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Bay Navigator COPD Pathway Launch

Bay Navigator COPD Pathway Launch. May 2012. Asthma & Respiratory Centre. Offices in Greerton , Waihi and Whakatane The team consists of:- Five nurses working in WBOP & two in EBOP Office Manager Two Receptionists (job share)

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Bay Navigator COPD Pathway Launch

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  1. Bay NavigatorCOPD Pathway Launch May 2012

  2. Asthma & Respiratory Centre • Offices in Greerton, Waihi and Whakatane • The team consists of:- • Five nurses working in WBOP & two in EBOP • Office Manager • Two Receptionists (job share) • Physiotherapist for the pulmonary rehabilitation programs & for COPD & breathing support We offer a free spirometry, education & advice service

  3. Our Services We provide Lung Function Testing using Spirometry for: • Correct diagnosis of Asthma/COPD/Breathing Pattern Disorder/Vocal Cord Dysfunction • Monitoring progress • Assessing response to treatment

  4. Our Services We provide: • One to one education and assessment of asthma/ COPD/ other respiratory conditions • Trigger identification and management • Correct device techniques – inhalers, spacers, peak flow meters, nebulisers • Self-management plans for Asthma and COPD • On-going review and follow-up education • Provision of spacers to children and adults • Nebuliser hire on doctors authority & education in use of a nebuliser

  5. Our Services We provide education programmes to: • Preschool/ Childcare Centre staff & families • Rest Home staff • Asthma Fundamentals Training Course for Practice Nurses & Community Respiratory Educators • Community Groups • Maori Community Health Workers • Pulmonary Rehabilitation for mainstream & Maori • Weekly COPD Support Group with exercises

  6. Referrals We accept referrals from: • GPs and Practice Nurses • Community, Public Health and Plunket Nurses • Hospital Emergency Dept and After-hours Clinics • Hospital Respiratory Nurses for community follow-up • Allied Health / Community workers • Client self referrals

  7. Referrals Referrals for spirometry, assessment & pulmonary rehabilitation should be in writing and must include: • Patient name • Daytime phone number and address • DoB • Reason for referral • Co-morbidities • Medications • Please send the referral direct to us, rather than giving to the patient!

  8. Community Pulmonary Rehabilitation • Programme started here in 1999 • Now funded for 85 clients per year • 8 x 8 week programmes per year, including 3 specifically for Maori • 3 maintenance sessions per week • COPD Support Groups around the region

  9. Community Pulmonary Rehabilitation Patients eligible for the programme are those with: • A diagnosis of COPD • Requirement for close monitoring of exercise and risk reduction therapy • An impairment that could benefit from pulmonary rehabilitation • A medical clearance/GP referral

  10. Community Pulmonary Rehabilitation Patients not suitable for the community programme are those with co-morbities which include: • Unstable angina • Life threatening arrhythmias • Uncontrolled hypertension and/or diabetes • Symptomatic congestive heart failure • Thrombophlebitis • Recent embolism • Orthopaedic problems prohibiting exercise • Severe psychiatric disturbance

  11. Process after Referral Received • Appointment made with patient for spirometry & assessment with Respiratory Nurse (this may take up to 2-4 weeks) • Appointment made for Physio assessment • Patient commences the next available programme – the longest wait is usually no more than 8-10 weeks

  12. Completion of Programme • Post completion assessment with physio & respiratory nurse • Physio writes patient report to GP • Patient entitled to free GP visit, funded by WBoP PHO • Patient encouraged to attend regular maintenance sessions • Patient also has 6-month follow up assessment with physio & nurse

  13. PulmonaryRehabilitation Helen Helm Breathe Physiotherapy

  14. What is Pulmonary Rehab Definition : ATS/ERS statements 2006: “Pulmonary rehabilitation is an evidence-based, multidisciplinary, and comprehensive intervention for patients with chronic respiratory diseases who are symptomatic and often have decreased daily life”

  15. 2009 Cochrane Review A systemic review of evidence on the effectiveness of pulmonary rehabilitation • Level A evidence • Concluded that there were large effects of pulmonary rehabilitation in the improvement of exercise capacity, health related quality of life and substantial reduction in the number of unplanned admission and mortality. Cochrane database of systemic reviews, issue 1, 2009. intervention review- pulmonary rehabilitation following exacerbation of COPD 2009 Cochrane Review

  16. Primary aims of pulmonary rehabilitation • To reduce activity limitation and participation restriction of patients with chronic lung diseases. • To restore patients to the highest possible level of independent functioning • It aims to address both the physical and psychological problems associated with the chronic disease.

  17. Goals of PR • Increase exercise capacity, endurance and muscle strength in order to reduce impairment. • Improve adherence to recommended treatments. • Reduce frequency and severity of symptoms • Decrease hospital admissions • Improve mood and motivation with reduction in anxiety and depression.

  18. Goals of PR • Enhance participation in therapy decisions by building self-management capacity. • Increase participation in everyday activities and reduce dependency. • Improve quality of life. • Reduce health care burden for patients, families and communities. • Decrease mortality rates.

  19. Team • Physiotherapist • Physiotherapy Assistant • Dietician – Fiona Boyle • Occupational Therapist – Yvonne Hartwell • Respiratory Nurse • Clinical Psychologist – Dr Geraldine Hancock

  20. Physio Assessment and Outcomes • Screening of referral • Assessment takes place • Outcome measures CRDQ, ISWT, SpO2 • Patient entered into the next available 8 week course

  21. ISWT The incremental shuttle walking test (ISWT) was developed to simulate a cardiopulmonary exercise test using a field walking test. • The patient is required to walk between two cones 10m apart in time to a set of auditory beeps • Initially, the walking speed is very slow, but progressively increases each minute. • The patient walks for as long as they can until they are either too breathless or can no longer keep up with the beeps. • The number of shuttles (laps between the cones) is recorded. • The results of the ISWT can be used to prescribe the intensity of walking exercise.

  22. ISWT • The ISWT is carried out at the pre, post and 6 month assessments • The change in the distance walked can be used to evaluate the efficacy of an exercise training programme and/or to track the change in exercise capacity over time. • An improvement of 47.5 metres in ISWT indicates that patients with COPD are ‘slightly better’ and an improvement of 78.7 metres represents ‘better’ Singh et al 2008.

  23. CRDQ • The Chronic Respiratory Disease Questionnaire looks at 4 different components: • Dyspnoea • Fatigue • Emotion function • Mastery of disease • Sensitive and responsive to change after pulmonary rehabilitation

  24. What the class involves • Breathing pattern review and breathing control • Breathless positions • Sputum clearance • Exercise training working on endurance and strength • Upper limb and lower limb weights • Circuit classes • Specific education sessions from outside professionals

  25. Discharge and Maintenance • Discharge letters are written to health care providers • Patients are given information on Green Prescription, City on Feet walking groups, Sit and be Fit, Recycled Teenagers etc • Recommended to continue with home exercise programme • Recommended to continue to attend maintenance classes • Six month review ISWT and CRDQ

  26. References • American Association of Cardiovascular and Pulmonary Rehabilitation. Guidelines for cardiac rehabilitation and secondary prevention programs. Champaign (USA): Human Kinetics Publishers; 2004. • Australian Lung Foundation Chronic Airflow Limitation Consultative Group. Case statement chronic obstructive pulmonary disease (COPD) [monograph on the Internet]. Australian Lung Foundation; 2000.  Available from http://www.lungfoundation.com.au/lung-information/publications/copd-case-statements-2001-2002 • British Thoracic Society Standards of Care Subcommittee on Pulmonary Rehabilitation. Pulmonary rehabilitation. Thorax 2001;56:827-834. • COPD Guidelines Group of the Standards of Care Committee of the British Thoracic Society. BTS Guidelines for the management of chronic obstructive pulmonary disease. Thorax. 1997;52 Suppl 5:S1-S28. • Ries A, Bauldoff G, Carlin B et al. Pulmonary Rehabilitation: Joint ACCP/AACVPR Evidence-based Clinical Practice Guidelines. Chest. 2007;131: 4s-42s • National Institute for Clinical Excellence.  Chronic obstructive pulmonary disease: Management of chronic obstructive pulmonary disease in adults in primary and secondary care [monograph on the Internet].  London: National Institute for Clinical Excellence; 2004. Available from: http://www.nice.org.uk • Singh S, Morgan D, Scott S, Walters D, Hardman A.  Development of a shuttle waking test of disability in patients with chronic airways obstruction. Thorax. 1992;47:1019-1024.

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