Exploring the perspectives of pulmonologists on referrals for pulmonary rehabilitation in India: insights into current practices

Pulmonary rehabilitation (PR) is an evidence-based treatment for chronic respiratory diseases that improves physical and psychosocial health. However, global referral rates remain low, especially in resource-limited settings where unique barriers complicate the referral process. This survey examined the facilitators of and barriers to PR referral among pulmonologists in India. A cross-sectional survey of pulmonologists in India was conducted via a validated questionnaire (content validation index of 0.93) with open- and closed-ended questions on facilitators and barriers to the referral of an individual to a PR. A total of 114 pulmonologists participated in the survey. Among the pulmonologists, facilitators of PR referrals included the availability of a PR centre within the hospital or nearby (n = 71, 81%), the availability of trained professionals at the PR centre (n = 67, 76%), positive beliefs about PR (n = 64, 73%) and major barriers were limited centres offering PR (n = 70, 80%), and financial constraints for patients (n = 58, 66%). According to the pulmonologists, the factors that facilitated patients’ participation in the PR program were good family support (n = 73, 86%), patients’ level of motivation (n = 68, 80%), easy accessibility to the rehabilitation centre (n = 66, 78%), and the barriers were a lack of awareness of the benefits of the PR (n = 59, 69%), and inaccessibility to the rehabilitation program (n = 55, 65%). Our survey identified various facilitators and barriers encountered by pulmonologists while referring patients to PRs. These factors can inform the development of context-specific referral pathways to improve PR access in resource-limited settings.