Improving the uptake of pulmonary rehabilitation in patients with COPD:

Harris, David R.; Hayter, Mark; Allender, Steven

doi:10.3399/bjgp08x342363

Cited by 98 publications

(131 citation statements)

References 26 publications

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“…57 Pulmonary rehabilitation and psychotherapy have been shown to reduce anxiety and depressive symptoms and improve quality of life in patients with COPD, [58][59][60][61][62] but the overall use of pulmonary rehabilitation in the COPD population is low. 63 Many of these patients with low socioeconomic status and psychological disorders get admitted to safety net hospitals, so readmission rate could vary in proportion to the number of patients with these psychological disorders cared for by a safety net hospital. Hospitals with a disproportionate share of patients with these disorders will be more likely to have higher rates of readmission and risk getting penalized, even though most of these conditions are nonmodifiable.…”

Section: Discussionmentioning

confidence: 99%

Association of Psychological Disorders With 30-Day Readmission Rates in Patients With COPD

Singh

Zhang

Kuo

et al. 2016

Chest

100

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Section: Discussionmentioning

confidence: 99%

Association of Psychological Disorders With 30-Day Readmission Rates in Patients With COPD

Singh

Zhang

Kuo

et al. 2016

Chest

100

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“…Second, patients who are being referred for prehabilitation should be given oral and written information about what this will entail and the potential benefits. Experience from pulmonary rehabilitation indicates that the uptake and effects of prehabilitation may be positively influenced by the initial clinician interaction and by what information is provided about the programme [23][24][25]. Initial discussions with the patient should also seek to identify their goals for prehabilitation, which should then be recorded, and may aid Figure 1 The prehabilitation concept.…”

Section: Background To Pre-operative Exercise Trainingmentioning

confidence: 99%

Clinical guideline and recommendations on pre‐operative exercise training in patients awaiting major non‐cardiac surgery

et al. 2018

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SummaryDespite calls for the routine implementation of pre-operative exercise programmes to optimise patient fitness before elective major surgery, there is no practical guidance for providing safe and effective exercise in this specific context. The following clinical guideline was developed following a review of the evidence on the effects of pre-operative exercise interventions. We developed a series of best-practice and, where possible, evidence-based statements to advise on patient care with respect to exercise training in the peri-operative period. These statements cover: patient selection for exercise training in surgical patients; integration of exercise training into multi-modal prehabilitation programmes; and advice on exercise prescription factors and follow-up. Although we acknowledge that further research is needed to identify the optimal exercise prescription in different clinical scenarios, we urge peri-operative teams to make use of these recommendations. Summary of key recommendations1 Pre-operative exercise training should be offered to patients scheduled for major or complex elective surgery with a view to improving their physical fitness and health status and reducing the risk of peri-operative morbidity and mortality. If resources are limited, priority of referral to preoperative exercise training should go to patients who are at increased risk of peri-operative complications, such as those with low cardiorespiratory fitness.2 Pre-operative exercise training should be offered as part of a multi-modal prehabilitation programme that addresses a variety of peri-operative risk factors including cigarette smoking, excessive alcohol consumption, and anaemia. 3 Healthcare professionals making referrals to a preoperative exercise programme should have basic knowledge about what the programme entails and its potential effects. A pre-operative exercise programme should be presented to the patient by the referring clinician as a fundamental part of their 750

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“…Finally, time and resource constraints meant that the original aim of seeking patients' views on ways of increasing referral rates for PR was not possible. Patientproposed strategies generated in research elsewhere include: individuals who have completed PR acting as mentors for newly referred patients (Moore et al, 2012) and clinician/patient discussions focusing on 'real life' benefits derived from PR such as individuals being more able to play with grandchildren (Harris et al, 2008b).…”

Section: Patient Samplementioning

confidence: 99%

Working with primary care clinicians and patients to introduce strategies for increasing referrals for pulmonary rehabilitation

Foster

Piggott

Riley

et al. 2015

Prim Health Care Res Dev

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Background: Pulmonary rehabilitation (PR), a programme of exercise, education and psycho-social support, is recommended for patients with chronic obstructive pulmonary disease but referral rates are relatively low compared with need. Aim: Working with primary care clinicians (GPs and practice nurses) from eight practices, this project developed strategies for influencing clinician and patient behaviours as a means of increasing referral rates for PR. Methods: A participatory action research design was employed. Semi-structured questionnaires captured clinicians' baseline knowledge of PR and their ideas for increasing referrals. Actionable changes were then recommended. Audits (at baseline, mid-point and end of project) were used to assess and initiate improvements in the quality of practice data about PR referrals. The impacts of these changes were explored via further clinician surveys (free text questionnaire). Semi-structured questionnaires, posted to patients eligible for PR, assessed their characteristics, and, where applicable, their views on PR referral processes and reasons for not wanting PR. Findings: The baseline survey of clinicians (n = 22) revealed inadequate knowledge about PR, particularly among GPs. Actionable changes recommended included in-house education sessions, changes to practice protocols, and 'pop-ups' and memory aids (mugs and coasters) to prompt clinician/patient discussions about PR. Audit findings resulted in changes to improve the quality and availability of coded information about patients eligible for PR. These changes, supported by clinicians (n = 9) in the follow-up survey, aimed to facilitate and increase the quality of patient/ clinician discussions about PR. Findings from the patient survey (n = 126, response rate 25.7%) indicate that such changes will increase the uptake of PR as patients who accepted a referral for PR provided more positive feedback about their discussions with clinicians. Conclusions: The strategies introduced were relatively easy to implement and the anticipated advantage is more patients accessing the health and quality of life benefits that PR offers.

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Improving the uptake of pulmonary rehabilitation in patients with COPD:

Abstract: Background

Cited by 98 publications

References 26 publications

Association of Psychological Disorders With 30-Day Readmission Rates in Patients With COPD

Association of Psychological Disorders With 30-Day Readmission Rates in Patients With COPD

Clinical guideline and recommendations on pre‐operative exercise training in patients awaiting major non‐cardiac surgery

Working with primary care clinicians and patients to introduce strategies for increasing referrals for pulmonary rehabilitation

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