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New approaches to PR

Read how PR providers have tried new ways to boost the number of people referred to PR and the number of people successfully completing the course.

Case studies

  1. How marketing can boost PR referrals
  2. Having a psychologist on the team to improve completion rates
  3. A new way of delivering tailored patient education in PR
  4. Using volunteer buddies to improve patient confidence and completion rates

How marketing can boost PR referrals

Why did they do it?

Key challenges for PR providers are to improve referral rates and to make sure patients are referred within 90 days. In Hertfordshire, there were low referral rates and low awareness of PR among COPD patients. To improve referral rates, the PR provider for the Hertfordshire Community NHS Trust ran a year-long marketing campaign.

What did they do?

A variety of approaches were adopted. They included displaying course information on computer and TV screens in hospitals and GP surgeries, social media activity and a promotional video on the Hertfordshire Community Trust’s website and YouTube. Patients were also invited to refer themselves.


Referrals to PR group across east and north Hertfordshire increased by 34% over the first year, and by a further 48% the following year too.

Having a psychologist on the team to improve completion rates

Adult Cardiorespiratory Enhanced and Responsive service (ACERs), who provide pulmonary rehabilitation at Homerton hospital, successfully piloted including a psychologist in the team running the sessions.

Why did they do it?

ACERs had the problem highlighted by the National Pulmonary Rehabilitation Audit in 2015 – low rates of people completing PR.  Evidence suggested lack of social support or perceived benefits as two reasons (Boutou et al. 2014). ACERs wanted to explore why people didn’t attend and identify those at risk of dropping out to boost completion rates.

What did they do?

ACERs piloted a trainee psychologist attending a PR class of 11 patients once a week. If someone didn’t attend, the psychologist gave them a call to explore why. The psychologists also offered 1:1 sessions to help people engage with the course.  


  • Completion of this PR course was 91% compared to ACER’s 2015 rate of 31%.
  • ACERs found people who had thought of dropping out felt they weren’t supported and weren’t motivated because they didn’t appreciate how they would benefit.
  • After talking to the psychologist, they said they felt they were listened to. They appreciated a follow-up phone call if they didn’t attend. Both made them feel they were being supported.
  • The cost of a trainee psychologist and their supervision is low compared to the long-term benefits of a patient completing PR (in terms of fewer flare-ups and hospital admissions).
  • As a result of such positive results, ACERs will embed this into all PR courses.

A new way of delivering tailored patient education in PR

South Lakes Community Respiratory Services (SLCRS) successfully piloted delivering PR education for all lung diseases separately from exercise sessions. 

Why did they do it?

SLCRS recognised that there were many patients not getting PR - on the waiting list or from within secondary care and primary care - who would benefit from the education sessions. Some patients were too tired after exercising to take in PR education sessions.

What did they do?

SLCRS developed disease-specific education workshops on COPD, bronchiectasis and ILD as well as generic education on symptoms and lifestyle. They opened them up to patients on the waiting list, those seeing other colleagues (for chest physiotherapy, OT and in nursing homes) and to patients not known to the community respiratory service (primary care). 


  • Access to education improved, with a 115% increase in patients (+77) attending the workshops. 
  • 63% of patients accessed the workshops before they had started their PR class, so they got the information sooner.
  • Patient satisfaction with the content and delivery was very positive.

Using volunteer buddies to improve patient confidence and completion rates

Bristol Community Health Community Respiratory Team (BCHCRT) works with volunteers to support patients attending PR.

Why do they do it?

The exercise buddy volunteer supports patients less confident about taking part and those unsure about exercising. Most buddies have attended PR themselves, so they know the exercises, how exercise has helped them and the PR staff know them.

What do they do?

Volunteer buddies offer verbal support and encouragement to attendees, demonstrate how to use equipment and encourage patients to complete their exercise routines. Buddies also help with writing down exercises and other admin for attendees.

They are trained by the PR staff about COPD, PR and the gym. During sessions they are supervised by the PR staff and report any signs or symptoms they come across to PR staff. Volunteer buddies provide handholding and advice, or motivate and encourage to PR patients.


Patient feedback is very positive. Patients say they are more confident and it helped them complete the course. Many volunteers felt their involvement enabled PR staff to spend more time with those patients who needed it. 28% more patients with buddies completed the course than those without. And more patients with buddies attended exercise maintenance classes afterwards.