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Early F, Ward J, Komashie A, Kipouros T, Clarkson J, Fuld J. A systems approach to developing user requirements for increased pulmonary rehabilitation uptake by COPD patients. NPJ Prim Care Respir Med 2024; 34:20. [PMID: 39013894 PMCID: PMC11252258 DOI: 10.1038/s41533-024-00370-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 04/24/2024] [Indexed: 07/18/2024] Open
Abstract
Chronic Obstructive Pulmonary Disease is a progressive lung disease associated with anxiety, depression, and reduced health-related quality of life. Pulmonary rehabilitation (PR) is a cost-effective and transformative treatment, but 31% of referred patients do not take up their PR appointment. The study aimed to develop user requirements for an intervention to increase PR uptake. A systems approach, the Engineering Better Care framework, was used to develop a system map of the PR pathway, translate evidence-based user needs into user requirements, and validate the user requirements in a stakeholder workshop. Eight user requirements addressed patient and health care practitioner needs to understand what PR entails, understand the benefits of PR and have positive conversations about PR to address patient concerns. The solution-independent user requirements can be applied to the development of any intervention sharing similar goals. The study demonstrates potential in taking a systems approach to more challenges within respiratory medicine.
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Affiliation(s)
- Frances Early
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
| | - James Ward
- Department of Engineering, University of Cambridge, Cambridge, UK
| | - Alexander Komashie
- Department of Engineering, University of Cambridge, Cambridge, UK
- The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, Cambridge, UK
| | | | - John Clarkson
- Department of Engineering, University of Cambridge, Cambridge, UK
| | - Jonathan Fuld
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Barradell AC, Singh SJ, Houchen-Wolloff L, Robertson N, Bekker HL. A pulmonary rehabilitation shared decision-making intervention for patients living with COPD: PReSent: protocol for a feasibility study. ERJ Open Res 2022; 8:00645-2021. [PMID: 35677396 PMCID: PMC9168082 DOI: 10.1183/23120541.00645-2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/25/2022] [Indexed: 11/05/2022] Open
Abstract
Background Despite the variety of pulmonary rehabilitation programmes for patients living with COPD, uptake remains low. To improve this, it is recommended that health professionals engage patients in informed decisions about pulmonary rehabilitation. Shared decision-making (SDM) facilitates informed and value-based decision-making between patients and health professionals. This protocol describes the development and evaluation of a complex SDM intervention for patients living with COPD, who are referred for pulmonary rehabilitation, and their pulmonary rehabilitation health professional. Methods and analysis We are developing a complex SDM intervention involving a patient decision aid (PtDA) and a decision coaching workshop. Prior to patient recruitment, pulmonary rehabilitation health professionals will attend the workshop. Upon referral to pulmonary rehabilitation, patients will receive the PtDA to support their decision-making prior to and during their pulmonary rehabilitation assessment with a health professional. The intervention will be evaluated in a one-arm exploratory study to investigate its feasibility and acceptability for patients and health professionals, with an integrated fidelity assessment. The primary outcome is recruitment feasibility, data collection feasibility and intervention fidelity. Secondary outcomes include routine pulmonary rehabilitation data, decisional conflict, patient activation, intervention attendance/attrition and patient and pulmonary rehabilitation health professional experience of the intervention. Quantitative outcomes will be evaluated using the most appropriate statistical test, dependent on the sample distribution. Qualitative outcomes will be evaluated using reflexive thematic analysis. Fidelity will be assessed using the Observer OPTION 5 scale. Conclusion This intervention will provide structure for an informed and values-based decision-making consultation between a patient with COPD and a pulmonary rehabilitation health professional with the potential for optimising pulmonary rehabilitation decision-making.
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Affiliation(s)
- Amy C. Barradell
- Dept of Respiratory Sciences, University of Leicester, Leicester, UK
- Centre for Exercise and Rehabilitation Science, Leicester Biomedical Research Centre-Respiratory, Glenfield Hospital, Leicester, UK
- National Institute for Health Research Applied Research Collaboration (East Midlands), College of Medicine, Biological Sciences and Psychology, Leicester General Hospital, Leicester, UK
| | - Sally J. Singh
- Dept of Respiratory Sciences, University of Leicester, Leicester, UK
- Centre for Exercise and Rehabilitation Science, Leicester Biomedical Research Centre-Respiratory, Glenfield Hospital, Leicester, UK
| | - Linzy Houchen-Wolloff
- Dept of Respiratory Sciences, University of Leicester, Leicester, UK
- Centre for Exercise and Rehabilitation Science, Leicester Biomedical Research Centre-Respiratory, Glenfield Hospital, Leicester, UK
| | - Noelle Robertson
- Dept of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Hilary L. Bekker
- Leeds Unit of Complex Intervention Development, School of Medicine, University of Leeds, Leeds, UK
- Research Centre for Patient Involvement, Central Denmark Region and Aarhus University, Aarhus, Denmark
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A Survey of Factors That May Cause Practice Inconsistencies and Impact Care in Pulmonary Rehabilitation. Cardiopulm Phys Ther J 2020. [DOI: 10.1097/cpt.0000000000000168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Grosbois JM, Heluain-Robiquet J, Machuron F, Terce G, Chenivesse C, Wallaert B, Le Rouzic O. Influence Of Socioeconomic Deprivation On Short- And Long-Term Outcomes Of Home-Based Pulmonary Rehabilitation In Patients With Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2019; 14:2441-2449. [PMID: 31802862 PMCID: PMC6827503 DOI: 10.2147/copd.s224348] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 10/13/2019] [Indexed: 11/23/2022] Open
Abstract
Background Pulmonary rehabilitation (PR) improves exercise tolerance and quality of life in patients with chronic obstructive pulmonary disease (COPD), regardless of disease severity. Socioeconomic deprivation has been linked to the incidence of COPD; however, little is known about its impact on PR outcomes. Methods In this retrospective observational study, 459 COPD patients were enrolled and dichotomized into socially deprived (n=276) and non-socially deprived (n=183) groups based on a cut-off of 30.17 in the EPICES questionnaire (Evaluation of Deprivation and Inequalities in Health Centers), which evaluates socioeconomic disadvantage. The PR program consisted of once-weekly home sessions for 8 weeks, and consisted of an individualized plan of retraining exercises, physical activities, therapeutic education, and psychosocial and motivational support. Exercise tolerance, anxiety and depression, and quality of life were assessed using the 6 min stepper test (6MST), Hospital Anxiety and Depression Scale (HADS), and Visual Simplified Respiratory Questionnaire (VSRQ). Assessments were made before the PR program (baseline) and then at 2 (T2), 8 (T8), and 14 (T14) months after baseline. Results Compared with the non-socially deprived group, socially deprived patients were younger, more frequently women, active smokers, and living alone, and belonged to lower socioprofessional categories. At baseline, 6MST, VSRQ, and HADS measures were lower for the socially deprived than the non-socially deprived group. At T2, T8, and T14, there were no significant between-group differences in any outcome, and the percentage of patients showing clinically important improvements was the same in both groups. Conclusion Home-based PR is effective for COPD patients in the short and long term, regardless of socioeconomic status.
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Affiliation(s)
- Jean-Marie Grosbois
- FormAction Santé, Pérenchies F-59840, France.,CH Béthune, Service de Pneumologie et Réhabilitation Respiratoire, Béthune F-62400, France
| | - Justine Heluain-Robiquet
- CHU Lille, Service de Pneumologie et Immuno-Allergologie, Centre de Référence Constitutif des Maladies Pulmonaires Rares, Department of Heart and Lung Diseases, Lille F-59000, France
| | - François Machuron
- CHU Lille, Department of Biostatistics, University Lille, EA 2694 - Santé Publique: Epidémiologie Et Qualité Des Soins, Lille F-59000, France
| | - Gaelle Terce
- CH Béthune, Service de Pneumologie et Réhabilitation Respiratoire, Béthune F-62400, France
| | - Cécile Chenivesse
- CHU Lille, Service de Pneumologie et Immuno-Allergologie, Centre de Référence Constitutif des Maladies Pulmonaires Rares, Department of Heart and Lung Diseases, Lille F-59000, France.,University Lille, Lille F-59000, France.,Inserm, CNRS, Institut Pasteur de Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, Lille F-59000, France
| | - Benoit Wallaert
- CHU Lille, Service de Pneumologie et Immuno-Allergologie, Centre de Référence Constitutif des Maladies Pulmonaires Rares, Department of Heart and Lung Diseases, Lille F-59000, France.,University Lille, Lille F-59000, France.,Inserm, CNRS, Institut Pasteur de Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, Lille F-59000, France
| | - Olivier Le Rouzic
- CHU Lille, Service de Pneumologie et Immuno-Allergologie, Centre de Référence Constitutif des Maladies Pulmonaires Rares, Department of Heart and Lung Diseases, Lille F-59000, France.,University Lille, Lille F-59000, France
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Spitzer KA, Stefan MS, Priya A, Pack QR, Pekow PS, Lagu T, Pinto-Plata VM, ZuWallack RL, Lindenauer PK. Participation in Pulmonary Rehabilitation after Hospitalization for Chronic Obstructive Pulmonary Disease among Medicare Beneficiaries. Ann Am Thorac Soc 2019; 16:99-106. [PMID: 30417670 PMCID: PMC6344454 DOI: 10.1513/annalsats.201805-332oc] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 09/26/2018] [Indexed: 01/14/2023] Open
Abstract
RATIONALE Current guidelines recommend pulmonary rehabilitation (PR) after hospitalization for a chronic obstructive pulmonary disease (COPD) exacerbation, but little is known about its adoption or factors associated with participation. OBJECTIVES To evaluate receipt of PR after a hospitalization for COPD exacerbation among Medicare beneficiaries and identify individual- and hospital-level predictors of PR receipt and adherence. METHODS We identified individuals hospitalized for COPD during 2012 and recorded receipt, timing, and number of PR visits. We used generalized estimating equation models to identify factors associated with initiation of PR within 6 months of discharge and examined factors associated with number of PR sessions completed. RESULTS Of 223,832 individuals hospitalized for COPD, 4,225 (1.9%) received PR within 6 months of their index hospitalization, and 6,111 (2.7%) did so within 12 months. Median time from discharge until first PR session was 95 days (interquartile range, 44-190 d), and median number of sessions completed was 16 (interquartile range, 6-25). The strongest factor associated with initiating PR within 6 months was prior home oxygen use (odds ratio [OR], 1.49; 95% confidence interval [CI], 1.39-1.59). Individuals aged 75-84 years and those aged 85 years and older (respectively, OR, 0.70; 95% CI, 0.66-0.75; and OR, 0.25; 95% CI 0.22-0.28), those living over 10 miles from a PR facility (OR, 0.42; 95% CI, 0.39-0.46), and those with lower socioeconomic status (OR, 0.42; 95% CI, 0.38-0.46) were less likely to receive PR. CONCLUSIONS Two years after Medicare began providing coverage for PR, participation rates after hospitalization were extremely low. This highlights the need for strategies to increase participation.
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Affiliation(s)
| | - Mihaela S. Stefan
- Institute for Healthcare Delivery and Population Science and
- Department of Medicine, University of Massachusetts Medical School–Baystate, Springfield, Massachusetts
| | - Aruna Priya
- Institute for Healthcare Delivery and Population Science and
- School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts
| | - Quinn R. Pack
- Institute for Healthcare Delivery and Population Science and
- Department of Medicine, University of Massachusetts Medical School–Baystate, Springfield, Massachusetts
- Division of Cardiovascular Medicine, and
| | - Penelope S. Pekow
- Institute for Healthcare Delivery and Population Science and
- School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts
| | - Tara Lagu
- Institute for Healthcare Delivery and Population Science and
- Department of Medicine, University of Massachusetts Medical School–Baystate, Springfield, Massachusetts
| | - Victor M. Pinto-Plata
- Division of Pulmonary and Critical Care Medicine, Baystate Medical Center, Springfield, Massachusetts
| | | | - Peter K. Lindenauer
- Institute for Healthcare Delivery and Population Science and
- Department of Medicine, University of Massachusetts Medical School–Baystate, Springfield, Massachusetts
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
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