BTS Summer - Pulmonary Rehab Update
PR Summary – BTS Summer 2016
BTS PR Audit:
Pulmonary rehab research has been growing over recent years, we have the BTS PR guidelines and Quality Standards but there was a need to audit the service provision across the country in order to see if we are meeting the Quality Standards.
The organisational audit identified 230 PR programmes across 674 sites. The clinical audit was completed on 210 programmes encompassing 7413 patients which was approximately 73% of all eligible patients.
Positive elements from the audit were that most services offered care to a range of disability and other respiratory conditions. The structure and content was generally in line the with Quality Standards. Education was universal, however, lacked structure. Assessment recording of outcomes was wide and varied.
Areas for improvement included offering to MRC 5 patients, 19% of programmes don’t accept patients with MRC 5. Only 22% of programmes offer PR to post exacerbation patients. Exercise should be prescribed and there is a lack of robust methods for exercise prescription. Many patients are waiting longer than 3/12 to be enrolled onto a programme.
Future recommendations include:
- Improving access to PR
- Improved quality of treatment provided
- Improved resources
Next steps:
- Quality Improvement – PR accreditation scheme and improving quality of referrals
- Re-audit – due to commence in Jan 2017
Current challenges in PR:
- Raising the profile of PR among public and patients
- Raising the awareness of the benefits of PR
- Stimulate demand and increase capacity
- Maintain quality
PR Accreditation:
Sally Singh has started this project, and some sites have completed the accreditation process.
Audit is critical to continuing development. Having a physio on the PR team helps with the process of defining specifics such as exercise prescription and exercise testing.
Having a lay person involved in the assessment of the accreditation process is important.
Many areas don’t prescribe exercise appropriately. Most use a best guess or use the Borg or heart rate to prescribe. Many do not have a written exercise plan.
Areas for development:
- Support for the referrers
- Information for patients – sell PR
- Standardised documentation
- Standardised SOP
- Staff training – e.g. exercise prescription
What next in PR? – Areas for improvement
- Referrals and uptake
- Adherence and response
- Delivery of PR
Most research in PR is on the people who attend PR. There are approx. 446,000 people who could be referred but only 68,000 get referred.
Therefore we are lacking evidence on the people who don’t even get referred. Of the 68,000 31% don’t attend the assessment, 29% of these drop out once they’ve started and only 40% complete PR.
Only 1/3 of post exacerbation patients get referred to PR and less than 10% complete PR.
Research questions:
How do we make sure the appropriate people get PR?
How do we increase referrals and uptake?
We need to identify patients at risk of non-compliance
Need to explore alternative ways of delivering PR
Frances Butler, Research Champion, ACPRC
research@acprc.org.uk
