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

Abstract

Background: 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). 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 self-efficacy in both phases of the study. 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 (implementation phase): Clinical important improvements at 3-month follow-up were found in knowledge, self-efficacy for exercise and walking. 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.