Abstract

Introduction: Group based courses of Pulmonary Rehabilitation(PR) lead to improvement in mortality, morbidity and quality for life for those who complete them. But studies show only 40-60% complete. In the UK completion rates vary between 17-59%. Our PR service is a part of an Integrated Community Respiratory Service since April 2015 serving 450,000. We try to identify patients (MRC3) who would benefit from PR whether referred directly for PR or to the service as a whole.

Methods: We have carried out a series of nested audits to examine PR referral, nature of respiratory disease and outcomes after PR.

Results: In 2014-5, 300 patients received PR. In 2015-6 there were 799 PR referrals with 94% COPD. In 2017 the service excluding PR received 997 referrals, including 664 after hospital admission for COPD and 64% were identified for potential PR at triage. 

Between Apr-Nov 2017 there were 376 referrals to PR (14% after in patients stay) equivalent to 564/yr. At initial telephone consultation 156 declined the service. There were 2441 group attendances and 224 patients commenced PR. For 122 booked for inital clinical assessment (Jun-Aug), 108 attended. 99 started PR and 75 completed all sessions (61%). Reasons for non completion included deterioration of respiratory or non-respiratory disease(13%), moved away/ too busy (5%). 71% showed increased walking distance, 53% reduced CAT score by =or>2, 45% reduced HAD anxiety/depression scores.

Conclusion: Group PR works well but many decline the service or are unable to attend or complete. We need to look at other options especially for those who are MRC2 or unable to attend sessions or too ill to attend including home based and internet supported PR where possible.