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REMOTE PULMONARY REHABILITATION A Model for Delivery

REMOTE PULMONARY REHABILITATION A Model for Delivery. Jane Dernie September 2010.

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REMOTE PULMONARY REHABILITATION A Model for Delivery

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  1. REMOTE PULMONARY REHABILITATION A Model for Delivery Jane Dernie September 2010

  2. Standard 4: Pulmonary rehabilitationStandard statement 4aPulmonary rehabilitation is available within the NHS board to people withCOPD who have an MRC dyspnoea scale score of 3 or more.RationalePulmonary rehabilitation delivered by a multidisciplinary team can improve thehealth-related quality of life, exercise capacity and breathlessness of people withCOPD. There is good evidence to support the benefits of pulmonary rehabilitationpost-exacerbation.Pulmonary rehabilitation has been shown to be an effective treatment for peoplewith COPD.References: 4, 9, 10Essential criteria4a.1 Pulmonary rehabilitation is offered to people with COPD with an MRCdyspnoea scale score of 3 or more.4a.2 Pulmonary rehabilitation is accessible to qualifying people with COPD.4a.3 Pulmonary rehabilitation incorporates:• upper and lower body physical training, and• disease education including smoking cessation.4a.4 - Pulmonary rehabilitation is available for people with COPD post exacerbation.Desirable criteria4a.5 Pulmonary rehabilitation incorporates:• medication management• nutritional intervention• psychological and behavioural interventions, and• occupational therapy.

  3. Running class at central PRI site with present staffing • Delivering class via Tanberg 880s Codec camera with 28 inch monitor to Pitlochry Community Hospital • Physiotherapy Assistant supporting and supervising patients at Pitlochry

  4. 12 patients assessed for PRI 10 patients completed 122 attendances 3 patients assessed for Pitlochry 2 patients completed 34 attendances Programme Ran Oct – Dec 2008 MeasuresReliability of EquipmentSkill mix of staffEffectiveness of modelEconomicsSatisfaction

  5. Overview of Service Referrals to Physiotherapy

  6. GUIDELINE FOR REFERRAL TO THE (PILOT) TELEMEDICINE PULMONARY REHABILITATION FOR COPD The principal goals of pulmonary rehabilitation are to reduce the symptoms, improve quality of life and increase physical and emotional participation in everyday activities. DRAFT CONFIRM DIAGNOSIS OF COPD YES Moderate/Severe COPD and/or MRC 3 or above NO • Optimise drug therapy • Smoking cessation • Lifestyle advice • Exercise referral scheme • Refer to PRI Pulmonary Rehab Programme (if meets criteria) • Optimise Drug Therapy • Trial of long acting bronchodilator anticholinergic and reg B2-agonist • Ex-smoker/ motivated to stop • Willing to attend twice per week for 8 weeks • Able to get to Pilot Centre NO YES • Any Contra-indications to rehab present? • Unstable angina • Unable to walk independently • Requires one-to-one input • Musculoskeletal problem causing ongoing stiffness or pain • Recent PE/DVT/MI (6 weeks) • 2nd/3rd Degree heart block • Resting HR > 120 • Resting BP systolic > 200/diastolic >100 • Dementia/Psychosis • Hearing or Visual impairment (i.e. not able to follow instruction from monitor) • Requiring oxygen to safely exercise MRC Dyspnoea scale Degree of breathlessness related to activities Not troubled by breathlessness except on strenuous exercise Short of breath when hurrying or walking up a slight hill Walks slower than contemporaries on level ground because of breathlessness, or has to stop for breath when walking at own pace Stops for breath after walking about 100m or after a few minutes on level ground Too breathless to leave the house, or breathless when dressing or undressing Grade YES 1 2 NO 3 REFER TO PULMONARY REHAB Pilot Telemedicine Pulmonary Rehab Physiotherapy Dept Perth Royal Infirmary Perth PH1 1NX 4 5

  7. Overview of Service What is COPD Breathing Control Sputum Clearance Medication and Inhalers Nutrition * Pensions and Benefits Coping Strategies & Anxiety Breathe Easy Holidays & Travel *Energy Consumption *Equipment *Time Management *Relaxation Keeping Active Format: 10 weeks x twice a week (currently testing 8) 8 weeks programme: 1 week either side for assessment pre and post Content: Physical activity; graduated exercise programme Education: OT Onward referral to Perth & Kinross Leisure Pilot of Art Therapy

  8. Regular delivery to 3 outlying sites • Part of National project to further roll out • Testing 8 weeks programme • Up-skilling of CRT’s to deliver intervention • Where do we go from here? • Further efficiencies required • Need to expand access to incorporate exacerbations • Need to look at role of community teams/virtual wards Where are we now?

  9. NEW DRIVERS TRIPLE AIM QUALITY AMBITIONS Health of the Population • Mutually beneficial partnerships between patients, their families and those delivering healthcare services. Partnerships which respect individual needs and values and which demonstrate compassion, continuity, clear communication and shared decision-making. • No avoidable injury or harm from the healthcare they receive, and that they are cared for in an appropriate, clean and safe environment at all times. • The most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit, with no wasteful or harmful variation. Experience of Care Per Capita Cost

  10. DISCUSSION

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