Box 2.

Topic guide

Could you tell me in what context do you currently see COPD patients? (for example, planned — annual review/flu jab or unplanned — exacerbation) On average how many COPD patients do you think you see per week? Do you currently refer to pulmonary rehabilitation programmes? What is your understanding/view surrounding pulmonary rehabilitation programmes in general? … And in relation to your local provider? Do you think pulmonary rehabilitation is beneficial for patients? In what ways? Or why not? How easy or difficult is it for you to refer to your local pulmonary rehabilitation provider? (for example, is it your role to refer? When is it appropriate to refer COPD patients to pulmonary rehabilitation?) What motivates you to refer patients to pulmonary rehabilitation? (for example, do patients/carers ever ask you about pulmonary rehabilitation? Does the post-pulmonary rehabilitation patient summary motivate you? Are you reminded by prompts or other guidance?) What do you think stops you from referring patients to pulmonary rehabilitation? Imagesa — two images shown to each PHCP, the sequence (A & D) or (B & C) alternated to reflect sex and possible disease severity differences. If this person was your COPD patient, would you consider discussing pulmonary rehabilitation with them? Why?/Why not? Is there anything that you think could improve the primary care discussion surrounding pulmonary rehabilitation and/or encourage you to make referrals to pulmonary rehabilitation?

^aThe images are available from the authors on request. COPD = chronic obstructive pulmonary disease.