H. Vreeken1, M. van Doormaal1, E. Beekman2,3, M. Spruit4,5, G. Meerhoff1,6
1Royal Dutch Society for Physical Therapy, Quality, Amersfoort, Netherlands, 2Zuyd University of Applied Sciences, Research Centre for Autonomy and Participation of Persons With a Chronic Illness, Heerlen, Netherlands, 3Maastricht University Medical Centre, CAPHRI School for Public Health and Primary Care, Maastricht, Netherlands, 4CIRO+, Department of Research and Development, Horn, Netherlands, 5Maastricht University Medical Center (MUMC+), Department of Respiratory Medicine, Maastricht, Netherlands, 6Radboudumc, Institute for Quality in Health Care (IQ Healthcare), Nijmegen, Netherlands

Background: Extensive research of the Dutch government (National Health Care Institute) concluded physiotherapy (PT) for COPD is effective, but highly underused. Per year only 5% of diagnosed COPD patients visit a physiotherapist. Health care professionals (physiotherapists, general practitioners and pulmonologists) are asked to develop clear criteria for referral to primary care PT and interdisciplinary pulmonary rehabilitation (PR) in order to provide effective COPD care in the Netherlands.

Purpose: To increase the referral rates and use of PT by patients with COPD through agreement with all disciplines on clear referral criteria.

Methods: A multidisciplinary group including all relevant health care professionals and other stakeholders, such as patients and health insurers, elaborated on the clinical question about referral criteria as part of the development of a new guideline on physiotherapy in COPD. They first determined the relevant parameters to determine to most adequate care; no PT, PT in primary care or PR. Secondly the multidisciplinary group determined the criteria for referral.

Results: The disease instability and the self-reported burden of disease were determined as the most important parameters for referral of patients with COPD to PT in primary care or PR. Disease instability was defined as a recent hospitalization because of an acute exacerbation of COPD (yes/no). The burden of disease was defined using the Clinical COPD Questionnaire (CCQ) or COPD Assessment Test (CAT); no or low (CCQ <1.0 point or CAT <10 points), mild-to-moderate (CCQ 1.0–1.8 points; CAT 10–17 points) or high burden of disease (CCQ ≥1.9 points or CAT ≥18 points). Patients with low burden of disease are not referred to PT. Patients with mild to moderate burden of disease are referred to PT in primary care. Patients with high burden of disease or patients who are admitted to the hospital because of an exacerbation are screened for PR.

Conclusion(s): Consensus between healthcare professionals and other stakeholders like patients and health insurers was reached on clear referral criteria for primary care PT and PR in patients with COPD. This consensus was published as a recommendation in the new KNGF-guideline COPD.  

Implications: To improve quality of care, the referral rate should increase drastically. Research on the burden of disease shows that two-third of the current patients with COPD should be referred to primary care PT or interdisciplinary PR according to the new referral criteria. Because the number of COPD patients who make use of PT currently does not exceed 5%, it is important that the new criteria are supported and implemented by all relevant healthcare disciplines, including physiotherapists, general practitioners and pulmonologists.

Funding, acknowledgements: Royal Dutch Society for Physical Therapy

Keywords: COPD, multidisciplinary criteria, referral

Topic: Cardiorespiratory

Did this work require ethics approval? No
Institution: N/A
Committee: N/A
Reason: Development in practice and policy

All authors, affiliations and abstracts have been published as submitted.

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