Pulmonary Rehabilitation Primary Care Education Event 23/11/16 Martin Sterry Physiotherapist – COPD & Pulmonary Rehabilitation Teams

Aims of session What is it? Who is it for? What are the benefits? Where is it? How to refer?

What is it? BTS 2013: Interdisciplinary programme of care for patients with chronic respiratory impairment that is individually tailored and designed to optimise each patient’s physical and social performance and autonomy. Programmes comprise individualised exercise programmes and education ATS/ERS 2013: Comprehensive intervention based on a thorough patient assessment followed by patient tailored therapies that include, but are not limited to, exercise training, education, and behaviour 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 behaviours.

What it’s not? “Breathing exercises” “Chest physio” “Learn how to breathe” “Somewhere nice to go and have a cup of tea and talk about breathing” Key Message Needs to be: Individualised and Adaptable Physical exercise training Education on self-management of chronic condition (including some breathing techniques) Behaviour Change

What is it? No nationally agreed set-up (BTS Audit – 2015 / 2017) Locally we run a service as: Cohort programme 6 weeks, twice a week Each session 2 hours – 1hr exercise / 1hr education Exercise focused on endurance and strength Education focused on knowledge of self-management of condition – medications / healthy diet / energy conservation

Who is it for? 1 a. People with COPD and self reported exercise limitation (MRC dyspnoea 3-5) are offered pulmonary rehabilitation. 2 Pulmonary rehabilitation programmes accept and enrol patients with functional limitation due to other chronic respiratory diseases (for example bronchiectasis, ILD and asthma) or COPD MRC dyspnoea 2 if referred. 3 a. People admitted to hospital with acute exacerbations of COPD (AECOPD) are referred for pulmonary rehabilitation at discharge.

Who is it not for? Patients with unstable cardiac disease or locomotor difficulties that preclude exercise (eg, severe arthritis or severe peripheral vascular disease) Careful consideration should be given to patients who have significant cognitive or psychiatric impairment that would lead to an inability to follow simple commands in a group setting. In certain individual cases, facilitation of pulmonary rehabilitation may be aided by the support and attendance of a relative or carer. In case of doubt over the appropriateness of a patient for pulmonary rehabilitation, clinicians are advised to contact their local provider.

What are the benefits? “Breathe better, feel good, do more” Reduce dyspnoea Increase exercise capacity Improves quality of life Improves symptoms of anxiety and depression ATS, 2013 Post exacerbation: improves mortality (NNT 6), and reduced re-admissions (NNT4) Puhan et al, 2011 “Breathe better, feel good, do more” IMPRESS 2011

What are the benefits? LABA £8,000/QALY LAMA £7,000/QALY Triple Therapy £7,000-£187,000/QALY LABA £8,000/QALY LAMA £7,000/QALY Pulmonary Rehabilitation £2,000-8,000/QALY Stop Smoking Support with pharmacotherapy £2,000/QALY Flu vaccination £?1,000/QALY in “at risk” population One QALY equates to one year in perfect health. If an individual's health is below this maximum, QALYs are accrued at a rate of less than 1 per year. To be dead is associated with 0 QALYs, and in some circumstances it is possible to accrue negative QALYs to reflect health states deemed 'worse than dead'.

Where is it? Aim to have maximum 30mins travel from patients home Venues flexible to demand / cost / availability Mildenhall – St John’s Community Centre BSE – Anselm Centre Eye – Hertismere Hospital Saxmundham – Riverside Centre Kesgrave – Scout Hall Stowmarket – Scout Hall Newmarket – Memorial Hall Haverhill – Leisure Centre Great Waldingfield – Village Hall Trimley St Martin – Parish Hall

How to refer? Post / Fax / Email referrals to CCC http://www.suffolkcommunityhealthcare.com/Portals/2/Pulm%20Rehab%20R eferral%20v1.doc \Pulm Rehab Referral v1.doc If referral suggested on clinic letter - can just forward on ? Is referral form on S1 – can email practice manager a copy Include Diagnosis / PMH / Spiro / DH Please don’t send referrals to COPD admission avoidance on this form If unsure – get in touch m.sterry@nhs.net or 07740 349 439

Any questions?