Development of a pulmonary rehabilitation service for people with COPD: a tiered model of integrated care
| Autor: | Ruth Stevens, Marguerite Harvey, William K. Gray, Sian Dogan, Liz Norman, Gbenga Afolabi, Maureen Turner |
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| Rok vydání: | 2013 |
| Předmět: |
Pulmonary and Respiratory Medicine
Spirometry Male medicine.medical_specialty Respiratory Therapy medicine.medical_treatment education Pulmonary Disease Chronic Obstructive health services administration Tier 2 network Surveys and Questionnaires Health care medicine Humans Pulmonary rehabilitation Lung health care economics and organizations Aged Retrospective Studies COPD Tiered service Rehabilitation medicine.diagnostic_test business.industry Delivery of Health Care Integrated Middle Aged medicine.disease United Kingdom Integrated care Exercise Therapy Dyspnea Treatment Outcome Physical therapy Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of cardiopulmonary rehabilitation and prevention. 33(5) |
| ISSN: | 1932-751X |
| Popis: | PURPOSE: Pulmonary rehabilitation (PR) services often are used for people with chronic obstructive pulmonary disease (COPD). This study describes the development and evaluation of a tiered service in North Tyneside, United Kingdom, which aimed to increase access to PR without negatively affecting clinical outcomes. METHODS: Data were collected retrospectively. Subjects, identified as having COPD by their general practitioner, based on spirometry, were tiered for PR on the basis of their dyspnea score. Tier 1 (1-2 dyspnea score) patients were prescribed exercise and referred to an exercise program. Those in tier 2 (3-4 dyspnea score) were referred to a specialized "healthy living" exercise and education group run by an exercise health trainer. Those scoring 4 (tier 3) received physiotherapist-led group exercise and education classes. Those scoring 5 were seen at home by trained health care professionals. Scores in the Chronic Respiratory Diseases Questionnaire, COPD assessment test, and 6-minute walk test were recorded at baseline and immediately after rehabilitation. RESULTS: Data were available for 199 cases recruited. Four patients (2.0%) were placed into tier 1, 107 (53.8%) into tier 2, 85 (42.7%) into tier 3, and 3 (1.5%) into tier 4. Because of the small number involved, data for tiers 1 and 4 were not analyzed further. In tiers 2 and 3, there was a significant improvement in performance across all 3 outcome measures. CONCLUSIONS: Tiered PR may be an effective way of increasing access to PR services. Further prospective data are needed to evaluate the service fully with regard to patient throughput and costs. |
| Databáze: | OpenAIRE |
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