Pulmonary Rehabilitation - key service for Chronic disease

Category:         Scheme best reducing the Burden of Chronic Disease

Name:               Sue Revill

Job Title:           Head of Pulmonary Rehabilitation

Organisation:    Sherwood Forest Hospitals NHS Trust

Email:                sue.revill@sfh-tr.nhs.uk

Telephone:        01623 785407

Key team:          Sue Revill, Diane Reynolds, Mike Ward

Title:                 Pulmonary rehabilitation - a key service for chronic respiratory disability

Aim:

To establish a comprehensive outpatient pulmonary rehabilitation programme for North Notts.

Background:

Chronic obstructive pulmonary disease (COPD) is a disabling lung disease that causes 30,000 deaths per year in the UK. Breathlessness is a serious problem for people with COPD and often leads to a deterioration of health leading to inactivity, isolation and dependence. The former mining areas of Mansfield and Ashfield have a concentration of people suffering with COPD, not least due, in part, to the former main employment amongst men but also because of the high levels of cigarette smoking. Pulmonary Rehabilitation however, has been found to significantly improve physical function and can improve quality of life in COPD. A mainstream therapy for respiratory patients in North America and Canada, there is sparse availability in the UK due to lack of mainstream funding.  COPD is a major cause of chronic morbidity in the North Notts area, therefore a determined, proactive approach was needed to design, integrate and implement a service for the community.

The Sherwood Forests Hospitals Pulmonary Rehabilitation Programme (PRP) would be a roll on/roll off programme for patients with symptomatic COPD. The exercise based therapy improves skeletal muscle function, known to deteriorate in COPD, thereby reducing breathlessness, improve daily activity and health related quality of life (QOL).  A comprehensive assessment was developed for all patients before and after the intervention. Demographic and clinical measurement data would form the core of a computerised database that would build year on year, providing rapid service audit and epidemiological information of the COPD population in the area. The database would also automatically generate a patient report.

The PRP was designed to complement a new chest clinic established at Ashfield Community Hospital. At the clinic, patients are reviewed; receive optimisation of medication and additional investigations.  Thus the new service would streamline the evidence based route recommended by the BTS National guidelines. 

The development of the 6 week PRP involved negotiation for space in the physiotherapy gym, consulting rooms for patient assessments, establishment of a budget and purchase of equipment. In addition a multidisciplinary team had to be recruited and co-ordinated to deliver the patient education component of the PRP.

Mrs Diane Reynolds, the respiratory specialist nurse for Kings Mill Hospital, gave invaluable advice concerning the COPD population and is part of the 3-person team that runs the exercise sessions.  Ms Carole Driummond, Senior Physiotherapist is also part of the exercise team and contributes to the educational component.  Dr Mike Ward, consultant chest physician, was able to negotiate with senior management on some resource issues and provided clinical advice. The educational component of the PRP is provided by a Multi-professional team comprising of occupational therapist, dietician, physiotherapist, respiratory specialist nurse, welfare rights officer (Notts CC), health and fitness advisor (Ashfield DC), chest physician and clinical scientist.

The programme runs continuously through the year and can accommodate 12 patients at a time.  As one patient completes the programme a new patient starts, maximising throughput. Our goals were achieved when we had completed the first 6 weeks of the programme and when the computerised patient report and database came on stream.

The main challenges were 1) negotiation of suitable times and days for gym space, 2) assemble and coordination of the multi-professional team for the education component 3) achieving competence in understanding and using MS Access Database in order to design the dedicated PRP database and its communication with the statistical package SPSS.

Unexpected benefits have been the popularity of the PRP with patients.  Many patients have asked if they can come back and repeat the therapy.  Additionally many of the graduates have gained enough confidence to move onto the Ashfield District Council exercise prescription scheme.

The next steps are to rollout the PRP template at Newark Hospital and Mansfield Community Hospital to provide satellite services closer to those communities.  Additionally we aim to develop a respiratory home care centre at Ashfield CH in order to provide a co-ordinated approach to management of the advanced disease within the community.  This will embrace co-ordination of long term home oxygen, nebuliser assessments and end of life issues.  We are also working with the PCT's to develop a systematic approach to the early diagnosis and long term care of patients with COPD in primary care.