Older Adults with COPD in Rural Arizona: An Evaluation of Barriers to Pulmonary Rehabilitation Referrals

Abstract

Chronic Obstructive Pulmonary Disease (COPD) exacerbations and hospitalizations are increasing. COPD readmissions are also becoming a burden to the healthcare system. Pulmonary rehabilitation (PR) is a treatment modality that has shown to reduce hospital readmissions by as much as 24% and increases the patient’s quality of life. Research has shown that only 9-16% of COPD patients discharged from the hospital after a COPD exacerbation were ever referred to a PR program. This study was designed to investigate the COPD hospital admission/readmission prevalence in a rural Arizona community. This study also investigated provider barriers to PR referrals, via a provider survey, and then made recommendations to systems and process to address these barriers to increase the number of provider PR referrals in a rural community in Arizona. It was found that the COPD hospital admission/readmission rates were significantly lower than the national average with 20.5-22.6% readmissions nationally with while readmission rates were at 4.2%. The provider survey results indicated several categories that affected the number of provider referrals to a PR program. These include lack of education for providers and patients; lack of provider time to initiate PR referrals; patient health status, home support and home responsibilities; and lack of patient progress and follow up data reporting. Recommendations to the study institution were designed to address these barriers.