Abstract
BACKGROUND: In high-altitude areas, while pulmonary rehabilitation (PR) is recognized as an effective intervention for enhancing exercise tolerance and reducing breathlessness, delivering these programs to patients living at high altitudes presents unique, environment-specific challenges. This study aimed to systematically investigate the current status, barriers, and optimization pathways for PR in patients with pulmonary hypertension (PH) in high-altitude areas, from the perspective of medical staff. METHODS: A mixed-methods design was employed, comprising a questionnaire survey of 326 medical staff and semi-structured interviews with 16 staff members from three tertiary hospitals in Xining, Qinghai Province. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using thematic analysis. RESULTS: Quantitative results revealed that only 62.58% of participants reported the implementation of PR in their departments. While 55.39% indicated that they adjusted the content of PR according to the high-altitude environment. Major barriers identified included insufficient awareness among patients and family members (90.80%), lack of high-altitude PR guidelines (88.04%), and shortage of healthcare human resources (87.42%). Optimization suggestions focused on developing high-altitude PR guidelines (86.50%), increasing in rehabilitation resources (82.82%), and improvement of patients' compliance (78.22%). Qualitative findings identified three core themes: current status of PR and effects, barriers to implementing PR, and optimization suggestions, with 13 subthemes. The quantitative and qualitative findings corroborated each other, indicating insufficient clinical penetration, a lack of standardization, and intertwined multi-level barriers for PR in high-altitude areas. Optimization needs were highly concentrated on guideline development, resource supplementation, technology empowerment, and policy support. CONCLUSION: Pulmonary rehabilitation for PH in high-altitude areas exhibits low adoption rates and poor standardization based on medical staff reports, facing a complex barrier system. There is a need to establish an integrated solution centered on high-altitude guidelines, supported by digital technology, and grounded in policy guarantees to facilitate a shift from the current fragmented, experience-based practice toward standardized and systematic services.