The latest report from the National COPD Audit says primary care must improve referral rates for pulmonary rehabilitation (PR) because it is such an effective and high value therapy for people with COPD.
Called Pulmonary rehabilitation: An exercise in improvement, the report says overall many areas in England and Wales are providing good quality PR services which deliver considerable health benefits for patients who complete treatment.
However in the audit of COPD Care in acute hospitals only 46% of hospitals reported availability of PR within 4 weeks of discharge and referral rates to PR from other parts of the healthcare system are also still very low.
The Royal College of Physicians, which complied the report, calls for action to be taken in both primary and secondary care to enhance these referral rates. The report also identifies the need for PR programmes to adapt their services to increase convenience and acceptability of programmes.
Other findings include:
Alex Woodward, respiratory physiotherapist, PCRS-UK Service Development Committee and Policy Committee member, says: “This national audit again highlights how important PR is in the care of patients with COPD and that in patients who complete a PR programme it leads to excellent improvements in exercise capacity and quality of life in COPD. Whilst completion rates and access to PR are improving there are still a number of patients who do not access or complete PR so all healthcare providers across the COPD pathway need to work together to develop ways to increase uptake and completion of PR especially for COPD patients after a hospital admission.”
For primary and community care:
- Practices should review COPD registers to ensure all eligible patients are offered PR and that this offer is considered at each annual review.
- Practices should record referral rates for PR in patient records and set specific targets for improvement.
- Community specialist COPD healthcare teams should work with PR programmes to arrange review of individual patient exacerbation prevention measures.
- Ensure that PR services receive sufficient funding to enable them to recruit and retain highly trained staff and develop processes to ensure that all patients are enrolled to PR within 90 days of receipt of referral.
- Ensure that there is an accessible PR service that can offer early post-discharge PR for patients leaving hospital after an exacerbation of COPD.
- Prioritise measures to enhance referral and completion of PR, including developing integrated referral pathways between PR services and other healthcare teams managing COPD
Read the report
Secondary care reports
Two other new reports from the National COPD Audit find many improvements in the organisation of secondary care services for patients with COPD however care still remains variable for many patients.
Findings from the, COPD: Time to integrate care and COPD: Working together, include:
Recommendations for primary care
- If a patient has been discharged from secondary care without having spirometry performed, start with a comprehensive breathlessness assessment. If the cause is COPD, then ensure that the correct spirometric test and result is documented within the patient record and shared with secondary care respiratory health professionals involved in the patient’s care.
- The reason for doing the assessment should be clearly explainable to the patient.