Pulmonary Rehab Sheffield Community - STH talk Sept 2017... · 2017-10-03 · SHEFFIELD TEACHING HOSPITALS NHS FOUNDATION TRUST PRACTICE feasibility study 2015 •Early rehab –

Pulmonary Rehab

Sheffield Community

“Active Programmes” Team

Ursula Freeman

Physiotherapist and Team Leader

PROUD TO MAKE A DIFFERENCE SHEFFIELD TEACHING HOSPITALS NHS FOUNDATION TRUST

Aims

• Update on most recent evidence

• PR National Audit

• Engaging with patients

• What we offer in Sheffield

• Contacts

• Video


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.


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


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


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


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


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


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


Engaging patients with PR–

what can you do?

• PAM

• MI + COM-B

• Goal setting and action plan

• Your enthusiasm

• Video

• Written information


PAM

• 1

• 2

• 3

• 4

• Trial using PAM

• 1-2 HEALTH TRAINERS before PR

• 3-4 PR


Alternatives to PR

• PAM 1-2

– Health Trainers

– COPD yoga Foxhill MC

– Breathe Easy Support group

– IMT

– ICT-Therapy

• PAM 4+

– Phase 4


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


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


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


• 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)


Referrals and Contacts

• Lightwood House – 0114 307 8260 • 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 Programmes @ Lightwood

House S8 8BG • Phone team – if patient know to us, we’ll take a

verbal referral


Video

• You Tube

• Vimeo

• Google under Videos

– search “Sheffield Pulmonary Rehab”

• Plus DVD’s

https://www.youtube.com/watch?v=IBErnTwbDMQ

https://www.youtube.com/watch?v=_ddYoK3_Sv4

https://www.youtube.com/watch?v=IBErnTwbDMQ

https://www.youtube.com/watch?v=_ddYoK3_Sv4

Documents

Pulmonary Rehab Sheffield Community - STH talk Sept 2017... · 2017-10-03 · SHEFFIELD TEACHING HOSPITALS NHS FOUNDATION TRUST PRACTICE feasibility study 2015 •Early rehab –