Developing Appropriate Pulmonary Rehabilitation Services in Sri Lanka: Assessment of People Living with COPD and Healthcare Providers in Urban and Semi Urban Areas in Sri Lanka

Abstract

Introduction Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, corresponding to 5% of all deaths globally, with more than 90% occurring in low- and middle-income countries (LMIC). Pulmonary Rehabilitation (PR) is a routine clinical service for COPD management, often used in western countries. At present, there is no formal PR in Sri Lanka; a culturally appropriate programme is required that considers the views of adults living with COPD and healthcare providers (HCPs) who would be involved in the referral or delivery of PR. Purpose The study assessed the attitudes and preferences of Sri Lankan adults living with COPD and attitudes and barriers of HCPs making PR referrals to inform an appropriate PR programme. Methodology A descriptive cross-sectional study was conducted with the ethical clearance of Colombo south teaching hospital ERC committee (ERC Application No. 674), among adults living with COPD and HCPs in Colombo district, Sri Lanka. Adults living with COPD were enrolled August 2018–December 2018 using systematic random sampling from Colombo South Teaching Hospital and were assessed using a pre-tested interviewer administered questionnaire. HCPs were recruited from Colombo South Teaching Hospital and Jaffna Teaching Hospital between August 2018 and November 2018 and assessed using self-administered questionnaire. Results Responses from 138 adults living with COPD (53% male, 52% aged ≥60 years) and 277 HCPs were collected. The majority of adults living with COPD were interested in participating in PR (80%) and would prefer PR to be delivered in a supervised, group-based, setting with hospital-based (49%). Adults living with COPD were mostly (73%) willing to spend between 30 minutes and 2 hours per day for PR-related activities. Among HCPs, 234 (83%) were nurses, 29 (11%) were hospital doctors and 14 (4%) were family physicians. The majority of HCPs stated that they were unsure about referring adults with COPD for PR (86%) and 61% stated considerable uncertainty regarding the availability of resources for PR. Nearly half of the HCPs (45%) felt they were not adequately prepared to refer adults living with COPD to PR programmes. Most HCPs (92%) reported that PR is worthwhile for COPD management. Conclusion Adults living with COPD in Sri Lanka are willing to attend PR and would prefer group-based programmes delivered in hospitals, under the supervision of qualified personnel. Awareness about PR is poor and there is a lack of readiness to refer to PR amongst HCPs. There is an urgent need to train HCPs on PR and develop effective referral strategies to support PR uptake and delivery for adults living with COPD in Sri Lanka.

The RECHARGE-IPCRG ‘Teach the Teacher’ programme: building capacity for pulmonary rehabilitation in low- and middle-income countries

“…With five project partners in four countries -India (Pune and Delhi), Sri Lanka (Colombo), Kyrgyzstan (Bishkek) and Uganda (Kampala), the project proposes to reduce the disability associated with CRD through context-specific PR and building capacity for research, 9 leadership and service development. 10,11 With NIHR support LMIC partners are exploring how to implement and take account of the cultural, workforce, demographic and health differences. 12 Accordingly, we describe an innovative education programme designed to build sustainable local capacity in PR teaching and delivery in LMIC.…”

Telerehabilitation in pulmonary diseases

“…Globally, current capacity of available centre-based pulmonary rehabilitation programmes can serve less than 2% of the population of potential patients [25]. Importantly, this limited access to pulmonary rehabilitation does not only affect low and mid-income countries [26–28], but also exists in high-income countries [9 ▪ ,29,30].…”

Burden of respiratory problems in low-income and middle-income countries

“…A cross-sectional study of 138 adults living with COPD in Sri Lanka used an interviewer-administered questionnaire to explore how breathing problems had impacted levels of activity [17 ▪▪ ]. The same study, explored the views of 277 healthcare practitioners [234 (83%) nurses, 29 (11%) hospital doctors and 14 (4%) family practitioners], regarding attitudes to making referrals for pulmonary rehabilitation for symptom control.…”

“…Half of participants reported being unable to visit family and friends as regularly as they would like because of breathing problems, and 80% would be interested in participating in a treatment to reduce their breathlessness and increase their physical activity. Despite this, most healthcare practitioners (86%) were unsure about how to refer to pulmonary rehabilitation, and 61% stated considerable uncertainty regarding the availability of services [17 ▪▪ ].…”