Evidence to support Pulmonary Rehabilitation

Transcription

1 Evidence to support Pulmonary Rehabilitation Around 1 in 5 people in the UK will develop some form of lung disease during their lifetime with someone dying due to lung disease every five minutes in the UK (1). This means that lung disease is responsible for over 700,000 hospital admissions each year (1). There is a clear need to keep people well in the community for longer to improve the quality of life for those with Lung disease. Although the following data focuses on outcomes for those with COPD this rehab programme can benefit those who suffer from other forms of lung disease. Pulmonary rehab is an important factor in the recovery of patients with a chronic respiratory disease having a demonstrable improvement on both the patient's capacity for exercise and overall health (2). Pulmonary rehab is a programme of twice weekly sessions which should last for at least six weeks (3). As well as defined education sessions these programmes should be well structured and include supervised, tailored and progressive exercise training enabling patients to leave with an individual plan for continued exercise (3). Pulmonary rehab has been shown to reduce readmission in the short term as it offers patients the chance to learn more about their condition, enabling them to self-manage their condition more effectively (4) (5). This increased self-management should improve the overall general health of the patient, improving their quality of life (4) (5). NICE Quality Standards for COPD (2016) recommend (4): - People with stable COPD and exercise limitation due to breathlessness are referred to a pulmonary rehabilitation programme - People admitted to hospital for an acute exacerbation of COPD start a pulmonary rehabilitation programme within 4 weeks of discharge. The appropriateness of referral to pulmonary rehab can be determined by assessment of MRC (Medical Research Council) dyspnoea (level of breathlessness) following recommendations from the British Thoracic Society (BTS) (3). Evidence for this recommendation comes from a clinical audit carried out in 2015 found that 90% of people who attend pulmonary rehabilitation find it easier to walk around afterwards, if not on longer walks than on shorter trips (2). This audit also shows that almost two thirds (63%) of patients who attend found the improvement was better than they d hoped for when they started and around three quarters (74%) saw a general improvement in their respiratory health (2). This audit also cited the need for improved access to pulmonary rehab for patients with COPD (2). These improvements included the development of robust referral pathways into pulmonary rehab as well as ensuring this service is flexible to meet the needs of patients. Despite the improved health outcomes evidenced in the clinical audit carried out by The Royal College of Physicians in 2015 the rate of referral to pulmonary rehab is poor nationally. An average of 15% of patients with an MRC Dyspnoea score of 3 or more are referred to pulmonary rehab (2). Of the patients referred to pulmonary rehab 69% attend their assessment and 85% of these patients go on to attend pulmonary rehab (2). Retention rates for pulmonary rehab are good but could be improved, with 71% of those enrolled completing the programme (2). Data provided by NHS England (6) shows that there are over 115,000 people in the North East and North Cumbria living with COPD and on average across the region only 16% of people with an MRC dyspnoea score of 3 or more are referred to pulmonary rehab. For some areas such as Northumberland this is as low as 4.2% (6) which is one of the lowest rates in the country. GPs and clinicians working in primary care play a pivotal role in the

2 referral of patients into pulmonary rehab where 51% of patients nationally are referred by their GP (2). Bibliography 1. British Lung Foundation. Home page. British Lung Foundation. [Online] [Cited: September 7, 2016.] ://statistics.blf.org.uk/. 2. Steiner M, Holzhauer-Barrie J, Lowe D, Searle L, Skipper E, Welham S, Roberts CM. Pulmonary Rehabilitation: Steps to Breath Better. National Chronic Obstructive Pulmonary Disease (COPD) Audit Programme: Clinical audit of. London : National clinical audit report, British Thoracic Society. Quality Standards for Pulmonary Rehabilitation in adults. London : Bristish Thoracic Society Reports, National Institute for Health and Social Care Excellence. SQ10 Guidance-List of Quality Statements. [Online] National Institute for Health and Social Care Excellence. [Cited: August 7, 2016.] 5. Clinical Indicators Team Health and Social Care Information Centre and Clinical Indicators Team Health and Social Care Centre. CCG Outcomes Indicator Set, England, March 2016: Quarterly publication. London : Health and Social Care Information Centre., NHS England. NHS Outcomes Tool. [Online] NHS England, July [Cited: August 9, 2016.]

3 NICE guidelines (4): 1. People aged over 35 years who present with a risk factor and one or more symptoms of chronic obstructive pulmonary disease (COPD) have post-bronchodilator spirometry[2011, updated 2016] 2. People with COPD who are prescribed an inhaler have their inhaler technique assessed when starting treatment and then regularly during treatment. [2011, updated 2016] 3. People with stable COPD and a persistent resting stable oxygen saturation level of 92% or less have their arterial blood gases measured to assess whether they need long-term oxygen therapy. [2011, updated 2016] 4. People with stable COPD and exercise limitation due to breathlessness are referred to a pulmonary rehabilitation programme. [2011, updated 2016] 5. People admitted to hospital for an acute exacerbation of COPD start a pulmonary rehabilitation programme within 4 weeks of discharge. [2011, updated 2016] 6. People receiving emergency oxygen for an acute exacerbation of COPD have oxygen saturation levels maintained between 88% and 92%. [new 2016] 7. People with an acute exacerbation of COPD and persistent acidotic hypercapnic ventilatory failure that is not improving after 1 hour of optimal medical therapy have non-invasive ventilation. [2011, updated 2016] 8. (Placeholder) Hospital discharge care bundle. [new 2016] Data from NHS England showing number of people in the region with COPD CCG Total Population % with COPD No. with COPD Percentage with MRC Dyspnoea score of 3 or more referred to PR Northumberland Cumbria North Tyneside Newcastle Gateshead Newcastle North and East Newcastle West South Tyneside Sunderland North Durham Durham Dales, Easlington and Sedgefield Darlington Hartlepool and Stockton on Tees South Tees Hamblton, Richmondshire and whitby Totals

4 % of population with COPD Percentage with MRC Dyspnoea score of 3 or more referred to PR % with COPD % referred to PR

5