Chronic obstructive pulmonary disease (COPD) is a leading cause of hospitalization in the United States. African American and Hispanic patients bear a high burden of illness and death due to COPD, with a prevalence similar to that of White patients but with poorer disease control. Both groups are disproportionately affected by social and economic inequalities that affect their access to care and are twice as likely to visit the emergency department for COPD-associated conditions than are non-Hispanic White individuals. Reasons for this high disease burden are complex and include higher rates of smoking, reduced health access (especially to pulmonary rehabilitation [PR]), and lower socioeconomic status. Early referral to PR after admission for COPD improves quality of life (QOL) and decreases hospital readmissions. Unfortunately, referral and uptake rates are poor among all persons with COPD and even worse for those from racial/ethnic minority groups. Telehealth-delivered PR (TelePR) for COPD is equivalent to standard clinic-based (ie, outpatient) PR (SPR), in terms of QOL and exercise capacity, and superior in terms of patient adherence in individuals with COPD, most of whom were White in nonrandomized studies. A referral to TelePR may lead to improved outcomes because TelePR has the potential to overcome many barriers that are more pronounced in populations of patients with an increased risk of health disparities and health care disparities.
