“You Leave There Feeling Part of Something”: A Qualitative Study of Hospitalized COPD Patients’ Perceptions of Pulmonary Rehabilitation

Kerry A Spitzer, 1 Mihaela S Stefan, 1–3 Aubri A Drake, 1 Quinn R Pack, 1– 4 Tara Lagu, 1, 2 Kathleen M Mazor, 5 Victor Pinto-Plata, 6 Peter K Lindenauer 1, 3, 7 1Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield, MA, USA; 2Department of Internal Medicine, Baystate Medical Center, Springfield, MA, USA; 3Department of Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, USA; 4Division of Cardiovascular Medicine, Baystate Medical Center, Springfield, MA, USA; 5Meyers Primary Care Institute, a Joint Endeavor of the University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, MA, USA; 6Pulmonary and Critical Care Medicine Division, Baystate Medical Center, Springfield, MA, USA; 7Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USACorrespondence: Kerry A SpitzerInstitute for Healthcare Delivery and Population Science University of Massachusetts Medical School-Baystate, 3601 Main Street, Springfield, MA 01199, USATel +1 413-794-7909Email Kerry.Spitzer@baystatehealth.orgRationale: Current guidelines recommend that patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease (COPD) initiate pulmonary rehabilitation (PR) shortly after discharge from the hospital. However, fewer than 2 percent of Medicare beneficiaries do so. Few studies have examined hospitalized patients’ perceptions of the barriers and facilitators to enroll in PR. The aim of this study was to develop an understanding of these factors by interviewing patients.Methods: We conducted semi-structured interviews with patients during a hospitalization for COPD exacerbation in a large teaching hospital. Directed content analysis was used to code and analyze interview transcripts.Results: Of the 15 patients we interviewed, 9 had participated in PR prior to their hospitalization, 10 were women; 4 were black, and 1 was Hispanic. Facilitators of enrollment included a desire to learn more about the disease, social support, and trust in the health-care provider recommending PR. Barriers to enrollment included lack of awareness, family obligations, lack of motivation, and transportation. For those who had previous experience with PR, but who did not complete the program, another barrier was not feeling well enough. Facilitators to adherence included the educational component of the program; feeling better through exercise; and a social connection with both participants and staff. For some patients. PR contributed to a renewed sense of hope or meaning. Most interviewees expressed interest in a peer coaching program.Conclusion: Our results highlight the importance of increasing awareness of PR and building trust between the provider and patients to facilitate initial enrollment. Future interventions to improve enrollment and adherence should address the need for education about the benefits of PR and the value of social support.Keywords: chronic obstructive pulmonary disease, COPD, pulmonary rehabilitation, hospitalization, patient perspectives