Pulmonary Rehab Sheffield Community Active Programmes Team. Ursula Freeman Physiotherapist and Team Leader

Transcription

1 Pulmonary Rehab Sheffield Community Active Programmes Team Ursula Freeman Physiotherapist and Team Leader

2 Aims Update on most recent evidence PR National Audit Engaging with patients What we offer in Sheffield Contacts Video

3 Update on evidence CCG for every 4 patients that complete PR 1 admission saved (Impress 2011) NICE guidelines (updated 2016) Quality statement 4: People with stable chronic obstructive pulmonary disease (COPD) and exercise limitation due to breathlessness are referred to a pulmonary rehabilitation programme. Quality statement 5: People admitted to hospital for an acute exacerbation of chronic obstructive pulmonary disease (COPD) start a pulmonary rehabilitation programme within 4 weeks of discharge.

4 Evidence based research BTS Guidelines 2013 ATS / ERS Statement: Key Concepts and Advances in Pulmonary Rehabilitation 2013 Cochrane reviews further RCT s comparing PR to conventional COPD treatment not required! NICE guidelines 2010 (plus updates) National PR audit 2014 & 2017 Quality Standards PR IS STANDARD TREATMENT FOR PEOPLE WITH COPD

5 What are the measured benefits? 30% Decrease in hospital readmissions following exac 50% reduction in LOS 40% reduction in readmission with home programmes Increase in psychological status Increase in functional ability HRQL improvements that last >12 months Decrease dyspnoea Increased Ex tol Increase in peripheral muscle mass and strength Cost Effective 152 additional cost to standard treatment Reduction in home visits from GP s

6 Health related utility measure linked to relative satisfaction or Quality of Life gained over a period of time COPD Value Pyramid London Resp Network & LSE 2013 Some hospital based and 12+ sessions

7 BTS quality statements 2014 BTS quality statements MRC 3 + & to be enrolled within 3/12 Accept other resp conditions Refer following hosp admission with exac. & enrol these within 1/12 6 weeks programme 2 x week Tailored, supervised, progressive exercise Education aspect Ongoing maintenance programmes Appropriate outcome measures used Annual audit of outcomes and processes SOP

8 PRACTICE feasibility study 2015 Early rehab PRACTICE STUDY Early home rehab reduced admissions (48hrs) 4 arms Standard treatment (PR at 6 weeks post D/C) Rehab in hospital once stable Early home rehab within 48 h of D/C Both hospital rehab and early home rehab Early home rehab reduced chances of being readmitted

9 National PR audit Part of the National COPD audit Second round audit (first report in 2015) Results out for general public in February Measured against the BTS quality standards 2014

10 Engaging patients with PR what can you do? PAM MI + COM-B Goal setting and action plan Your enthusiasm Video Written information

11 PAM Trial using PAM 1-2 HEALTH TRAINERS before PR 3-4 PR

12 Alternatives to PR PAM 1-2 Health Trainers COPD yoga Foxhill MC Breathe Easy Support group IMT ICT-Therapy PAM 4+ Phase 4

13 Engaging patient with PR what were doing Making referral easier Phoning patients as part of triage Offering home visits and programmes Referring onto Health Trainers Transport CCG business case Offer informal PR info sessions at GP? Offer roving programmes around the city

14 Questions to ask your patients What would you like to be able to do if you felt less breathless? How important is it for you to feel less breathless when doing things? 1-10 How confident are you that you want to change how things are with your lung condition? 1-10

15 What we offer in Sheffield Established in Sheffield approx. 13 years ago Offered to patients with COPD ILD Bronchiectasis Post LVRS (COPD and Lung Cancer) Severe / brittle Asthma Funded for COPD only (CCG) 3 group venues S5, S2 & S8 4 assessment venues (as above plus S6) ESD (COPD ONLY) Individual routine home rehab Breathe Easy support groups

16 Absolute contraindications Unstable angina AAA >5.5cm Severe aortic stenosis Other contraindications that are looked at Triage Assessment sessions + exercise test before starting group Groups run by Specialist B6 nurses and Physiotherapist plus B4 therapy assistant (SPTA) ESD and routine home rehab - Physio and SPTA Educations sessions Nurses, Physio and OT Mental Health Respiratory Team (MHRT)

17 Referrals and Contacts Lightwood House Referrals are made by Health Care Professionals Through SPA Referral form 1 side A4 On CCG portal Via task to Active Programmes Admin if you're on System One Clinic letter to Active Lightwood House S8 8BG Phone team if patient know to us, we ll take a verbal referral

18 Video You Tube Vimeo Google under Videos search Sheffield Pulmonary Rehab Plus DVD s