Introduction: The lack of referral constitutes a major problem for the participation of COPD patients in pulmonary rehabilitation (PR). We were interested in framing the barriers to referral reported by clinicians and patients using behaviour-related framework, in the primary care setting.

Methods: Scoping review using the Joanna Briggs Institute methodology. Records from Embase, Medline, Scopus, Web of Science, and PsycINFO databases were analysed - and one manually identified. Pilot and peer review for records screening and selection. Inclusion criteria: in context, primary quantitative and qualitative studies on barriers to referral.

Results: 9 out of 861 studies analysed - all from high-income countries (1-9). Two survey-based studies and seven interview-based studies. Two studies conducted among COPD patients and seven studies conducted among clinicians. 62 barriers framed in total; 21 reported by COPD patients and 41 by clinicians. Barriers related to knowledge on PR and the environmental context and resources were the most frequently reported. Unknown delivery location of PR and inconvenient timing were the most frequently cited barriers in these framework domains by COPD patients. Insufficient publicity, practical difficulties in making referrals, limited understanding of patient eligibility, the treatment itself and its delivery site were barriers frequently mentioned by clinicians in these domains.

Conclusions: Original review that showed multiple barriers to referral of COPD patients for PR in the primary care setting. Further studies are needed to understand how these barriers operate in the referral process.