医护人员对慢性阻塞性肺疾病患者开展居家肺康复阻滞因素及应对策略的质性研究

Background: The latest epidemiological survey shows that there are about 100 million patients with chronic obstructive pulmonary disease(COPD) in China, about 1 million people die of respiratory diseases each year, and more than 5 million people become disabled due to respiratory diseases. The effectiveness of home-based pulmonary rehabilitation is as good as hospital and community pulmonary rehabilitation in improving the quality of life and lung function of COPD patients. However, there are few studies showing the barriers to the delivery of home-based pulmonary rehabilitation from the perspective of physicians and nurses. Objective: To investigate the barriers to the delivery of home-based pulmonary rehabilitation based on a survey of physicians and nurses blocking the quality of life and lung function of COPD. Methods: From July to November 2019, in-depth semi-structural interviews regarding the barriers to the delivery of home-based pulmonary rehabilitation based on a self-developed framework were carried out in a purposive sample of 14 medical workers from respiratory and rehabilitation departments of a grade A tertiary hospital in Shanghai. Content analysis was performed to sort out and analyze the recorded interview results. Results: Three themes with nine sub-themes(each including three sub-themes) were extracted: patients' negative health, cognitive, and psychological conditions(prevalence of multiple comorbidities and low motivation of receiving home-based pulmonary rehabilitation; insufficient knowledge of home-based pulmonary rehabilitation; distrust of the efficacy of home-based pulmonary rehabilitation and low exercise compliance). Physicians and nurses' insufficient knowledge and trainings and attentions regarding home-based pulmonary rehabilitation(insufficient related knowledge and feeling incompetent to carry out home-based pulmonary rehabilitation; insufficient related standard trainings; insufficient attentions paid to home-based pulmonary rehabilitation by hospitals and related departments ). Limited capacities at the organizational level for the delivery of home-based pulmonary rehabilitation(inadequate communication and cooperation among the hospital, community and family and imperfect follow-up monitoring system; insufficient medical professionals for delivering such services; lack of systematic rehabilitation training mode and simple and practical evaluation indicators). Conclusion: There are many barriers to the delivery of home-based pulmonary rehabilitation. To address these barriers to make sure COPD patients can really benefit from home-based pulmonary rehabilitation, strengthened professional trainings for physicians and nurses to improve their knowledge, more attentions paid to the guidance on home-based pulmonary rehabilitation are needed, with the joint help of social supports as well.