Sláintecare funded improvements in chronic respiratory care on World COPD Day, 17th November Sláintecare funded improvements in chronic respiratory care on World COPD Day, 17th[...]

In Ireland it is estimated that 500,000 people are living with Chronic obstructive pulmonary disease (COPD) of whom over 200,000 have moderate or severe disease and only half are likely to be diagnosed. COPD has considerable impact on the quality of life of the patient, families, and carers, involving on-going medical care, frequent hospital admissions and often resulting in premature death. At least 1,500 patients die each year of this disease and over 15,000 patients are admitted to hospital with COPD. It has a profound effect on patients but also has a significant strain on the health service.

The Sláintecare funded Community Based Pulmonary Rehabilitation Programme in HSE Community Healthcare East has successfully implemented a brand-new integrated Community Pulmonary Rehabilitation service in Wicklow. Patients living with a chronic respiratory condition such as COPD are referred to the programme via GP, Respiratory Integrated Care Clinical Nurse Specialist or Consultant led hospital respiratory teams.

Mary Gowing, Self-Management Support Coordinator for Long-term Health Conditions, Joint Project Lead, Community Healthcare East says:

"This project delivers an 8-week structured pulmonary rehabilitation programme in the community setting to those diagnosed with respiratory conditions causing functional disability such as COPD and Asthma. The programme was moved online due to Covid 19 but has recently resumed in-person in Rathdrum Primary Care Centre."

Pulmonary rehabilitation is a multidisciplinary evidence-based exercise and education programme that teaches people with a long-term respiratory condition the skills they need to manage their symptoms and improve their quality of life.

Patricia Davis, Clinical Nurse Specialist Respiratory Integrated Care, Joint Project Lead, Community Healthcare East adds:

"Participants attend classes twice a week where they increase physical fitness through exercise classes and learn how to manage their condition through a series of educational talks. Research has shown that patients who complete pulmonary rehabilitation have a better quality of life and are less likely to require hospital admissions. They also leave the course with a much greater understanding of their condition and are therefore able to manage it more effectively."

Key outcomes:

Delivering care closer to home

To access a Pulmonary Rehabilitation Programme patients in South Wicklow previously had to travel at least 80kms to attend programmes in Dublin. Providing a virtual service in Wicklow significantly reduced patients need to travel for classes and reduced distance travelled for face-to-face pre and post assessments.

Improved patient experience and increased physical fitness

"I would never have done the exercises myself, and if I did, I would have stopped halfway. It was great to be monitored all the way through. I know how to use my inhalers better and I am walking a lot longer on my daily walk." - patient testimonial.

As a result of taking part in this Pulmonary Rehabilitation Programme participants reported increased fitness levels, a reduced fear of becoming breathless, attained increased knowledge about their condition and how to manage it and had a referral to other services if required e.g., psychology services.

Improved integration of care

Staff were supported by the Pulmonary Rehabilitation Department in St Michaels Hospital and Respiratory Integrated Care - Clinical Nurse Specialist who provided training for the Physiotherapists, alongside the governing Respiratory Consultant Physician who reviewed cases and policies as needed.

Positive feedback from GP's

"My experience of the rehab programme is positive. Patients appreciate the local service and are more likely to take part compared to travelling to Dublin. Clinically, the benefit is seen in an increased confidence level with quality-of-life improvement." - Dr Tom Finnegan, local GP

Positive feedback from Consultants

"The rollout of this important programme has allowed patients living with chronic lung disease to receive pulmonary rehabilitation, an intervention proven to improve quality of life and reduce mortality, in their own community. Proximity to a pulmonary rehabilitation centre is an important factor in patient adherence and completion of rehabilitation programmes, we have seen excellent outcomes from this community-based programme both in terms of engagement and benefits such as improved symptoms, quality of life and self-management." - Dr Sarah O'Beirne, Consultant Respiratory Physician St Michael's and St Vincent's Hospitals

Enhancing digital skills

"As the programme moved from face-to-face to online delivery, it gave me a valuable opportunity to extend my IT skills. I developed and provided virtual patient education on continence, fatigue management and exercise. I also made links with respiratory colleagues in hospital and community settings promoting integrated care.' - Mary Burke, Senior Physiotherapist on the Pulmonary Rehabilitation Team

Integration with Wicklow COPD Support Group

The Pulmonary Rehab team supported the re-establishment of the Wicklow COPD support group by working with COPD support Ireland, Local patient representatives and by facilitating PR participants transitioning into the support group after rehab finished.

Integrated pathways

A referral pathway to Wicklow Primary Care Psychology Services has been established for participants of the Pulmonary Rehabilitation programme that have significant anxiety and depression scores.

Despite the challenges presented by Covid 19 the project succeeded in providing an integrated community-based service and is now being mainstreamed via the Enhanced Community Care programme with a focus on moving care out of the hospitals and keeping people well closer to home.

Muthuraman Krishnamoorthy, Senior Physiotherapist, HSE delivering the project says:

"We went through a lot of challenges with Covid 19 including pivoting to virtual classes, but we overcame almost all of them and are now back doing in person classes in Rathdrum Primary Care Centre. We had very positive feedback from participants with patients saying the programme was a game changer and they felt much fitter and more confident. Looking to the future we hope to continue with a sustainable hybrid in person and remote model for programme delivery."

About COPD

Chronic obstructive pulmonary disease (COPD) is a disease of the lungs characterised by airflow obstruction this can result in shortness of breath or tiredness because you are working harder to breathe. Although it is a preventable disease, exposure to inhaled gases and particles, e.g. tobacco smoke, which accounts for 85-90% of cases, usually begins decades before symptomatic disease can be detected. COPD is a term used to include chronic bronchitis, emphysema or a combination of both conditions.

Further Information: https://goldcopd.org/world-copd-day/ and [external-link www.copd.ie | www.copd.ie ]