Patients with chronic respiratory conditions Structured programme Exercise Education Group Class and home alone Evidence based Patient driven
Presenter
Presentation Notes
COPD, pulmonary fibrosis, alpha 1, asthma 8 weeks, twice weekly 2 hours exercise, 30 minutes education per week. Staffed by qualified physiotherapist and clinical support worker/fitness instructor
Role of PR
Improve – Dyspnoea – Loss of skeletal mass/muscle strength – Decreased exercise capacity – Psychological wellbeing – Energy levels – Sense of control – Patients ability to cope – Patient involvement in own condition
Presenter
Presentation Notes
Recommended for patients with limited exercise capacity and limited by breathlessness or fatigue. Follows BTS guidelines sept 2013
Exacerbations of 3+ per year
Impact on patient life span
What’s involved.....
8 week programme 150 minutes class time per week 12 participants per class Completion of 14 sessions Combination of CV and resistance exercise Progressive and individual approach Circuit based Education
Presenter
Presentation Notes
In line with PR studies a third session is recommended and can be unsupervised. COPD patients afraid exercise makes them more breathless by gradually increasing activity this can improve breathing. By improving muscle strength (arms,legs – quads, trunk, heart) this will in turn make everyday activities less tiring and less demanding of your energy.
Education
Diagnosis Implications of condition Why PR will help Local support groups Anxiety management External speakers – OT, DT, Pharmacy,
Smoking cessation
Presenter
Presentation Notes
Educational component is fundamentally integral to the format and success of the programme. Comes into every aspect of pulmonary rehabilitation . The intention is to support the lifestyle and behavioural change and assist self management to promote decision making and self efficacy.
Self Management - Education
• Chest clearance • Breathing patterns • Inhaler technique • Recognition of health change • When to get help • Energy conservation • Coping strategies • Use of no delays
Presenter
Presentation Notes
All reinforced with booklets and no delays
Self Management - Exercise
Patient centred goals Patient self scores every time Patient owns record sheets Patient has ultimate decision Home exercise diary Use of no delays
The Idea Behind No Delays
Joint venture - NHS Grampian and Digital Life Sciences (Scottish Digital Health Programme)
Redesign the delivery of health and care services in a way that
allows people to remain in their communities as far as possible and only travel to traditional clinic appointments when absolutely necessary
Better inform patients
Worked closely with clinicians and patients to understand how
they exchange information during a consultation.
Presenter
Presentation Notes
20/20 vision Better inform – improve self management allowing patients to gleam more from face to face consultations
How it works
Video clips
Tailored to patient requirement
Prescribed to patient via email
Presenter
Presentation Notes
Video clips filmed by local teams , key information filmed of both staff and patients
Presenter
Presentation Notes
Package creator, easy to select appropriate topics for patient to email.
What the patient receives
Dear Mrs Smith, Your No Delays health information package is ready
for you. This package contains health information that has been tailored for you. Click on the link below or paste into your browser to complete your registration and view the package.
When patient clicks on their individualised link this is where it will take them. There is a personalised message at the top from their clinician. When patient clicks on link this is what they see. There is a personalised message from the clinician at the top of the screen. The patient can then view the package whenever they like. They can share the video package with family or carers. This page shows how the information is chunked – patients have told us they like ‘sound bytes’, not one person droning on forever Timings show topics in main videos Lollipops are reference points for the subclips shown down the side and allow you to switch to the chosen clip Page also includes links to other ‘approved’ resources Can include quizzes so patient can test their knowledge Future is the ability to submit back information to the clinical team
Presenter
Presentation Notes
Video clip style is perfect for practical demonstrations Can play over and over again and also show other people involved in your care Clinician can check that patient has accessed package Collection of email addresses is basis of a data base of patients so can easily update them if new information needs to be shared.
Making it work
Whole team involvement Patient input Identifying the service needs Identifying patient benefit Equal improvement Deployment Following through Measuring impact
Presenter
Presentation Notes
Notified if patient doesnt access it, resend, Explain how it fits in with current PR service At referral point, intro to PR is sent so tells patient about the class, can see live demo of a class and assessment. At later date can send clips on inhaler technique, breathing exercises
Improve ease of referrals Educated referrers Opportunity to explore Opportunities for signposting Fundamental treatment not optional Reassessment important
Presenter
Presentation Notes
Improve ease of referrals – SCI, web address, form, email Initial referral point – opportunity to explore patients understanding of PR, address concerns and educate patients on the benefits. Referer – PR presented as fundamental treatment for COPD rather than optional extra.
Reassessment Maintenance classes Fitness classes Home exercise programme Nothing Feedback
Presenter
Presentation Notes
Improvement gains noted and demonstrated to patient which improves compliance with home programme and maintenance. Maintenance classes are all held in the same venue as the class patients currently attended with fitness instructors. Feedback – info, satisfaction of patients, what they learnt
Looking forward
Spoke and hub development Increased use of telehealth Expanding no delays access Transport support Patient friendly paperwork Mapping areas of need Increasing knowledge of referrers Expert patient
