Lauren M Manzo and Joanie C Jackson
Pulmonary Rehabilitation (PR) is an underutilized service for patients with COPD. This integrative review aims to compile current evidence-based research about the benefits of physician generated PR referrals for the moderate-tosevere COPD patient. An integrative review of the literature was initiated by searching these electronic databases: PubMed, The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Nursing and Allied Health, Health and Management, and Health and Wellness. The articles utilized for this review spanned from the years of 2010- 2018, except for two articles that were published in 2008. Types of articles included in this integrative review include randomized controlled clinical trials, quantitative studies, and qualitative studies. The number of studies included in this integrative review is 33. Referral to PR programs is recommended by COPD GOLD Guidelines and the American Thoracic Society. Physician PR referral rates is as low as 3%-16% due to health care provider and patient lack of awareness of both the benefits of PR and the PR referral process. Authors of these studies posit that providers who are knowledgeable of the PR referral process are more likely to initiate PR referrals. Findings from this integrative review are would be beneficial to the creation of a proposal to increase PR referrals in the primary care setting. Health care provider and patient limited knowledge about the benefits of PR for the moderate-to-severe COPD patient poses a clinical practice gap. Continued research centered around benefits of PR, barriers to referral, and a streamlined PR referral process is imperative to improve PR uptake and utilization.