PULMONARY REHABILITATION

02 About PR 05 How do patients benefit from pulmonary rehabilitation?

06 Clinical Engagement Coordinator

Newsletter

BOC: Living healthcare

Breathe Easy Week18th - 24th June 2018

BOC Healthcare supported this annual week of awareness & focus on lung health by sharing information with healthcare professionals about pulmonary rehabilitation (PR).

Our aim is to highlight and remind healthcare professionals about the the health outcomes which PR can offer, as well as sharing feedback from patients who have attended a PR programme and the impact it has had on their lives.

About PR02 Pulmonary Rehabilitation Newsletter

What is PR?

Pulmonary rehabilitation is an evidence-based intervention for people with diagnosed chronic lung conditions. It is a six-week programme comprising of exercise & education to help patients:

• manage breathlessness• improve their ability to exercise• learn to self-manage their condition• reduce anxiety & depression.

It is delivered in community settings by qualified respiratory specialists & technical instructors.

Evidence of the health outcomes is documented in:• Global Initiative for Chronic Obstructive

Lung Disease (GOLD) (2016 & 2017)• British Thoracic Society (BTS): Guideline on

Pulmonary Rehabilitation in Adults (2013)• NICE Quality Standard COPD in Adults (2016)

It is also one of the most cost-effective COPD interventions after the flu jab and smoking cessation.

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What is it not?

Pulmonary rehabilitation is not just for COPD sufferers: it can improve exercise capacity in people with a variety of respiratory conditions such as bronchiectasis, interstitial lung disease (ILD) & asthma.

It is not an aerobics class: patients will exercise, under supervision, only within their ability.

Who should be referred for pulmonary rehabilitation?

People should be considered for referral to pulmonary rehabilitation who:

• Have an MRC dyspnoea score of 3-5 (might be worth having a copy of the MRC scoring here or visible somewhere.)

Reproduced with permission of V. Mak, NHSE London Respiratory Network (May 2017)

Flu vaccination? £1000/QALY in “at risk” population

Stop Smoking Support with pharmacotherapy £2000/QALY

Pulmonary Rehabilitation £2000-8000/QALY

Tiotropium/LAMA £7000/QALY

LABA £5-8000/QALY

Long term Oxygen Therapy £11000-16000/QALY

Triple Therapy £7000-187000/QALY

Telehealth £92000/QALY

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• Have an MRC dyspnoea score of 2 and are functionally limited by breathlessness

• Have had a recent hospitalisation for an acute exacerbation of COPD

• Have previously attended pulmonary rehabilitation but have experienced deterioration in health status.

BTS Guidelines state that patients should be referred regardless of:• Smoking status• Presence of chronic respiratory

failure

• Co-existent stable cardiovascular disease

• Co-existent anxiety &/or depression

• Abdominal aortic aneurysm (AAA) ≤ 5cm (provided blood pressure is controlled).

For more information about referral criteria, contact your local pulmonary rehabilitation service on 0800 012 1858.

How do patients benefit from pulmonary rehabilitation?The 2015 National Pulmonary Rehabilitation COPD Audit recently reported:

05 Pulmonary Rehabilitation Newsletter

Six-Minute Walk Test

Bed days (mean) for those admitted within 180 days

0

⬛ Assessed but not completed PR ⬛ Completed PR

⬛ Improved ≥ MCID ⬛ Improved but < MCID ⬛ No change/worse

⬛ Improved > MCID ⬛ Improved < MCID ⬛ No change/worse

2 4 6 8 10 12

Health Status (CAT, SGRQ, CRQ)

BOC issues feedback surveys to all patients who complete pulmonary rehabilitation and the feedback is overwhelmingly positive:

“It far exceeded my goals. I feel like a new person.”

“Learnt so much and my breathing is now much easier to manage.”

“I didn’t really have any goals at the beginning. But it helped me have the confidence that I could do more than I thought I could. It taught me how to manage my illness and how important it is to exercise.“

“Excellent course, wish I had known about it sooner.”

“I feel more positive about the future now.”

Out of every 100patients referred to PR:

31 don’t attendan assessment

10 don’t enrol

17 don’t complete PR

42 complete their PR

59 enrol onto PR

69 attend anassessment

Clinical Engagement CoordinatorAs the 2015 Pulmonary Rehabilitation COPD Audit recently reported – see visual – getting patients through a pulmonary rehabilitation programme can be a challenge.

06 Pulmonary Rehabilitation Newsletter

Attending a six-week programme, twice a week, can feel like a burden for people, especially if they don’t fully understand what pulmonary rehabilitation is, nor what outcomes it can bring them.

We receive hundreds of referrals to pulmonary rehabilitation every year & have heard a wide range of concerns from patients, & their carers, about why they decline to attend a programme. We have

Reproduced with permission of Royal College of Physicians

07 Pulmonary Rehabilitation Newsletter

appointed a dedicated resource to engage with patients who decline a pulmonary rehabilitation assessment appointment: meet Amanda Anderson, our Clinical Engagement Coordinator.

What reasons do patients give for declining Pulmonary Rehabilitation?

Amanda: Some have transport difficulties or existing commitments (care for spouse or grandchildren, for example) but many are under a misapprehension of what pulmonary rehabilitation is. They have heard ‘exercise’ & think ‘aerobics’. They are scared to come because they feel too breathless to undertake an exercise class. PR hasn’t been explained to them well enough. People are more interested when they understand that there are talks in the programme about different aspects of their condition.

How do you motivate a patient who is breathless & anxious about exercise?

Amanda: I explain to them that exercise is only part of the programme, and that any exercise will be tailored to their ability (we are not training them to run a 5km race). I talk about the improvements in daily activity that other people have achieved (getting upstairs at home, doing the supermarket shop or getting back to golf), and ask them to think of what goal they might like to set themselves.

08 Pulmonary Rehabilitation Newsletter

I reassure them that they will be supervised by our respiratory specialists who will help them manage their breathlessness, whist they improve their muscle strength.

What other concerns do people raise?

Amanda: Some people don’t want to burden their carer in having to take them to the classes. I always tell them that carers are welcome to attend the classes with them. It’s just as important for their spouse or family member to learn about how the patient’s condition can be managed – all patients will receive a self-management plan on what to do if their symptoms change. Plus it’s good for carers to see that their loved one can keep active despite breathlessness because sometimes it’s the carer who has the most anxiety. Often they have become trapped by their partner’s breathlessness so carers can also benefit.

What other support can you offer about pulmonary rehabilitation?

Amanda: Patients will be given details of local support groups, such as Breathe Easy, when they attend the assessment and the programme classes. Our specialists also signpost them to relevant organisations such as referral exercise schemes, singing groups or carer support groups. Whatever is available locally.

I share with patients that attending the programme in itself is a support group. They get to meet people with the same issues as themselves, and share coping techniques or information. There have been some great friendships struck in PR classes; we know some people who have continued to meet up for friendship and support after the programme. Some of the 230 Breathe Easy groups have been formed following or around pulmonary rehabilitation services.

Pulmonary Rehabilitation Newsletter

Any final messages?

If you identify a patient suitable for pulmonary rehabilitation and talk to them about a referral, please make every effort to encourage them to attend at least the assessment appointment for pulmonary rehabilitation programme, even if they are anxious or don’t want to attend the programme. Our specialists will make every effort to engage with them and find the goals that will motivate them to give it a go.

✂

If you would like to receive more information & education for your team on pulmonary rehabilitation so that all your referring staff can help ensure that patients understand what a programme is about & the health benefits that could be achieved, our teams can attend Practice meetings or learning sessions. Please contact us on BOC.ClinicalServices@nhs.net to request an educational session.

Please contact us on BOC.ClinicalServices@nhs.net to arrange a visit to your local programme.

Your invitationPulmonary rehabilitation classes are running weekly in your area:

Farnborough Leisure Centre, Westmead, Farnborough, GU14 7LD

Brightwells Gostrey Centre, Brightwells Road, East Street, Farnham, GU9 7SB

You are welcome to come along to see a class in action.

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