Perceived barriers and criteria for referral to pulmonary rehabilitation used in primary health care by general practitioners

Introduction: Chronic obstructive pulmonary disease encompasses both pharmacological and non-pharmacological components. The most cost-effective non-pharmacological component is pulmonary rehabilitation, an individualised, comprehensive intervention, including exercise training, education, and behavior change, to improve the physical and psychological condition and promote adherence to long-term healthy behaviors. The aim was to understand the habits and barriers perceived by Portuguese general practitioners when referring people with chronic obstructive pulmonary disease to pulmonary rehabilitation and the criteria valued in decision-making. Methodology: We conducted a cross-sectional study to assess general practitioners' knowledge, referral practices, and perceived barriers regarding pulmonary rehabilitation using an online questionnaire. The questionnaire evaluated knowledge of PR benefits, referral criteria, and existing barriers. Results: Sixty-one responses were obtained, of which 31.1% (n=19) never referred to PR. Of those who were referred, the most used criterion for referral, 78.5% (n=33), was functional limitation. This criterion was considered extremely important for referral by 64% (n=39) of the participants in this study. Discussion: To increase referrals to pulmonary rehabilitation, doctors must raise awareness of the advantages of these programmes. Publicising existing programmes is essential to ensure that general practitioners know these responses. Information from the assessment of the impact of pulmonary rehabilitation programmes on a person's condition should be shared. Conclusion: Insufficient available PR programmes, Lack of patient adherence and feedback of programme outcomes and lack of knowledge of referencing criteria are the most perceived barriers by general practitioners to referring patients to pulmonary rehabilitation programmes.