Introduction/Aim: Pulmonary rehabilitation (PR) improves exercise capacity, symptoms and quality of life in patients with chronic obstructive pulmonary disease (COPD). PR also reduces hospital admissions following an exacerbation. However, only a small proportion of patients access PR. This audit aimed to assess barriers to utilization of the local PR program within the Mackay Hospital and Health Service.

Methods: A retrospective audit using data from the Electronic Medical Record was conducted. All adults with symptomatic COPD who were reviewed in outpatient Respiratory clinic during January 2021 and who presented to Mackay Base Hospital with an exacerbation of COPD from January 2021 to March 2021 were included. Rates of referral to PR were calculated and for inpatients, stratified according to clinical department caring for the patient. Patients were excluded if they met PR exclusion criteria as per Lung Foundation Australia guidelines. Rates of attendance to PR and completion rates for new patients with appointments from January 2021 to June 2021 were calculated. Documented reasons for non-attendance were noted.

Results: 21 of 67 (31%) of eligible inpatients were referred to PR following an inpatient admission with exacerbation of COPD. All referrals were from General Medical rather than Subspeciality or Emergency Medicine departments (21/49 [43%] vs. 0/18 [0%]). 5/50 (10%) of patients were referred following outpatient review. Seventeen of 38 (45%) patients offered PR attended any session and, of those, 7 (41%) subsequently completed PR. Common reasons for non-attendance were patients not wanting to attend (11), no response from patient (5), becoming medically unfit (5) or unsuitable times (4).

Conclusion: PR is an underutilized intervention for COPD within this centre. Barriers occur at multiple levels, with low clinician referral rates a significant contributor, as well as low attendance and completion rates for those referred. Further quality improvement should address key underlying service, clinician and patient-related factors.

Key words: pulmonary rehabilitation, COPD, audit.

Grant Support: Nil.