Caring for My COPD: Successes, Challenges and Lessons Learned from a Community-Based Pulmonary Rehab Program ELSA DEYELL, Program Coordinator / Certified Respiratory Educator KEIRA RAINVILLE, Community Health Counsellor / Certified Tobacco Educator
Presenter Disclosure Presenters: Elsa Deyell Keira Rainville
Relationships with financial sponsors: –
Grants/Research Support: None
–
Speakers Bureau/Honoraria: None
–
Consulting Fees: None
–
Patents: None
–
Other: None
Disclosure of Financial Support •
This program has received financial support from HNHB LHIN in the form of Base Funding.
•
Potential for conflict(s) of interest: –
None
Agenda
COPD Overview
What Is Pulmonary Rehab?
The Burden of COPD
HNHB Caring for my COPD
Formal Evaluation
Patient Engagement
Program Testimonials
Challenges and Lessons Learned
COPD ď ľ
Chronic Obstructive Pulmonary Disease
Emphysema
Chronic Bronchitis 1
1
What is Pulmonary Rehab?
According to the American Thoracic Society (ATS) & the European Respiratory Society (ERS), pulmonary rehabilitation can be defined as follows:
An evidence-based, multidisciplinary, and comprehensive intervention based on a thorough patient assessment followed by patient-tailored therapies, which include, but are not limited to: Exercise training Education Behavior change designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence of health enhancing behaviors.
Components of Pulmonary Rehab Baseline/ Outcome Assessment Medication Optimization
Interdisciplinary Education
Psychological Support
Comprehensive Pulmonary Rehab
Nutritional Support
Collaborative Chronic Disease Self-management
Exercise Prescription
Benefits of Pulmonary Rehab
Reduced dyspnea
Increased exercise tolerance
Improved quality of life – activities of daily living
Improved mood
Reduced anxiety
Reduced depression
Increased motivation
Reduced exacerbations
Reduced health care utilization hospitalizations/ER vists
2
COPD Burden
3
Burden on the healthcare system
Burden patients’ quality of life
Burden on caregivers
Hamilton Niagara Haldiman Brant Local Health Integration Network
•7000 km₂ •1.4 million people •High # of seniors •Higher prevalence of daily or occasional smokers
Program Locations
Caring for my COPD Core Components
10 week Community-based program
Individually-tailored exercise program - two days a week
Weekly education
Smoking cessation support
Multidisciplinary team
Baseline and outcome assessments
Spirometry
6mwt
Screening for anxiety and depression
Follow up phone calls
Graduate program
Updates sent to referring physician
Program Goals
Better self-manage
Decrease COPD ER visits, hospitalizations, and readmissions
Improve quality of life
4
Program Eligibility Who is eligible?
Patients with a CONFIRMED Dx OF COPD through spirometry with an FEV1/FVC ratio of less than .70 Patients who have been recently hospitalized or at risk of an acute exacerbation Ability to travel to a community centre for a core program of exercise and education Ability to participate in group settings Willingness to participate
Who is NOT eligible?
Patients residing in long-term care facilities Medically unstable patients Patients with unconfirmed COPD
Program Referral
Referral from physician required
Exercise approval or Education Only
Main referral sources :
Primary Care
Respirology
Hospital
Self-Referral
Home Care
Formal Evaluation
12-month, longitudinal observational study
4 program sites
130 study participants
4 assessments
Intake
10 week
6 month
12 month
Monthly follow up calls
5
Client Engagement Planning
Client interviews
Client experience mapping sessions
Consultation with St.Joseph’s Pulmonary Rehab Breathing Buddies peer support group
Delivery
Graduates of Caring for my COPD program invited to provide peer support to new clients in program as volunteers
Evaluation
Client satisfaction/client experience survey
Client Testimonials
“Patient engagement is vital to quality improvement, better patient outcomes, and population health management.” Phytel, (2012)
Testimonial Video
Challenges & Lessons Learned
Challenges
Physician engagement / Promotion strategies
Buy-in from FHTs and other service providers
Competing vs. complementary
Uptake
Time commitment / Competing priorities
Transportation
Anxiety
Retention
Client-centered approach
6
Client-Centered Care
Helping clients with their COPD needs sometimes means helping with a lot more than just COPD
Benefits of a multidisciplinary team
Building Trusting Relationships
Flexibility
“Taking the time to get to know your clients and their individual needs is vital.” AACVPR, (2011)
CBT & Psychological Support
Screening for Depression, Anxiety & Stress
Broader application – not only for COPD
Supporting clients with change
Finding motivation
Psychologist
5 week group
1:1 counselling as needed
7
Value of Peer Support
Group sessions for exercise and education
Social connections / sense of belonging
Motivation
Learning from shared lived experiences
Volunteers have a sense of purpose 9
8
Health Education
Repetition
Teach-Backs
Literacy level
Multiple tools/methods
PowerPoint, Handouts, Demonstrations, Videos, Scenarios etc.
Importance of Continuous Quality Improvement
Behaviour change takes time – Client-centered
Clients are eligible to re-enroll after 12 months
10
References ď ľ
American Association of Cardiovascular and Pulmonary Rehabilitation (2011). Guidelines for Pulmonary Rehabilitation Programs. Champaign, IL: Human Kinetics .
ď ľ
Phytel (2012). Provider Based Patient Engagement - An Essential Strategy for Population Health. Retrieved from https://www.slideshare.net/Phytel/provider-based-patient-engagement-an-essential-strategy-forpopulation-health
Images 1.
Living Well with COPD (2016, Feb). Summary Guide. Retrieved from www.livingwellwithcopd.com
2.
Wilkinson, E. (2016, Dec 2). Patients need training to use inhalers properly, study finds. Retrieved from https://www.pharmaceutical-journal.com/news-and-analysis/news/patients-need-training-to-use-inhalers-properlystudy-finds/20202013.article
3.
Canadian Lung Association (2012, Nov 22). COPD is deadly, costly and disruptive. Retrieved from https://www.lung.ca/news/latest-news/latest-news/check-out-our-new-infographic-copd-deadly-costly-and-disruptive
4.
Find and Convert (2013, May 10). How to set PPC Marketing Goals . Retrieved from http://www.findandconvert.com/2013/05/how-to-set-ppc-marketing-goals
5.
Tendersinfo Blogs (2017, Nov 23). How are tenders evaluated. Retrieved from http://www.tendersinfo.com/blogs/howare-tenders-evaluated-2/
6.
BI Consult (2018). Sales. Retrieved from https://businessqlik.com/solutions/sales
7.
A Better Today Recovery Service (2018). Cognitive Behavioral Therapy in Addiction Rehab. Retrieved from http://alcoholrecoveryrehab.com/cognitive-behavioral-therapy-in-addiction-rehab/
8.
University of Southampton. Peer Learning. Retrieved from http://www.sbsaob.soton.ac.uk/peer-support/peer-learning/
9.
Gofal (2018). Peer Support Groups. Retrieved from http://www.gofal.org.uk/journeys/groups/
10.
Institute of Health Promotion and Education (2018) Career Development. Retrieved from http://ihpe.org.uk/careerdevelopment/
Questions
Contact Information Elsa.deyell@cschn.ca Keira.rainville@cschn.ca