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Morsø L.1,2, Sall Jensen M.1,2, von Plessen C.1,2, Qvist P.1,2
1University of Southern Denmark, Department for Regional Health Research, Odense, Denmark, 2Centre for Quality, Region of Southern Denmark, Middelfart, Denmark
Background: Exacerbations of COPD is associated with increased mortality and reduced quality of life. Exacerbations frequently lead to hospital admissions often initiating a vicious circle of inactivity, conditional decline and repeated exacerbations. Early rehabilitation after hospital stay reduces the risk of readmission and is widely recommended. Few patients, however, participate in early rehabilitation. In spite of the documented benefits, complex provider, organizational and patient related factors hinder the implementation of early rehabilitation. We need to focus on how to overcome these obstacles and how to incorporate the resources of COPD patients.
Purpose: In the frame of a case study, we describe both the considerations on how to target issues influencing the uptake of a program of early rehabilitation in the primary health care. Furthermore, we assess the feasibility of a developed rehabilitation program from the patient perspective.
Methods: For patients to start early rehabilitation they must first accept to participate and second they need referral. The literature shows, that for health care providers to refer to rehabilitation, they need awareness of existing programs, the program has to be feasible to them and the referral has to be simple. We informed about programs, elaborated and answered any questions, simplified referral procedures and disseminated guidelines to clinical staff.
To encourage patients to participate in rehabilitation shortly after discharge a patient handout were developed and patients were explained about rehabilitation in a broad sense. The rehabilitation program was individualized with gradual increase in intensity. After discharge, a COPD nurse contacted patients for reassurance and light exercises. Physiotherapists guided patients through progressing exercises in small groups online. Patients proceeded to rehabilitation with class-based exercises, patient education and/or leisure activities or continued tele-rehabilitation with increasing intensity.
The effects of the intervention (information, referral procedure, patient handout and rehabilitation program) was evaluated by referral, completion and readmission rates. We interviewed patients completing rehabilitation in terms of feasibility and satisfaction.
Results: Sixteen (23% of discharged patients) were referred and 14 started rehabilitation. Twelve patients completed rehabilitation, all having severe COPD. All started the individualized program within two weeks and proceeded to the online guided exercises within four weeks of discharge. Readmission 30 days; 1 of 16 patients for the rehabilitation group and 8 of 55 for patients not referred. Readmission 90 days; 2 and 11 patients, respectively. When interviewed all patients except one were excited about the program. Seven patients said the program had changed their coping strategies.
Conclusion(s): Even though the referral rate to early rehabilitation was only 23%, it was higher than shown earlier. Adherence and completion of the program was high, even though all patients had severe COPD. Patients were highly satisfied with the benefits of the program. The emphasis put into the recruitment of patients did only partly have the intended effect and further studies should address the challenge of getting more patients referred to early post discharge rehabilitation.
Implications: Focus needs to be on both development of feasible interventions and on implementation models for patients to benefit from future rehabilitation programs.
Funding acknowledgements: The study was fully funded internally at the Centre for Quality
Topic: Disability & rehabilitation
Ethics approval: The study was approved by the Regional Data Protection Agency (id number: 15/36088)
All authors, affiliations and abstracts have been published as submitted.
