Implementation and Sustainability of an Enhanced Pulmonary Rehabilitation Program in a Single Centre

Abstract

Rationale: Pulmonary rehabilitation (PR) has major benefits for patients with chronic obstructive pulmonary disease (COPD). The availability of PR in Canada is low. To facilitate implementation, a standardized and enhanced PR Program has been developed with a self-management education intervention that has been validated and shown to be effective. The objectives of our study were to assess the implementation of this program into a single site; determine the sustainability 18 months after implementation; and to identify the satisfaction with, facilitators of and barriers to implementation and sustainability of the program as perceived by patients with COPD and HCPs. Methods: We conducted a prospective pre-post study which consisted of two phases: 1) the implementation phase (first six months after implementation) and 2) the sustainability phase (18 months after implementation). Guided by the RE-AIM framework, outcomes including: Reach (number of patients enrolled and demographics), Effectiveness (Change in patient outcomes), Adoption (HCPs' characteristics), Implementation (Program fidelity) and Maintenance (Patient outcomes at 3-month follow-up). Additional outcomes were: satisfaction with, facilitators of and barriers to implementation and sustainability of the program as perceived by patients with COPD and HCPs. Results: Reach -Twenty-six patients were included for both phases (two different samples). Effectiveness -Clinically important improvements in patient outcomes were found for functional exercise capacity, knowledge, functional status and selfefficacy in both phases of the study (See table). Adoption -All HCPs involved in PR (N=8) agreed to participate and used the program in both phases of the study. Implementation -Fidelity for the group education sessions ranged from 76-95% in the implementation phase and from 82-88% in the sustainability phase. Maintenance -Clinical important improvements at 3-month follow-up measured in the implementation phase were found in knowledge, self-efficacy for exercise and walking. Satisfaction -Patients and HCPs were highly satisfied with the program. 'Lack of time' was reported as the most common barrier and 'having longstanding procedures' as the most common facilitator by HCPs to implementation and sustainability of the program.Conclusions: The enhanced PR program was accepted by the patients and HCPs and could be reliably implemented and maintained at a single expert center. The program provided clinical benefits for patients in terms of functional capacity, knowledge and self-efficacy for walking. These findings will guide planning for wide scale dissemination and implementation of the program.

Effect of Tai Ji and/or Qigong on Patients with Stable Chronic Obstructive Pulmonary Disease A protocol for meta-analysis and systematic review

“…Patient with stable COPD was normally managed by inhaled medications presented as bronchodilators and inhaled corticosteroids (ICSs) [3] , however the treatment outcomes were not always satisfactory due to patient's poor tolerance with pharmacy side effect. Pulmonary rehabilitation (PR) is described as a comprehensive intervention based on a thorough patient assessment followed by patient-tailored therapies that include exercise training, education, and behavior change, designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence to health-enhancing behaviors [4,5] , and is an essential component of COPD management, would benefit the disease stabilization, and reduce exacerbation. Daily practice of PR included breathing trainings such as pursed lip breathing, yoga breathing, or breathing with computer-aided feedback, and exercise training which aimed to strengthen back, arms, and legs, as well as the muscles used to breathe.…”