Physicians’ Attitudes, Beliefs and Barriers to a Pulmonary Rehabilitation for COPD Patients in Saudi Arabia: A Cross-Sectional Study
Abstract
:1. Introduction
2. Methods
2.1. Study Design
2.2. Questionnaire Tool
2.3. Study Population and Sampling Strategy
2.4. Sample Size
2.5. Ethical Approval
2.6. Statistical Analysis
3. Results
3.1. Pulmonary Rehabilitation Referral Rate by Physicians’ Specialties
3.2. Physicians’ Opinions on Referring COPD Patients, Mode of Delivery and Component of Pulmonary Rehabilitation
3.3. Patient-Related Factors That Influence Referral Decision to Pulmonary Rehabilitation
3.4. Pulmonary Rehabilitation Referral Barriers
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Mathers, C.D.; Loncar, D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 2006, 3, e442. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Alqahtani, J.S.; Njoku, C.M.; Bereznicki, B.; Wimmer, B.C.; Peterson, G.M.; Kinsman, L.; Aldabayan, Y.S.; Alrajeh, A.M.; Aldhahir, A.M.; Mandal, S.; et al. Risk factors for all-cause hospital readmission following exacerbation of COPD: A systematic review and meta-analysis. Eur. Respir. Rev. 2020, 29, 190166. [Google Scholar] [CrossRef] [PubMed]
- Spruit, M.A.; Singh, S.J.; Garvey, C.; ZuWallack, R.; Nici, L.; Rochester, C.; Hill, K.; Holland, A.E.; Lareau, S.C.; Man, W.D.C.; et al. An official American Thoracic Society/European Respiratory Society statement: Key concepts and advances in pulmonary rehabilitation. Am. J. Respir. Crit. Care Med. 2013, 188, e13–e64. [Google Scholar] [CrossRef] [PubMed]
- Evans, R.A.; Singh, S.J. Minimum important difference of the incremental shuttle walk test distance in patients with COPD. Thorax 2019, 74, 994–995. [Google Scholar] [CrossRef] [Green Version]
- Vogelmeier, C.F.; Criner, G.J.; Martinez, F.J.; Anzueto, A.; Barnes, P.J.; Bourbeau, J.; Celli, B.R.; Chen, R.; Decramer, M.; Fabbri, L.M.; et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report. Am. J. Respir. Crit. Care Med. 2017, 195, 557–582. [Google Scholar] [CrossRef]
- Sakkijha, H.; Idrees, M.M. Saudi Guidelines on the Diagnosis and Treatment of Pulmonary Hypertension: Pulmonary hypertension due to lung diseases and/or hypoxia. Ann. Thorac. Med. 2014, 9 (Suppl. S1), S56–S61. [Google Scholar] [CrossRef]
- Aldhahir, A.M.; Alghamdi, S.M.; Alqahtani, J.S.; Alqahtani, K.A.; Al Rajah, A.M.; Alkhathlan, B.S.; Singh, S.J.; Mandal, S.; Hurst, J.R. Pulmonary rehabilitation for COPD: A narrative review and call for further implementation in Saudi Arabia. Ann. Thorac. Med. 2021, 16, 299–305. [Google Scholar] [CrossRef]
- Al Moamary, M.S.; Tamim, H.M.; Al-Mutairi, S.S.; Al-Khouzaie, T.H.; Mahboub, B.H.; Al-Jawder, S.E.; Alamoudi, O.S.; Al Ghobain, M.O. Quality of life of patients with chronic obstructive pulmonary disease in the Gulf Cooperation Council countries. Saudi Med. J. 2012, 33, 1111–1117. [Google Scholar]
- Al-Moamary, M.S.; Köktūrk, N.; Idrees, M.M.; Şen, E.; Juvelekian, G.; Abi Saleh, W.; Zoumot, Z.; Behbehani, N.; Hatem, A.; Masoud, H.H.; et al. Unmet need in the management of chronic obstructive pulmonary disease in the Middle East and Africa region: An expert panel consensus. Respir. Med. 2021, 189, 106641. [Google Scholar] [CrossRef]
- Hill, K.; Vogiatzis, I.; Burtin, C. The importance of components of pulmonary rehabilitation, other than exercise training, in COPD. Eur. Respir. Rev. 2013, 22, 405. [Google Scholar] [CrossRef] [Green Version]
- Holland, A.E.; Cox, N.S.; Houchen-Wolloff, L.; Rochester, C.L.; Garvey, C.; ZuWallack, R.; Nici, L.; Limberg, T.; Lareau, S.C.; Yawn, B.P.; et al. Defining Modern Pulmonary Rehabilitation. An Official American Thoracic Society Workshop Report. Ann. Am. Thorac. Soc. 2021, 18, e12–e29. [Google Scholar] [CrossRef]
- Alqahtani, J.S.; Alghamdi, S.M.; Aldhahir, A.M.; Althobiani, M.; Oyelade, T. Key toolkits of non-pharmacological management in COPD: During and beyond COVID-19. Front. Biosci. 2021, 26, 246–252. [Google Scholar]
- Milner, S.C.; Boruff, J.T.; Beaurepaire, C.; Ahmed, S.; Janaudis-Ferreira, T. Rate of, and barriers and enablers to, pulmonary rehabilitation referral in COPD: A systematic scoping review. Respir. Med. 2018, 137, 103–114. [Google Scholar] [CrossRef] [Green Version]
- Tang, C.Y.; Taylor, N.F.; McDonald, C.F.; Blackstock, F.C. Level of adherence to the GOLD strategy document for management of patients admitted to hospital with an acute exacerbation of COPD. Respirology 2014, 19, 1191–1197. [Google Scholar] [CrossRef]
- Perez, X.; Wisnivesky, J.P.; Lurslurchachai, L.; Kleinman, L.C.; Kronish, I.M. Barriers to adherence to COPD guidelines among primary care providers. Respir. Med. 2012, 106, 374–381. [Google Scholar] [CrossRef] [Green Version]
- Jenkins, S.; Hill, K.; Cecins, N.M. State of the art: How to set up a pulmonary rehabilitation program. Respirology 2010, 15, 1157–1173. [Google Scholar] [CrossRef]
- Ward, J.A.; Akers, G.; Ward, D.G.; Pinnuck, M.; Williams, S.; Trott, J.; Halpin, D.M. Feasibility and effectiveness of a pulmonary rehabilitation programme in a community hospital setting. Br. J. Gen. Pract. 2002, 52, 539–542. [Google Scholar]
- Maltais, F.; Bourbeau, J.; Shapiro, S.; Lacasse, Y.; Perrault, H.; Baltzan, M.; Hernandez, P.; Rouleau, M.; Julien, M.; Parenteau, S.; et al. Effects of home-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: A randomized trial. Ann. Intern. Med. 2008, 149, 869–878. [Google Scholar] [CrossRef]
- Alsubaiei, M.; Cafarella, P.; Frith, P.; McEvoy, R.; Effing, T. Factors influencing management of chronic respiratory diseases in general and chronic obstructive pulmonary disease in particular in Saudi Arabia: An overview. Ann. Thorac. Med. 2018, 13, 144–149. [Google Scholar] [CrossRef]
- Aboshaiqah, A. Strategies to address the nursing shortage in Saudi Arabia. Int. Nurs. Rev. 2016, 63, 499–506. [Google Scholar] [CrossRef]
- Kuzma, A.M.; Meli, Y.; Meldrum, C.; Jellen, P.; Butler-Lebair, M.; Koczen-Doyle, D.; Rising, P. Multidisciplinary care of the patient with chronic obstructive pulmonary disease. Proc. Am. Thorac. Soc. 2008, 5, 567–571. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Alsubaiei, M.E.; Frith, P.A.; Cafarella, P.A.; Quinn, S.; Al Moamary, M.S.; McEvoy, R.D.; Effing, T.W. COPD care in Saudi Arabia: Physicians’ awareness and knowledge of guidelines and barriers to implementation. Int. J. Tuberc. Lung Dis. 2017, 21, 592–595. [Google Scholar] [CrossRef] [PubMed]
- Horton, E.J.; Mitchell, K.E.; Johnson-Warrington, V.; Apps, L.D.; Sewell, L.; Morgan, M.; Taylor, R.S.; Singh, S.J. Comparison of a structured home-based rehabilitation programme with conventional supervised pulmonary rehabilitation: A randomised non-inferiority trial. Thorax 2018, 73, 29–36. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Alghamdi, S.M.; Rajah, A.M.A.; Aldabayan, Y.S.; Aldhahir, A.M.; Alqahtani, J.S.; Alzahrani, A.A. Chronic Obstructive Pulmonary Disease Patients’ Acceptance in E-Health Clinical Trials. Int. J. Environ. Res. Public Health 2021, 18, 5230. [Google Scholar] [CrossRef]
- McCarthy, B.; Casey, D.; Devane, D.; Murphy, K.; Murphy, E.; Lacasse, Y. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst. Rev. 2015, 2, Cd003793. [Google Scholar] [CrossRef]
- MacNee, W. Chronic Obstructive Pulmonary Disease, 5th ed.; Oxford University Press: Oxford, UK, 2010. [Google Scholar] [CrossRef] [Green Version]
- Tønnesen, P. Smoking cessation and COPD. Eur. Respir. Rev. 2013, 22, 37. [Google Scholar] [CrossRef]
- Badaran, E.; Ortega, E.; Bujalance, C.; Del Puerto, L.; Torres, M.; Riesco, J.A. Smoking and COPD exacerbations. Eur. Respir. J. 2012, 40 (Suppl. S56), P1055. [Google Scholar]
- Alqahtani, J.S.; Aldhahir, A.M.; Oyelade, T.; Alghamdi, S.M.; Almamary, A.S. Smoking cessation during COVID-19: The top to-do list. Npj Prim. Care Respir. Med. 2021, 31, 22. [Google Scholar] [CrossRef]
- Brown, A.T.; Hitchcock, J.; Schumann, C.; Wells, J.M.; Dransfield, M.T.; Bhatt, S.P. Determinants of successful completion of pulmonary rehabilitation in COPD. Int. J. Chronic Obstr. Pulm. Dis. 2016, 11, 391–397. [Google Scholar]
Demographic Variables | Frequency (%) |
---|---|
Gender | |
Male Female | 312 (62.0%) 190 (38.0%) |
Profession | |
Pulmonologist Internal medicine General physician Other | 33 (6.6%) 135 (26.9%) 257 (51.2%) 77 (15.3%) |
Years of experience with COPD patients | |
<1 year 1–2 years 3–4 years 5–6 years 7–8 years 9–10 years >10 years | 46 (9.2%) 64 (12.7%) 119 (23.7%) 111 (22.1%) 68 (13.5%) 29 (5.8%) 65 (12.9%) |
Responsibilities for the care of COPD patients | |
Diagnosis Urgent assessments Non-urgent care Ongoing management Admission prevention Medication check Prescribing Oxygen therapy In-patient treatment Outpatient clinics Primary care Other | 318 (63.3%) 291 (58.0%) 252 (50.2%) 301 (60.0%) 318 (63.3%) 225 (44.8%) 240 (47.8%) 206 (41.0%) 231 (46.0%) 238 (47.4%) 194 (38.6%) 13 (2.6%) |
Item | Frequency (%) |
---|---|
Patient Referral Pulmonologist | |
Yes No Not sure | 18 (54.5%) 10 (30.0%) 5 (15.0%) |
Internal medicine | |
Yes No Not sure | 42 (31.0%) 71 (52.5%) 22 (16.2%) |
General physician | |
Yes No Not sure | 70 (27.2%) 148 (57.5%) 39 (15.1%) |
Other profession | |
Yes No Not sure | 16 (20.8%) 52 (67.5%) 9 (11.6%) |
Item | Frequency (%) |
---|---|
Physicians’ perception of referring COPD patients to PR | |
I believe PR will improve patients’ exercise capacity | |
Strongly agree Agree Neutral Disagree Strongly disagree | 313 (62.2%) 136 (27.1%) 22 (4.4%) 4 (0.8%) 27 (5.4%) |
I believe PR would reduce dyspnea and fatigue | |
Strongly agree Agree Neutral Disagree Strongly disagree | 227 (55.2%) 157 (31.3%) 39 (7.8%) 8 (1.6%) 21 (4.2%) |
I believe PR will improve patients’ anxiety and depression | |
Strongly agree Agree Neutral Disagree Strongly disagree | 231 (46.0%) 187 (37.3%) 58 (11.6%) 6 (1.2%) 20 (4%) |
I believe PR will improve patients’ health-related quality of life | |
Strongly agree Agree Neutral Disagree Strongly disagree | 281 (56.0%) 174 (34.7%) 20 (4.0%) 8 (1.6%) 19 (3.8%) |
I believe PR will reduce the risk of future COPD exacerbation | |
Strongly agree Agree Neutral Disagree Strongly disagree | 259 (51.6%) 163 (32.5%) 47 (9.4%) 14 (2.8%) 19 (3.8%) |
I believe PR will reduce hospital readmission | |
Strongly agree Agree Neutral Disagree Strongly disagree | 262 (52.2%) 164 (32.7%) 48 (9.6%) 12 (2.4%) 16 (3.2%) |
I believe PR will improve patients’ nutritional status | |
Strongly agree Agree Neutral Disagree Strongly disagree | 217 (43.2%) 180 (35.9%) 75 (14.9%) 13 (2.6%) 17 (3.4%) |
I believe PR will improve patients’ disease self-management | |
Strongly agree Agree Neutral Disagree Strongly disagree | 269 (53.6%) 167 (33.3%) 36 (7.2%) 10 (2.0%) 20 (4.0%) |
The best way to deliver a PR program for COPD patients | |
At home. In-hospital supervised program. Online program with healthcare provider support. Tailored program with healthcare provider support through phone. | 379 (75.5%) 321 (63.9%) 223 (44.4%) 112 (22.3%) |
Component of PR program aside from exercise component | |
Smoking cessation Symptoms management Information about COPD disease Psychological support Information about medications Nutritional counseling | 448 (89.2%) 406 (80.9%) 402 (80.1%) 363 (72.3%) 318 (63.3%) 267 (53.2%) |
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Aldhahir, A.M.; Alqahtani, J.S.; Alghamdi, S.M.; Alqarni, A.A.; Khormi, S.K.; Alwafi, H.; Samannodi, M.; Siraj, R.A.; Alhotye, M.; Naser, A.Y.; et al. Physicians’ Attitudes, Beliefs and Barriers to a Pulmonary Rehabilitation for COPD Patients in Saudi Arabia: A Cross-Sectional Study. Healthcare 2022, 10, 904. https://doi.org/10.3390/healthcare10050904
Aldhahir AM, Alqahtani JS, Alghamdi SM, Alqarni AA, Khormi SK, Alwafi H, Samannodi M, Siraj RA, Alhotye M, Naser AY, et al. Physicians’ Attitudes, Beliefs and Barriers to a Pulmonary Rehabilitation for COPD Patients in Saudi Arabia: A Cross-Sectional Study. Healthcare. 2022; 10(5):904. https://doi.org/10.3390/healthcare10050904
Chicago/Turabian StyleAldhahir, Abdulelah M., Jaber S. Alqahtani, Saeed M. Alghamdi, Abdullah A. Alqarni, Shahad K. Khormi, Hassan Alwafi, Mohammed Samannodi, Rayan A. Siraj, Munyra Alhotye, Abdallah Y. Naser, and et al. 2022. "Physicians’ Attitudes, Beliefs and Barriers to a Pulmonary Rehabilitation for COPD Patients in Saudi Arabia: A Cross-Sectional Study" Healthcare 10, no. 5: 904. https://doi.org/10.3390/healthcare10050904