First Pulmonary Rehabilitation audit shows variation in care nationally

Published: 18 Nov 2015

The National Chronic Obstructive Pulmonary Disease (COPD) Programme for the first time today, reviews the resources and the organisation of pulmonary rehabilitation (PR) services in both England and Wales, which are set against British Thoracic Society (BTS) quality standards.

The report entitled: ‘Pulmonary rehabilitation: time to breathe better’, shows that most pulmonary rehabilitation (PR) programmes are providing treatment in line with national guidelines and quality standards. However, there are some variations of care, and not all eligible patients who would benefit from PR treatment are being referred, and a significant number of those who are referred do not attend for treatment.

Download the report

Key areas for improvement include:

  • Compared to the estimated need, insufficient numbers of patients with COPD are being referred for PR. Of those who are referred for PR, 31% do not attend their appointment for an assessment
  • Referral for PR following hospitalisation for COPD is known to benefit patients but only 68% of programmes offer this, and only 22% of programmes are able to provide it within 1 month of discharge from hospital (as set out in the quality standards)
  • A number of programmes report insecurity of on-going funding and of those with fixed term funding, 79% reported that this was for 2 years or less
  • In some programmes (18%), the prescription of exercise during PR is not performed in line with evidence-based guidance and some programmes (35%) do not provide a personal on-going exercise plan for patients when they complete PR

Main recommendations for PR commissioners and providers include:

  • Commissioners and providers should work together to review and enhance referral pathways for PR and education and training to ensure that all eligible patients in their area are offered treatment
  • Commissioners should take steps to ensure PR providers have an adequate long term funding framework that will allow programmes to recruit and retain staff with an appropriate skill
  • PR programmes should review their exercise prescription practice to ensure that they are providing treatment in line with BTS Quality standards
  • PR programmes should examine their discharge processes to ensure each patient receives a written, individualised plan for on-going exercise and maintenance when they finish rehabilitation

Patients can now begin to use these results to understand the quality of their local services and if these services do not meet the standards, both patients and commissioners should encourage providers to improve their standards.

The second report, expected early next year, will look at what happens to individual patients in more detail.

The review identified 230 PR programmes across England and Wales. Participation in the COPD audit has been excellent, with 97% providing data in England and a 100% response rate in Wales which is really encouraging.

Prof Michael Steiner, national COPD audit clinical lead for pulmonary rehabilitation and consultant respiratory physician, said:

“This is the first national audit of resources and organisation of pulmonary rehabilitation (PR) services. It is the first step to understanding the current availability and quality of PR services across England and Wales. We have been really encouraged by the overwhelming participation of PR providers and hope the results will be a starting point to improving care for people with COPD.”

Dr Bernard Higgins, Chair of the British Thoracic Society said:

“The audit is an important milestone and has examined Pulmonary Rehabilitation services across England and Wales for the first time ever. It has assessed the services provided against the BTS Quality Standards for Pulmonary Rehabilitation and we are pleased to note that there is an overall adherence to these standards.  However, variation in the quality of care remains across programmes and this audit will provide the impetus for a widespread improvement in this important area.”

COPD is the collective term for emphysema and chronic bronchitis, and is mainly caused by smoking. People with COPD have breathing difficulties, which can affect the quality of their everyday life and prevents normal physical activity.  Pulmonary Rehabilitation (PR) is a combination of exercises to improve physical activity and fitness, together with advice and education about self-care; all of which help patients with COPD to cope with this incurable medical condition. Exercise programmes include a mixture of strength and aerobic exercise training. PR has been proven to reduce breathlessness and help those who live with COPD undertake every day activities like walking or climbing stairs.

PR is an accepted standard of care for people with COPD and its lack of availability or referral can affect the quality of care for patients. PR is one of the few therapies that has shown to reduce time spent in hospital and is a really good cost effective treatment for COPD. Therefore, PR programmes should be a high priority for national and local health policymakers.

The National COPD Audit Programme is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP)*. The National COPD Audit Programme is led by the Royal College of Physicians, working closely with stakeholders, including the British Thoracic Society (BTS), the Primary Care Respiratory Society UK (PCRS-UK), the British Lung Foundation (BLF) and the Royal College of General Practitioners (RCGP).