Local Pulmonary Rehabilitation in Glasgow and Clyde Elaine Mackay 3.09.10

Population 1.2 million people COPD Referrals to Pulmonary Rehabilitation 6 week progamme Rolling programme Assessment / reassessment AM Classes pm

Referral Maintenance classes Pulmonary Rehabilitation BREATHING CONTROL EXERCISE EDUCATION

Referral Sources in 2009 Secondary Care Doctor 633 39.70% Nurse 243   Nurse 243 15.20% Physiotherapist 97 6% 60.90% Primary Care GP 275 17.30% PN 329 20.60% Other 15 1% 38.90% Total 1592

How to improve uptake / adherence? Information Leaflet Knowledge of referrers describing service “Overcoming The Fear Of Exercise”Bulley et al. Graves et al 2010 Pre-rehabilitation / group opt in

Patients experience prior to rehabilitation Doctor Inhalers +/ - spirometry Ill Antibiotics Steroids Hospital admission Zero expectation

Patients experience prior to rehabilitation Pulmonary Rehabilitation Education Exercise Self Management Doctor Inhalers +/- spirometry Ill Antibiotics Steroids Hospital admission Zero expectation Prescription only Empower the patient to self manage Ethos:

Assessment 6 weeks classes Re-assessment 20

Class Locations - Glasgow Southern General Victoria Infirmary Castlemilk Sports Centre Tollcross Leisure Centre Easterhouse Sports Centre Balgrayhill Comm Centre Kirkintilloch Leisure Centre Maryhill swimming Pool Gartnavel General Drumchapel Swim Pool Playdrome Clydebank Pollok Civic Realm Class Locations – Clyde 13 Elderslie Pool 14. Lagoon Leisure Centre 15 Vale of Leven Pool 16 Boglestone Gym 17 Westburn Church Symbols Hospital Site Maintenance Classes Maintenance Classes potentially outwith a 5 mile radius 15 Vale of Leven Hospital Inverclyde Royal Hospital 7 17 16 10 11 Stobhill Hospital 9. Gartnavel General Hospital 8 6 5 Glasgow Royal Infirmary 4 13 1. Southern General Hospital Royal Alexandra Hospital 2. Victoria Infirmary 2 14 3

map Class venues Travelling distance Taxi if eligible Encourage benefits application Am assessment easterhouse hc new Pm classes

Health Education Breathing Control What is COPD? Relaxation Inhaler technique Common medicines in COPD Recognising Warning Signs Healthy promotion and Smoking Cessation Breathing Control Relaxation Chest Clearance Benefits of Exercise and Maintenance Anxiety Management Energy Conservation

Standardised service Education across 17 classes -group session 20-30 mins -posters 4-5 with bullet points Booklet Exercise / practical

Breathing Control Distress -pacing “Breathing is the basic rhythm of life” Hippocrates

Puffing Panicking Cannot get a breath Gasp Panting Heavy chest Rapid Breathing Breathed your last

Pulmonary Rehabilitation “More in control of my breathing” “Know more about my breathing” “I’ve got some confidence back” “Love the classes especially the talks” “Being able to see and talk to other patients”

Pulmonary Rehabilitation Staffing Band WTE Physiotherapy   Team Leader Band 7 0.4 Physiotherapist Band 6 1 0.8 Physiotherapist-Clyde 0.2 0.6 Physiotherapist-Rotation 0.5 Total Physiotherapy 3.7 Nursing Nurse Nurse-Rotation Nurse-Clyde Total Nursing 3 Management Administrator Band 4 Clinical Psychologist Band 8b Coaches 12

Role of team members Physiotherapist Instructor Nurse Contact with patients 6 weeks of rehabilitation………………………..Maintenance

Physiotherapist Instructor Nurse Contact with patients 6 weeks of rehabilitation………………………..Maintenance

Warm up –cool down 6 weeks of rehabilitation………………………..Maintenance Physiotherapist Instructor Warm up –cool down Nurse Contact with patients 6 weeks of rehabilitation………………………..Maintenance

Vitalty Council run Qualified staff Trained by rehab staff 4 levels of intensity Cost £2.20

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