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Auditors call for better access to rehab for COPD patients

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Pulmonary rehabilitation delivers significant health benefits, but too many patients with chronic obstructive pulmonary disease are missing out, according to clinical auditors.

The National Chronic Obstructive Pulmonary Disease Audit Programme’s report revealed that 40% of patients find it difficult to complete the pulmonary rehabilitation programme.

“I hope the findings of this milestone pulmonary rehabilitation clinical report will widen access to services and in turn, improve care for people with COPD”

Michael Steiner

The report also found that 37% of patients in England and Wales were waiting longer for rehabilitation than the three months recommended by the British Thoracic Society.

The report – titled Pulmonary Rehabilitation: Steps to breathe betterreviewed the care received by 7,413 patients across 210 rehabilitation services in primary, secondary and community care.

Overall, the report revealed that many areas of good quality rehabilitation treatment for COPD patients, including widespread provision of walking (95%), cycle (70%) and aerobic and resistance exercise therapy (89%).

However, 26% of patients were not being provided with an ongoing individual exercise plan, noted the report.

It also warned there remained significant variations in waiting times and quality of care when patients attend rehabilitation.

“Unacceptably” long waits for treatment were more common when rehabilitation was given as part of a group, because patients have to wait until the start of the next scheduled programme.

The report highlighted the need for greater awareness of the benefits of pulmonary rehabilitation in primary and secondary care.

“It will be crucial that pulmonary rehabilitation services are sufficiently resourced to meet this demand”

Lisa Davies

It also urged commissioners and providers to ensure that all patients received an offer to start rehabilitation treatment within the recommended three months following their referral.

In addition, the report highlighted that “significant” numbers of patients who attended a rehabilitation assessment did not complete the treatment, despite those that did showing “substantial” improvements in quality of life and ability to exercise.

The report recommended that rehabilitation programmes should examine their processes and ensure that they were performing exercise outcome measures to accepted standards, including exercise tests.

Referrers and patients should also be provided with up-to-date and clear written information about the benefits of attending and completing pulmonary rehabilitation.

In addition, programmes should ensure they offered a sufficiently flexible service to encourage patients to complete the treatment – for example, flexibility about times and days of sessions and the availability of transport.

Professor Michael Steiner, national COPD audit clinical lead for pulmonary rehabilitation, said: “I hope the findings of this milestone pulmonary rehabilitation clinical report and other audit reports will widen access to services and in turn, improve care for people with COPD.”

Dr Lisa Davies, chair of the British Thoracic Society, added: “We hope and expect that action will be taken to increase referral rates of eligible patients and it will be crucial that pulmonary rehabilitation services are sufficiently resourced to meet this demand.”

The National COPD Audit Programme was commissioned by the Healthcare Quality Improvement Partnership.

It was led by the Royal College of Physicians, working with the British Thoracic Society, the Primary Care Respiratory Society UK, the British Lung Foundation and the Royal College of GPs.

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