Case study: Integrated pulmonary rehabilitation
The following case study from Dr Lissa Spencer, Sydney LHD, provided a clinician's perspective on models of care from a local perspective.
What is important to know about your service?
The Royal Prince Alfred Hospital in Sydney offers pulmonary rehabilitation that is individually designed for patients with respiratory conditions and delivered by physiotherapists. This is one of the largest pulmonary rehabilitation programs in Australia. The service offers an initial evidenced-based, eight-week program. It works closely with the local health district Respiratory Chronic Care Program.
What organisational model do you use?
Pulmonary rehabilitation is an integrated hospital, outpatient and community-based model of care.
During the COVID-19 pandemic, tele-rehabilitation began and it continues to play a vital role in the pulmonary rehabilitation program.
Diagnostic testing
Exacerbation management
Ongoing care
Last year of life
What is special about the way care is delivered?
Patients with respiratory conditions are referred by their healthcare provider following a hospital admission.
Online referrals are generated through the Respiratory Coordinated Care Program and from the wards. Referrals are prioritised based on individual need and circumstances, with a recent hospital admission and/or an acute chest infection escalating the referral process. There is an alert on the electronic medical record for patients involved in the program.
Pulmonary rehabilitation includes exercise training, self-management education and support for people with all respiratory conditions, including COPD.
Most of the sessions are conducted in a group setting. Individual sessions are available for patients requiring chest physiotherapy or support for musculoskeletal conditions. Chest physiotherapy is available for patients experiencing an acute exacerbation of their condition to avoid a hospital admission and as part of Hospital in the Home.
A companion document describes options for organisational models in COPD. One option is integrated pulmonary rehabilitation – this vignette describes the model from a local perspective.
How does it make a difference?
The program has shown to improve breathlessness, health-related quality of life and exercise capacity. The completion rate is 70%.
As an example of the difference it can make, recently a young Aboriginal man was referred to pulmonary rehabilitation. He was wheelchair bound and very frail. We set some goals with him. He wanted help to be able to mobilise and put on weight. It was too difficult for him to come to us, so one of our team members went to see him. They helped him to get back on the road to improved health.
What tips do you have for others?
- Establish time-limited individualised exercise programs.
- Work in partnership with the Respiratory Coordinated Care Program.
- Know what the research says and review your program regularly.