People continue to wait too long for chronic obstructive pulmonary disease (COPD) treatment despite improvements in the organisation of care for patients according to three new reports released by the Royal College of Physicians (RCP).
The Pulmonary rehabilitation: An exercise in improvement report shows that only 60% of people with COPD referred for pulmonary rehabilitation (PR) were enrolled to a PR programme within 90 days, and more than a third (38%) do not complete the treatment course once assessed. In addition, conduct of routine exercise assessments were not performed according to accepted standards in over 50% of patients.
However, the report also highlights some important improvements: 84% of services provide a written discharge exercise plan (compared to only 65% in 2015) and more services have a standard operating procedure detailing local policies (84% in 2017, compared with 67% in 2015).
Overall, the report reveals many areas of good quality PR treatment and, for patients that do complete therapy, meaningful improvements are seen in their quality of life.
84% of services provide a written discharge exercise plan (compared to only 65% in 2015) and more services have a standard operating procedure detailing local policies (84% in 2017, compared with 67% in 2015).
Professor Michael Steiner, national COPD audit clinical lead for pulmonary rehabilitation and a consultant respiratory physician, said:
The audit demonstrates the substantial health benefits received by people who complete PR. I hope the findings of this report and other PR audit reports will widen access to PR services and in turn, improve care for people with COPD.
Patients and commissioners can also now begin to use these results in a practical way to understand the quality of their local services.
Secondary care reports
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:
- 85% of hospitals provide COPD patients with access to specialist respiratory nurses, up from 71% 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% of hospitals report pulmonary rehabilitation was available to patients within 4 weeks of discharge from hospital, up from 38% in 2014, over half of patients are still waiting longer than a month to receive this treatment.
These reports also find that, of those admissions that were current smokers, only a quarter were prescribed smoking cessation pharmacotherapy. Smoking cessation services are one of the most effective ways to reduce exacerbations of COPD, but nearly half of hospitals (46%) no longer provide this service.
Dr Robert Stone, RCP COPD clinical lead said:
It is very encouraging to see more hospitals than ever are providing specialist respiratory care for COPD patients. However, there is still clearly much more work to be done to ensure COPD patients are being seen in the correct ward and much more support is given to the already overstretched respiratory staff.
It is paramount that there is greater collaboration across teams to provide the best care possible, including the provision of really effective services such as PR and smoking cessation help.
Dr Lisa Davies, chair of the British Thoracic Society (BTS), said:
This audit is really important in understanding the care COPD patients are receiving in secondary care. It is pleasing to see that NHS staff are providing such high quality work in line with BTS standards, but more clearly needs to be done in supporting staff to provide care for patients. We support the recommendations of the RCP coming out of this report and hope that these are addressed soon.
85% of hospitals provide COPD patients with access to specialist respiratory nurses, up from 71% in 2014
RCP recommendations
The RCP has called for PR services to:
- enrol 85% of patients referred for PR within 90 days
- ensure all exercise assessments are performed to the recommended standards
- aim for at least 70% of patients assessed to have completed PR.
The An exercise in improvement report 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.
