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Abstract
Aim:
Pulmonary rehabilitation (PR) is effective and recommended for all symptomatic patients with chronic obstructive pulmonary disease (COPD). An audit from the UK highlighted issues of low referral rates, limited uptake, and low completion rates. We wished to explore whether these issues applied in the PR service in Wellington, New Zealand, and to assess attainment of British Thoracic Society Quality Standards.
Methods:
Retrospective cohort study of a PR program for a calendar year in a secondary care hospital by case note review for demographics, diagnosis, spirometry, referral source, attendance, and 6-minute walk test (6MWT) at baseline and program exit. Attendance rates by sex, ethnicity, smoking status, age, percent predicted forced expiratory volume in 1 second (FEV1%), and baseline 6MWT are described and associations estimated by Poisson regression.
Results:
In the year of the cohort study, 323 patients were referred, which represents only about 2% of the estimated prevalent population of COPD in the hospital catchment. Of these, 256 (80%) attended at least one session. Almost half (46%) completed 75% or more sessions. Lower session attendance was significantly associated with ethnicity, P=0.002, with European compared to Māori relative rate of 1.34 (95% confidence interval [CI] 1.07 to 1.73) and compared to Pacific Island 1.82 (95% CI 1.18 to 2.80); and with smoking, with current smokers less likely to attend than ex-smokers, relative rate 0.67 (95% CI 0.49 to 0.92), P=0.031. There was no association between attendance rates and sex, age, FEV1%, and a weak association with baseline 6MWT. The 6MWT improved from baseline by 35 meters (95% CI 25.0 to 45.6 meters), P<0.001. Areas for improvement in the quality standards were earlier PR attendance after an acute exacerbation of COPD, identification of all those with acute exacerbation of COPD in hospital, and more consistent completion of health status instruments.
Conclusion:
Completion rates for PR are similar to those in the UK audits. The program could be improved by encouraging referral, a shorter rolling program of hospital-based PR to improve attendance rates, and better ways of delivering PR to current smokers and people of all ethnicities.