Enhanced Pulmonary Rehabilitation Service

Southend Hospital University NHS Foundation Trust Enhanced Pulmonary Rehabilitation Service.

The Problem

Pulmonary rehabilitation is one of the most effective interventions for people living with COPD. It includes exercise rehabilitation, disease-specific education and advice for the self-management of chronic lung conditions and is considered an essential part of the care pathway. 

An audit conducted in 2018 by the National Asthma and COPD Audit Program (NACAP) highlighted issues of low referral rates, limited uptake, and low completion rates of Pulmonary Rehabilitation nationally.  The NHS long term plan highlights the importance of improving this and if achieved estimates that over the 10 years, 500,000 exacerbations can be prevented, and 80,000 admissions avoided.

The Pulmonary Rehabilitation Service delivered by Southend University Hospital NHS Trust (SUHFT) identified its own completion rate as 40% versus a target of 70% set by NACAP. A significant contributory factor leading to this shortfall was lack of flexibility of the service offering. Furthermore, referral of eligible patients is <50% as reported by the Primary Care Respiratory Society (PCRS). 

The Solution

SHUFT set out to redesign their Pulmonary Rehabilitation service by offering a hybrid model of delivery utilising myCOPD, a digital self-management and educational platform from my mhealth. 

Following an Initial centre-based assessment the enhanced service offers patients one of three options for accessing the program that best suits patients’ needs.

1. Centre-based - Delivered across 4 sites. This option included 12 sessions, supervised by a physiotherapist, combining exercise and education over 6 weeks. Attendance was required twice weekly. Patients were provided myCOPD or British Lung Foundation (BLF) materials as supporting information.
   
   
2. Hybrid - This option blended the centre-based approach with a home-based approach. Patients were offered 6, weekly, supervised, exercise sessions combined with additional exercise and education accessed at home via the myCOPD app (or BLF materials if no internet access).
   
   
3. Home-based - Patients we provided exercise rehabilitation and education accessed at home via MyCOPD app (or BLF materials if no internet access). Patients were given 6 weeks to complete the programme and received regular phone calls to monitor progress.

Assessment sessions were completed across all three groups on completion to measure improvement. All patients were discharged with a personalised exercise plan. Those with more significant impairment on initial assessment and those receiving inpatient care for a respiratory-related exacerbation at the point of referral were prioritised for a centre-based option.

The Result

Based on the first cohort of patients to be offered these options, completion rates for those referred increased from 40% to 72%. Exceeding the both the NACAP target (70%) and the national average (62%). 

Measurable outcomes have also been positive. An average increase in 6-Minute Walk Test distances reported in the home-based group being 105m. The Minimum Clinically Important Difference of this measure is >40m.

Based on these successes the enhanced service is being extended to increase the capacity of the Pulmonary Rehabilitation service to meet PCRS recommended referral rate of 70% and is being adopted by neighbouring services facing similar challenges.