Pulmonary rehabilitation (PR), a programme of exercise, education and psycho-social support, is recommended for patients with chronic obstructive pulmonary disease but referral rates are relatively low compared with need.

Working with primary care clinicians (GPs and practice nurses) from eight practices, this project developed strategies for influencing clinician and patient behaviours as a means of increasing referral rates for PR.

A participatory action research design was employed. Semi-structured questionnaires captured clinicians’ baseline knowledge of PR and their ideas for increasing referrals. Actionable changes were then recommended. Audits (at baseline, mid-point and end of project) were used to assess and initiate improvements in the quality of practice data about PR referrals. The impacts of these changes were explored via further clinician surveys (free text questionnaire). Semi-structured questionnaires, posted to patients eligible for PR, assessed their characteristics, and, where applicable, their views on PR referral processes and reasons for not wanting PR.

The baseline survey of clinicians (n=22) revealed inadequate knowledge about PR, particularly among GPs. Actionable changes recommended included in-house education sessions, changes to practice protocols, and ‘pop-ups’ and memory aids (mugs and coasters) to prompt clinician/patient discussions about PR. Audit findings resulted in changes to improve the quality and availability of coded information about patients eligible for PR. These changes, supported by clinicians (n=9) in the follow-up survey, aimed to facilitate and increase the quality of patient/clinician discussions about PR. Findings from the patient survey (n=126, response rate 25.7%) indicate that such changes will increase the uptake of PR as patients who accepted a referral for PR provided more positive feedback about their discussions with clinicians.

The strategies introduced were relatively easy to implement and the anticipated advantage is more patients accessing the health and quality of life benefits that PR offers.

To describe experiences among patients with chronic obstructive pulmonary disease (COPD) of the lasting usefulness one year after participating in a multidisciplinary pulmonary rehabilitation (PR) programme in a primary health care (PHC) setting.

COPD affects patients’ functioning in daily life. In a previous study, the patients participated in a programme for PR and were found to increase their functional capacity, quality of life and decrease exacerbations. The present study aims to provide a deeper understanding of the experience of participating in the programme.

The study has a descriptive, qualitative design and is part of a longitudinal study on a multidisciplinary programme for PR of patients with COPD.

Semi-structured interviews with 20 participants were performed and data analysed by qualitative content analysis.

The findings are presented in one theme that illustrates the participants’ experience of their current situation; I live life at my own pace, and three sub-themes illustrating this experience related to the participation in the programme; Awareness of limitations in my life; Regained control over my life; and No change in my life.

Irrespective of whether the patients had already found their own strategies for managing the disease or whether the programme changed their lives, they lived their lives at their own pace. However, their lives were shadowed by worry.

A multidisciplinary programme for PR in PHC could be an alternative for patients suffering from COPD, in order to facilitate for them in their daily life. It is suggested that the inclusion of patients in such groups should be based on each individual's need based on symptoms or functional capacity in everyday life, not based on spirometry values.