Factors associated with adherence to pulmonary rehabilitation in patients with COPD in family health centers and hospitals in Chile from the perspective of professionals: A cross-sectional study

Abstract

Background/objective: Pulmonary rehabilitation (PR) is a central component in the treatment of chronic obstructive pulmonary disease (COPD), although it is not widely used and between 40 and 60% of patients do not adhere. Low adherence has been associated with clinical and sociodemographic factors. However, no factors associated with adherence have been described in Chile. Therefore, we aimed to determine factors associated with adherence to pulmonary rehabilitation in patients with COPD in family health centers and hospitals in Chile. Methods: A quantitative, observational, analytical and cross-sectional study was designed considering PR programs conducted in 2019. A non-probabilistic sample was obtained by convenience. Characteristics of the centers, perceived influence of clinical/sociodemographic variables on adherence to PR were determined and, subsequently, the estimated value of clinical variables in PR adherents and non-adherents by center were determined, using a questionnaire designed, validated in this study and sent by email. Results: Twenty-nine responses were obtained (8.7%). Professionals indicated that 45% of patients adhere to PR and, from their perspective, age, dyspnea, cardiorespiratory capacity, tobacco use, exacerbations, travel time, access to transportation and level of education are factors that influence adherence. When values of clinical variables estimated by professionals in adherent and non-adherent patients are analyzed, the frequency of smokers was the only factor associated with adherence (OR 0.96, 95% CI 0.93–0.99). Conclusions: The factors found by the present study may be useful in the development of strategies aimed at improving adherence to PR, for example, by supporting smoking cessation.