Barriers and facilitators for referring patients with chronic obstructive pulmonary disease to pulmonary rehabilitation and physical activity recommendation: a qualitative study

• Autor(a) principal: Dorásio da Silva, Laura Bianca
• Data de Publicação: 2022
• Outros Autores: de Oliveira , Hugo Henrique, Gomes Neves, Luis Henrique, da Silva Teixeira, Isabella, Alves Cabral, Laura, Oliveira, Cristino
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: HU Revista (Online)
• Texto Completo: https://periodicos.ufjf.br/index.php/hurevista/article/view/36278
• topic: Atenção Primária à Saúde; Doença Pulmonar Obstrutiva Crônica; Reabilitação; Exercício Físico; Primary Health Care; Pulmonary Disease, Chronic Obstructive; Rehabilitation; Exercise

Introduction: Chronic obstructive pulmonary disease (COPD) has a high prevalence and entails high costs to health systems. Pulmonary rehabilitation (PR) is a non-pharmacological intervention that generates clinical benefits for patients and cost savings for the health system due to a reduced number of exacerbations and hospitalizations. Although strongly recommended, PR has been underutilized, with a low rate of indications. Objective: To identify barriers and facilitators for referring patients with COPD to PR and physical activity. Method: Qualitative study was carried out with medical staff working in primary health care using semi-structured interviews. The interviews were recorded, transcribed literally and underwent content analysis. Items (text excerpts) identified in the speeches and related to the referral of patients with COPD to PR and physical activity were classified according to as barriers or facilitators, and among the fourteen domains of the Theoretical Domains Framework (TDF) and its definitions; aiming to identify the determinants of behaviour which were relevant to change in clinical practice. Results: Seven hundred and fifty-six items were identified in the speeches of twenty-one participants and classified as barriers (n= 279, 37%) or facilitators (n= 477, 63%) mainly related to the TDF domains of "Knowledge" (n= 245, 32%), "Context and environmental resources" (n=124, 16%) and "Role and social/professional identity" (n= 107, 14%). Conclusion: The main barriers identified were related to referring patients PR due to lack of knowledge by medical staff about PR programs, the limited number of programs available, and the restricted access to PR program locations. The main facilitators were related to physical activity, mainly the medical staff’s knowledge on physical activity benefits and availability of exercise group activities delivered at primary health care centres.