A pilot project to include psychological care as part of a multidisciplinary pulmonary rehabilitation community programme for patients with COPD

Abstract

An introduction: (comprising context and problem statement) Chronic Obstructive Pulmonary Disease (COPD) is a progressive long term condition characterised by persistent airflow limitation and increasing experience of breathlessness. There are higher rates of anxiety and depression amongst COPD patients than within the general population. This can impact people’s quality of life (QOL) and ability to manage their condition. While physiological co-morbidities are routinely treated, psychological distress such as anxiety and depression are rarely addressed. Short description of practice change implemented: Pulmonary Rehabilitation (PR) is an evidence based multidisciplinary intervention aimed at improving daily functioning and QOL and decreasing symptoms and healthcare costs. It consists of assessment, exercise, education and self-management support. The HSE PR programme in Co. Donegal, Ireland is offered across multiple community locations and is delivered by a Respiratory Nurse Specialist and a Senior Physiotherapist. A pilot project was launched introducing psychological care into the programme, delivered by a Clinical Psychologist on a part-time basis. This included group education and brief intervention, one-to-one patient input and staff consultation and training. Aim and theory of change: The aim of including psychological care in the PR programme was to support patient self-management and improve patient QOL. NICE guidelines recommend that PR programmes should include psychological intervention and this is reiterated by the Irish National Model of Care for COPD. Targeted population and stakeholders: The targeted population are PR patients in Co. Donegal, Ireland. The stakeholders include all healthcare services involved in the care of this patient group. Timeline: The 6 month pilot project started in October 2016 and evaluation is ongoing. Highlights: (innovation, Impact and outcomes) Despite being part of the National Model of Care, having access to psychological care within a PR programme is not standard practice throughout Ireland. The need for such has been highlighted and as far as the authors are aware, this project is one of the first attempts in the Country to address this issue. The project has not yet been completed but it is intended that by addressing COPD patients’ psychological needs as part of the PR programme, patient levels of anxiety and depression will decrease, engagement and completion of the programme will increase, and patient confidence in ability to manage their condition will improve along with QOL. Comments on sustainability: The cost effectiveness of the PR programme in Co. Donegal has been evidenced in terms of reduced healthcare utilisation and it is predicted that this project will further improve cost effectiveness through increased completion rates. Comments on transferability: Based on the findings of this project and the conclusion of it to be effective, similar initiatives could be introduced in other PR programmes throughout the Country. Conclusions: (comprising key findings) Conclusions will be drawn when the project has been completed and key findings available. Discussions: The findings of this project will be discussed in relation to current practice guidelines and the available research base. Lessons learned: These are still being learned!