Establishing a pulmonary rehabilitation programme in primary care in Greece: A FRESH AIR implementation study

Abstract

Pulmonary rehabilitation (PR) is an evidence-based, low-cost, non-medical treatment approach for patients with chronic respiratory diseases. This study aimed to start and assess the feasibility, acceptability and impact of a PR programme on health and quality of life of respiratory patients, for the first time in primary care in Crete, Greece and, particularly, in a low-resource rural setting. This was an implementation study with before–after outcome evaluation and qualitative interviews with patients and stakeholders. In a rural primary healthcare centre, patients with chronic obstructive pulmonary disease (COPD) and/or asthma were recruited. The implementation strategy included adaptation of a PR programme previously developed in United Kingdom and Uganda and training of clinical staff in programme delivery. The intervention comprised of 6 weeks of exercise and education sessions, supervised by physiotherapists, nurse and general practitioner. Patient outcomes (Clinical COPD Questionnaire (CCQ), COPD Assessment Test (CAT), St. George’s Respiratory Questionnaire (SGRQ), Patient Health Questionnaire-9 (PHQ-9), Incremental Shuttle Walking Test (ISWT)) were analysed descriptively. Qualitative outcomes (feasibility, acceptability) were analysed using thematic content analysis. With minor adaptations to the original programme, 40 patients initiated (24 with COPD and 16 with asthma) and 31 completed PR (19 with COPD and 12 with asthma). Clinically important improvements in all outcomes were documented (mean differences (95% CIs) for CCQ: −0.53 (−0.81, −0.24), CAT: −5.93 (−8.27, −3.60), SGRQ: −23.00 (−29.42, −16.58), PHQ-9: −1.10 (−2.32, 0.12), ISWT: 87.39 (59.37, 115.40)). The direct PR benefits and the necessity of implementing similar initiatives in remote areas were highlighted. This study provided evidence about the multiple impacts of a PR programme, indicating that it could be both feasible and acceptable in low-resource, primary care settings.

Patient outcomes following GPs’ educations about COPD: a cluster randomized controlled trial

“…These findings may be related to disease progress, or GPs’ improved adherence to guidelines, or both. Other CME projects have led to increased use of pulmonary rehabilitation 17 , so we reason that the CME in in this study may have had similar effects. Previously published results on PRIMAIR’s baseline data showed that the participating GPs had a high level of knowledge about smoking cessation support 18 , yet they rarely offered smoking cessation support to patients 19 .…”

Pilot of a community-based interprofessional “student-infused” pulmonary rehabilitation program in Saint John, New Brunswick

“…It was essential that space for the program be located on a ground floor next to a major entrance and adjacent to a washroom to accommodate potential mobility challenges of participants. Structural considerations such as free parking, access, and timing of programs have been identified as either anticipated factors or known to be an impediment to participation and retention of clients in similar programs [8][9][10]27]. To that end, we either assisted participants by parking their vehicle for them or absorbed transit costs to decrease physical and economic barriers to the program.…”

A systematic approach to context-mapping to prepare for health interventions: development and validation of the SETTING-tool in four countries

“…To overcome the hesitance of patients to participate in the Pulmonary Rehabilitation Programme, 60 we had to introduce a component in the programme that emphasised the benefits of exercise for respiratory symptoms.…”

“…We embraced this norm as a motivator in the Pulmonary Rehabilitation Programme. 60 We capitalised on the positive social pressure to exercise together as a group and help each other to complete the programme by not…”