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Pulmonary rehab 'lowers COPD mortality'

Pulmonary rehabilitation (PR) courses can reduce hospital readmissions, shorten time spent in hospital and lower mortality rates in COPD patients.

This is the finding of a report published by the Royal College of Physicians (RCP), which added that GPs had a 'huge role to play' in referring more patients.

The RCP's study, which reviewed the hospital admissions and mortality of 7,135 patients in England following assessment for PR, concluded that ‘transforming referral practice in acute and primary care settings to enhance access to and uptake of PR should be a priority for healthcare commissioners and providers’.

But it added that this had to be matched by CCGs ‘ensuring sufficient capacity to meet demand’ for PR.

The study found that 76% of COPD patients who completed their PR course avoided hospital admission within six months after their initial assessment, compared to 62.1% who did not.

Patients who did not complete their PR course within six months after their initial assessment, spent twice as long in hospital - 9.6 days in six months - compared to those who were also admitted and did complete a course - 4.8 days in six months. 

Within three months, 1.6% of COPD patients had died compared to 0.1% who had completed PR treatment. Within six months it was 3.2% compared to 0.5%.

Professor Michael Steiner, national COPD audit clinical lead for pulmonary rehabilitation and a consultant respiratory physician, said: ‘The PR audit report highlights the benefits delivered to patients by attending and completing PR.

‘GPs and their practice teams have a huge role to play as they often have regular contact with patients and can do so much to improve referral rates.

‘GPs who are involved in local commissioning will also have a huge role to play in developing integrated care pathways that enhance access to PR for patients.’

Dr Lisa Davies, consultant respiratory physician, and chair of the British Thoracic Society’s Board of Trustees, added: ‘The results of this comprehensive audit show just how beneficial pulmonary rehabilitation can be to people living with COPD.

‘The treatment is a real "win-win" option, offering excellent clinical outcomes whilst also being a very efficient use of NHS resources.’

This follows a recent report finding that spirometry access in primary care helps to correctly diagnose COPD.

Recommendations from the RCP's COPD audit

  • Commissioners and providers should ensure that robust referral pathways for PR are in place and that PR programmes have sufficient capacity to assess and enrol all eligible people.
  • Healthcare providers should work with patient support organisations and charities to make patients and the public aware of the benefits of attending and completing PR so to encourage patient referral.
  • Referrers and patients should be provided with up-to-date and clear written information about the benefits of attending and completing PR.
  • Commissioners should incentivise providers to enrol a higher proportion of patients discharged from hospital.
  • Commissioners should incentivise providers to measure completion rates as a key performance indicator.

Source: RCP Pulmonary Rehabilitation: Beyond Breathing Better

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