Despite improvements in the organisation of care for patients with chronic obstructive pulmonary disease (COPD), many continue to wait too long for treatment, according to the Royal College of Physicians (RCP).
The findings of their research are contained in three reports published today.
The report Pulmonary rehabilitation: An exercise in improvement shows that only 60 per cent of people with COPD referred for pulmonary rehabilitation (PR) were enrolled to a PR programme within 90 days, and more than a third (38 per cent) do not complete the treatment course once assessed. In addition, conduct of routine exercise assessments was not performed according to accepted standards in over 50 per cent of patients.
Two secondary care reports: COPD: Time to integrate care and COPD: Working together find that patients have greater access to specialist respiratory staff than ever before:
- Eighty-five per cent of hospitals provide COPD patients with access to specialist respiratory nurses, up from 71 per cent in 2014
- Over half of admissions are also reviewed by a member of the respiratory team within 24 hours, up from 2014.
- However, while 46 per cent of hospitals report pulmonary rehabilitation was available to patients within four weeks of discharge from hospital, up from 38 per cent in 2014, over half of patients are still waiting longer than a month to receive this treatment.
Recommendations
The RCP's recommends that:
- Eighty-five per cent of patients referred for PR are enrolled within 90 days
- PR programmes should ensure all exercise assessments are performed to the recommended standards, and
- Aim for at least 70 per cent of patients assessed to have completed PR.
The report: An exercise in improvement, also identifies the need for PR programmes to adapt their services to increase convenience and acceptability. This includes:
- Offering flexible start dates
- Increasing the provision of rolling programmes
- Ensuring that the location at which PR is held is accessible to as many people as possible.
Key recommendations from the Time to integrate care and Working together reports include ensuring that:
- Pulmonary rehabilitation is available to all appropriate patients, including early post-discharge
- All current smokers are identified, offered, and if they accept, prescribed smoking cessation pharmacotherapy
- A spirometry result is available for all patients admitted to hospital with an acute exacerbation of COPD
- All patients requiring NIV on presentation receive it within 60 minutes of the blood gas result associated with the clinical decision to provide NIV and within 120 minutes of arrival for those who present acutely.