promoting PR. PHCPs frequently described assessing patient suitability based on presumed accessibility, social, and disease-specific characteristics rather than the clinical benefits of PR. Referrals were facilitated by financial incentives for the practice and positive feedback from patients and providers.
CONCLUSION
There were more barriers to PR referral than enablers. Providers must engage better with PHCPs, patients with COPD, and carers, and actively promote PR. Increasing PHCPs' awareness of the benefits of PR, financial incentives, and alternative referral pathways should be considered.
背景
肺康复（PR）是一种具有成本效益的、国际推荐的慢性阻塞性肺疾病（COPD）患者干预措施。转诊主要由初级保健医生（PHCPs）主导，但转诊和患者参与度都很差。
目的
了解 PHCPs 在考虑将患者转诊至 PR 时的障碍和促进因素，探讨患者特征的影响，并了解如何提高转诊率。
设计和设置
从剑桥郡和彼得伯勒以及西米德兰兹郡的综合实践中有意选择照顾和转诊 COPD 患者至 PR 的 PHCPs。
方法
一项定性研究。进行半结构化访谈以达到主题饱和，探讨 PR 转诊。使用描绘不同 COPD 严重程度的患者图像来刺激记忆和联想回忆。记录访谈，逐字转录，并使用快速定性分析进行分析。
结果
共对 19 名 PHCPs 进行了访谈。PR 转诊的障碍包括对临床益处的认识有限、对当地 PR 提供者的了解甚少、咨询时间限制以及推测的低患者动机。虽然执业护士的知识最丰富，但他们仍然描述了在促进 PR 方面的困难。PHCPs 经常根据推测的可及性、社会和疾病特异性特征而不是 PR 的临床益处来评估患者的适宜性。经济激励措施对实践和患者及提供者的积极反馈促进了转诊。
结论
PR 转诊的障碍多于促进因素。提供者必须更好地与 PHCPs、COPD 患者和照顾者接触，并积极推广 PR。应考虑提高 PHCPs 对 PR 益处的认识、经济激励措施和替代转诊途径。
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