Pulmonary Rehabilitation is an evidenced-based approach to help with the management of lung conditions such as COPD using prescribed exercise and targeted education. People with respiratory problems such as COPD are known to struggle with symptoms on a daily basis which Pulmonary Rehabilitation can help with, such as breathlessness. Although the evidence states that it can help with reducing admission, help with the quality of life and anxiety management. Retention to programs can be a problem due to multiple factors such as access, location, transport, co-morbidities, and deteriorating health, this is recognized nationally.
We decided to review and audit our current programs covering Basildon, Brentwood and Thurrock CCGs completion rates for Pulmonary Rehabilitation to see how the team was performing in comparison to the national average stated in the 2018 Pulmonary Rehabilitation Audit which was 45%.
The results for the catchment time audited show that Kelly-Ann and her team are reaching a higher completion rate than the national average of 45% at 61% in consecutive years; these are patients that have completed the program and attended an initial and final assessment to gauge benefit.
The reasons for this could be many, including patient buy-in, positive opinion of the treatment option from referring clinicians, encouragement, structure of the program and also active follow up from the staff on the team. These are obviously difficult to quantify and qualify and patients being individuals may find one or all of these beneficial.
The team currently have multiple locations across the CCGs increasing the access to this service which undoubtedly is one of the reasons that completion rates are higher, more location options and more time options giving rise to the increased access.
Kelly-Ann and her team also keep a high profile of Pulmonary Rehabilitation in the area and engage with the medical community, as well as the patient community, creating positive relationships which are likely to be a factor for higher completion rates. First, the medical community understand the importance of Pulmonary Rehabilitation so are more able to discuss this with the appropriate patient but they also know the team they are referring too. Secondly, the engagement with local patient groups, family members and constant contact and support for patients on the caseload helps build a positive relationship, this could be argued as a factor for increased rates of completion; the patient has buy-in and knows the team; helping with their compliance to attend such programs.
My recommendations from this are that although the current figures shown are above the national average it still shows that there are those that can’t, don’t or won’t attend. Barriers for attending need to be found and addressed to improve and evolve the service further; to provide a more inclusive approach with more options for the patient to access the benefits that can be attained by Pulmonary Rehabilitation. The team does this by asking for feedback from those that use the service and where practicable action suggestions.
Alternatives to standard Pulmonary Rehabilitation format need to be assessed, trailed and researched in real-time. Possibilities include looking into adapting and standardising a home Pulmonary Rehabilitation Program, creating a standardised pathway for those that are too unwell to attend traditional Pulmonary Rehabilitation. Although the team currently do provide Home Pulmonary Rehabilitation, it is limited due to high levels of one to one input required and no standardised format for this approach has been found nationally.
The use of technologies is also an area that needs to be considered for the future. This approach could be beneficial to those that are younger with more technological know-how or who work, thus unable to commit to a face to face approach. Research in this area is currently limited so true benefit is unknown; the team has access to an app which if a patient fits criteria will be encouraged to use.
In short, there needs to be a constant cycle of evaluation, action, and evaluation within the team and further audit on new incentives to evaluate effectiveness, common barriers need to be found and where possible removed to further increase patient completion of Pulmonary Rehabilitation programs.