Abstract
A loss of physical functioning (i.e., a low physical capacity and/or a low physical activity) is a common feature in patients with chronic obstructive pulmonary disease (COPD). To date, the primary care physiotherapy and specialized pulmonary rehabilitation are clearly underused, and limited to patients with a moderate to very severe degree of airflow limitation (GOLD stage 2 or higher). However, improved referral rates are a necessity to lower the burden for patients with COPD and for society. Therefore, a multidisciplinary group of healthcare professionals and scientists proposes a new model for referral of patients with COPD to the right type of exercise-based care, irrespective of the degree of airflow limitation. Indeed, disease instability (recent hospitalization, yes/no), the burden of disease (no/low, mild/moderate or high), physical capacity (low or preserved) and physical activity (low or preserved) need to be used to allocate patients to one of the six distinct patient profiles. Patients with profile 1 or 2 will not be referred for physiotherapy; patients with profiles 3–5 will be referred for primary care physiotherapy; and patients with profile 6 will be referred for screening for specialized pulmonary rehabilitation. The proposed Dutch model has the intention to get the right patient with COPD allocated to the right type of exercise-based care and at the right moment.
Highlights
Despite medical treatment by the general practitioner, an impaired physical, emotional and/or social functioning has been frequently reported in Dutch primary care patients with chronic obstructive pulmonary disease (COPD) [1,2,3]
Use of primary care physiotherapy or specialized pulmonary rehabilitation programs is very limited in patients with COPD (5.0 and 0.2%, respectively), while a larger proportion of these patients clearly qualify for this type of care
As profile 5 patients have to increase their physical capacity and physical activity, it seems fair that they are entitled to the reimbursement of the costs of more physiotherapy sessions provided in the primary care setting compared to profile 3 or 4 patients (Table 2)
Summary
Despite medical treatment by the general practitioner, an impaired physical, emotional and/or social functioning has been frequently reported in Dutch primary care patients with chronic obstructive pulmonary disease (COPD) [1,2,3]. An interdisciplinary comprehensive pulmonary rehabilitation (PR) program is defined as ‘a comprehensive intervention based on a thorough patient assessment followed by patient-tailored therapies, which include, but are not limited to, exercise training, education, and behavior change, designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence of healthenhancing behaviors’ [9] Such programs have shown to improve the performance of activities of daily living, to increase self-efficacy, and to lower the degree of care dependency and healthcare utilization [5, 10,11,12,13,14] in COPD patients with a combination of physical, emotional and/or social treatable traits. Even though safety and efficacy of these interventions are clear, referral by physicians remains poor [15]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
