A5 caring for my copd

Caring for My COPD: Successes, Challenges and Lessons Learned from a Community-Based Pulmonary Rehab Program ELSA DEYELL, Program Coordinator / Certified Respiratory Educator KEIRA RAINVILLE, Community Health Counsellor / Certified Tobacco Educator

Presenter Disclosure Presenters: Elsa Deyell Keira Rainville

Relationships with financial sponsors: –

Grants/Research Support: None

–

Speakers Bureau/Honoraria: None

–

Consulting Fees: None

–

Patents: None

–

Other: None

Disclosure of Financial Support •

This program has received financial support from HNHB LHIN in the form of Base Funding.

•

Potential for conflict(s) of interest: –

None

Agenda 

COPD Overview



What Is Pulmonary Rehab?



The Burden of COPD



HNHB Caring for my COPD



Formal Evaluation



Patient Engagement



Program Testimonials



Challenges and Lessons Learned

COPD ď ľ

Chronic Obstructive Pulmonary Disease

Emphysema

Chronic Bronchitis 1

1

What is Pulmonary Rehab? 

According to the American Thoracic Society (ATS) & the European Respiratory Society (ERS), pulmonary rehabilitation can be defined as follows:

An evidence-based, multidisciplinary, and comprehensive intervention based on a thorough patient assessment followed by patient-tailored therapies, which include, but are not limited to:  Exercise training  Education  Behavior change designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence of health enhancing behaviors.

Components of Pulmonary Rehab Baseline/ Outcome Assessment Medication Optimization

Interdisciplinary Education

Psychological Support

Comprehensive Pulmonary Rehab

Nutritional Support

Collaborative Chronic Disease Self-management

Exercise Prescription

Benefits of Pulmonary Rehab 

Reduced dyspnea



Increased exercise tolerance



Improved quality of life – activities of daily living



Improved mood 

Reduced anxiety



Reduced depression



Increased motivation



Reduced exacerbations



Reduced health care utilization   hospitalizations/ER vists

2

COPD Burden

3



Burden on the healthcare system



Burden patients’ quality of life



Burden on caregivers

Hamilton Niagara Haldiman Brant Local Health Integration Network

•7000 km₂ •1.4 million people •High # of seniors •Higher prevalence of daily or occasional smokers

Program Locations

Caring for my COPD Core Components 

10 week Community-based program



Individually-tailored exercise program - two days a week



Weekly education



Smoking cessation support



Multidisciplinary team



Baseline and outcome assessments 

Spirometry



6mwt



Screening for anxiety and depression



Follow up phone calls



Graduate program



Updates sent to referring physician

Program Goals 

Better self-manage



Decrease COPD ER visits, hospitalizations, and readmissions



Improve quality of life

4

Program Eligibility Who is eligible?    



Patients with a CONFIRMED Dx OF COPD through spirometry with an FEV1/FVC ratio of less than .70 Patients who have been recently hospitalized or at risk of an acute exacerbation Ability to travel to a community centre for a core program of exercise and education Ability to participate in group settings Willingness to participate

Who is NOT eligible?   

Patients residing in long-term care facilities Medically unstable patients Patients with unconfirmed COPD

Program Referral 

Referral from physician required



Exercise approval or Education Only

Main referral sources : 

Primary Care



Respirology



Hospital



Self-Referral



Home Care

Formal Evaluation 

12-month, longitudinal observational study



4 program sites



130 study participants



4 assessments





Intake



10 week



6 month



12 month

Monthly follow up calls

5

Client Engagement Planning 

Client interviews



Client experience mapping sessions



Consultation with St.Joseph’s Pulmonary Rehab Breathing Buddies peer support group

Delivery 

Graduates of Caring for my COPD program invited to provide peer support to new clients in program as volunteers

Evaluation 

Client satisfaction/client experience survey



Client Testimonials

“Patient engagement is vital to quality improvement, better patient outcomes, and population health management.”

Phytel, (2012)

Testimonial Video

Challenges & Lessons Learned

Challenges 

Physician engagement / Promotion strategies



Buy-in from FHTs and other service providers 





Competing vs. complementary

Uptake 

Time commitment / Competing priorities



Transportation



Anxiety

Retention 

Client-centered approach

6

Client-Centered Care 

Helping clients with their COPD needs sometimes means helping with a lot more than just COPD



Benefits of a multidisciplinary team



Building Trusting Relationships



Flexibility

“Taking the time to get to know your clients and their individual needs is vital.”

AACVPR, (2011)

CBT & Psychological Support 

Screening for Depression, Anxiety & Stress 

Broader application – not only for COPD



Supporting clients with change



Finding motivation

Psychologist 

5 week group



1:1 counselling as needed

7

Value of Peer Support 

Group sessions for exercise and education



Social connections / sense of belonging



Motivation



Learning from shared lived experiences



Volunteers have a sense of purpose 9

8

Health Education 

Repetition



Teach-Backs



Literacy level



Multiple tools/methods 

PowerPoint, Handouts, Demonstrations, Videos, Scenarios etc.



Importance of Continuous Quality Improvement



Behaviour change takes time – Client-centered 

Clients are eligible to re-enroll after 12 months

10

References ď ľ

American Association of Cardiovascular and Pulmonary Rehabilitation (2011). Guidelines for Pulmonary Rehabilitation Programs. Champaign, IL: Human Kinetics .

ď ľ

Phytel (2012). Provider Based Patient Engagement - An Essential Strategy for Population Health. Retrieved from https://www.slideshare.net/Phytel/provider-based-patient-engagement-an-essential-strategy-forpopulation-health

Images 1.

Living Well with COPD (2016, Feb). Summary Guide. Retrieved from www.livingwellwithcopd.com

2.

Wilkinson, E. (2016, Dec 2). Patients need training to use inhalers properly, study finds. Retrieved from https://www.pharmaceutical-journal.com/news-and-analysis/news/patients-need-training-to-use-inhalers-properlystudy-finds/20202013.article

3.

Canadian Lung Association (2012, Nov 22). COPD is deadly, costly and disruptive. Retrieved from https://www.lung.ca/news/latest-news/latest-news/check-out-our-new-infographic-copd-deadly-costly-and-disruptive

4.

Find and Convert (2013, May 10). How to set PPC Marketing Goals . Retrieved from http://www.findandconvert.com/2013/05/how-to-set-ppc-marketing-goals

5.

Tendersinfo Blogs (2017, Nov 23). How are tenders evaluated. Retrieved from http://www.tendersinfo.com/blogs/howare-tenders-evaluated-2/

6.

BI Consult (2018). Sales. Retrieved from https://businessqlik.com/solutions/sales

7.

A Better Today Recovery Service (2018). Cognitive Behavioral Therapy in Addiction Rehab. Retrieved from http://alcoholrecoveryrehab.com/cognitive-behavioral-therapy-in-addiction-rehab/

8.

University of Southampton. Peer Learning. Retrieved from http://www.sbsaob.soton.ac.uk/peer-support/peer-learning/

9.

Gofal (2018). Peer Support Groups. Retrieved from http://www.gofal.org.uk/journeys/groups/

10.

Institute of Health Promotion and Education (2018) Career Development. Retrieved from http://ihpe.org.uk/careerdevelopment/

Questions

Contact Information Elsa.deyell@cschn.ca Keira.rainville@cschn.ca