Few COPD Patients Enroll in Pulmonary Rehabilitation, Despite Benefits, Study Shows

Very few patients with chronic obstructive pulmonary disease (COPD) start pulmonary rehabilitation after being hospitalized, despite its proven benefits and clinical guidelines recommending it shortly after discharge, a study shows.

Study results were published in the journal Annals of the American Thoracic Society, in an article titled “Participation in Pulmonary Rehabilitation Following Hospitalization for COPD among Medicare Beneficiaries.”

Pulmonary rehabilitation programs are tailored to patients and offer physical training, self-management advice, nutrition counseling, and emotional support. They are recommended by healthcare professionals and have been shown to benefit COPD patients, improving their physical and psychological well-being, as well as their quality of life.

Medicare, a national health insurance program in the U.S., expanded coverage to include pulmonary rehabilitation in 2010. However, according to a survey commissioned by the American Thoracic Society, 62% of COPD patients aren’t even aware these programs exist.

The present study analyzed how many COPD patients enrolled in pulmonary rehabilitation programs after hospitalization.

Researchers included claims data — healthcare data collected for billing and administration — from 223,832 Medicare beneficiaries hospitalized for COPD in 2012. Most of the participants had a primary COPD diagnosis, while the remaining had acute respiratory failure with a secondary COPD diagnosis.

They found that pulmonary rehabilitation participation following hospitalization was low. Following discharge, only 1.9% received pulmonary rehabilitation within six months, and 2.7% within 12 months.

Results also showed that prior home oxygen use was the strongest indicator for patients starting pulmonary rehabilitation within six months. Apart from that, being younger, white, and having a higher socioeconomic status (measured by Medicaid eligibility) were factors associated with an increased likelihood of beginning pulmonary rehabilitation within six months.

In contrast, smokers and patients who had to travel more than 10 miles to facilities were less likely to enroll in pulmonary rehabilitation programs.

More than half of the participants who started rehabilitation completed 16 sessions, and about 10% completed 35 sessions or more. Medicare typically pays for up to 36 sessions.

Kerry A. Spitzer, PhD, senior clinical research coordinator at Baystate Medical Center in Massachusetts and lead author of the study, believes that more research is needed to understand the low participation rate in pulmonary rehabilitation programs among COPD patients, and strategies to increase it.

“Unfortunately, many patients face multiple barriers to participating, such as family responsibilities or transportation, and participation rates are especially low among vulnerable populations,” Spitzer said in a press release.

Previous studies have shown that pulmonary rehabilitation can reduce disease exacerbation and hospitalization in COPD patients. Due to its benefits, patients are typically recommended to begin pulmonary rehabilitation within three weeks after hospital discharge.

“As hospitals and health systems, like ours, increase efforts to keep patients with COPD healthy and out of the hospital, we have prioritized enrolling patients into our rehabilitation program prior to hospital discharge. As a result, we are seeing improvements in readmission rates among patients with COPD,” said Peter Lindeauer, MD, the study’s senior author, a hospitalist at Baystate Medical Center, and director of the Institute for Healthcare Delivery and Population Science at the University of Massachusetts Medical School.