James M Bowen1, Kaitryn Campbell1, Simone Sutherland1, Ann Bartlett2, Dina Brooks3, Riaz Qureshi1, Roger Goldstein4, Andrea S Gershon5, Shelley Prevost6, Lorelei Samis7, Alan G Kaplan8, Robert B Hopkins1, Craig MacDougald1, Erica Nunes1, Daria J O'Reilly1, Ron Goeree1. 1. Programs for Assessment of Technology in Health (PATH) Research Institute, St. Joseph's Healthcare Hamilton and Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada. 2. Firestone Institute for Respiratory Health, St. Joseph's Healthcare Hamilton and McMaster University School of Nursing, Faculty of Health Sciences, Hamilton, Ontario, Canada. 3. Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Toronto, and West Park Healthcare Centre, Toronto, Ontario, Canada. 4. Department of Medicine, Department of Physical Therapy, Faculty of Rehabilitation Medicine University of Toronto and West Park Healthcare Centre, Toronto, Ontario, Canada. 5. Division of Respirology, Sunnybrook Health Sciences Centre, Institute for Clinical Evaluative Sciences and Department of Medicine, University of Toronto, Toronto, Ontario, Canada. 6. St. Joseph's Hospital, Thunder Bay, Ontario, Canada. 7. Physiotherapy Department, Providence Care - St. Mary's of the Lake Hospital, Kingston, Ontario, Canada. 8. Family Physician Airways Group of Canada and Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
Abstract
BACKGROUND: Pulmonary rehabilitation (PR) is a comprehensive intervention of exercise training, education, and behaviour change to improve the physical and psychological condition of people with chronic respiratory disorders, such as chronic obstructive pulmonary disease (COPD) and to promote long-term adherence to health-enhancing behaviours. Although PR is considered the standard of care for patients with COPD who remain symptomatic despite bronchodilator therapies, current evidence suggests that only 1.15% of COPD patients across Canada have access to PR facilities for care. OBJECTIVES: The objectives of this study were to identify the number of health care facilities across Ontario providing PR services for patients with COPD, describe the scope of those services, and determine the province's current capacity to provide PR services relative to need, for the province as a whole and by local health integration network (LHIN). METHODS: The Pulmonary Rehabilitation Programs in Ontario (PRO) Survey was a province-wide, descriptive, cross-sectional survey of health care facilities (hospitals, family health teams, and community health centres). It was distributed to 409 facilities to collect information on various aspects of PR services in the province. RESULTS: Between April 2013 and February 2014, 187 facilities responded to the survey (46% response rate). Most responding centres (144) did not offer PR services, and only 43 were full PR sites providing a comprehensive program. Hospital-based programs made up the majority of sites offering full PR services (67%), followed by programs based at family health teams (19%) and community health centres (14%). More than 90% of PR programs are outpatient-based. The average wait time for outpatient PR was 6.9 weeks, and 58% of programs provide services 5 days per week. More than 80% of patients attending PR complete the full program. Across all program types, the total estimated provincial capacity for PR outpatient care is 4,524 patients per year, or 0.66% to 1.78% of patients with COPD, depending on the estimated prevalence of disease. LIMITATIONS: These results are representative of 12 of the 14 LHINs in Ontario due to low response rates in facilities in 2 LHINs. CONCLUSIONS: Although some increase in capacity has occurred since a similar survey in 2005, PR resources in Ontario are insufficient to support the delivery of care to people with COPD in accordance with clinical practice guideline recommendations.
BACKGROUND: Pulmonary rehabilitation (PR) is a comprehensive intervention of exercise training, education, and behaviour change to improve the physical and psychological condition of people with chronic respiratory disorders, such as chronic obstructive pulmonary disease (COPD) and to promote long-term adherence to health-enhancing behaviours. Although PR is considered the standard of care for patients with COPD who remain symptomatic despite bronchodilator therapies, current evidence suggests that only 1.15% of COPDpatients across Canada have access to PR facilities for care. OBJECTIVES: The objectives of this study were to identify the number of health care facilities across Ontario providing PR services for patients with COPD, describe the scope of those services, and determine the province's current capacity to provide PR services relative to need, for the province as a whole and by local health integration network (LHIN). METHODS: The Pulmonary Rehabilitation Programs in Ontario (PRO) Survey was a province-wide, descriptive, cross-sectional survey of health care facilities (hospitals, family health teams, and community health centres). It was distributed to 409 facilities to collect information on various aspects of PR services in the province. RESULTS: Between April 2013 and February 2014, 187 facilities responded to the survey (46% response rate). Most responding centres (144) did not offer PR services, and only 43 were full PR sites providing a comprehensive program. Hospital-based programs made up the majority of sites offering full PR services (67%), followed by programs based at family health teams (19%) and community health centres (14%). More than 90% of PR programs are outpatient-based. The average wait time for outpatient PR was 6.9 weeks, and 58% of programs provide services 5 days per week. More than 80% of patients attending PR complete the full program. Across all program types, the total estimated provincial capacity for PR outpatient care is 4,524 patients per year, or 0.66% to 1.78% of patients with COPD, depending on the estimated prevalence of disease. LIMITATIONS: These results are representative of 12 of the 14 LHINs in Ontario due to low response rates in facilities in 2 LHINs. CONCLUSIONS: Although some increase in capacity has occurred since a similar survey in 2005, PR resources in Ontario are insufficient to support the delivery of care to people with COPD in accordance with clinical practice guideline recommendations.
Authors: Martijn A Spruit; Sally J Singh; Chris Garvey; Richard ZuWallack; Linda Nici; Carolyn Rochester; Kylie Hill; Anne E Holland; Suzanne C Lareau; William D-C Man; Fabio Pitta; Louise Sewell; Jonathan Raskin; Jean Bourbeau; Rebecca Crouch; Frits M E Franssen; Richard Casaburi; Jan H Vercoulen; Ioannis Vogiatzis; Rik Gosselink; Enrico M Clini; Tanja W Effing; François Maltais; Job van der Palen; Thierry Troosters; Daisy J A Janssen; Eileen Collins; Judith Garcia-Aymerich; Dina Brooks; Bonnie F Fahy; Milo A Puhan; Martine Hoogendoorn; Rachel Garrod; Annemie M W J Schols; Brian Carlin; Roberto Benzo; Paula Meek; Mike Morgan; Maureen P M H Rutten-van Mölken; Andrew L Ries; Barry Make; Roger S Goldstein; Claire A Dowson; Jan L Brozek; Claudio F Donner; Emiel F M Wouters Journal: Am J Respir Crit Care Med Date: 2013-10-15 Impact factor: 21.405
Authors: Josefin Sundh; Helena Lindgren; Mikael Hasselgren; Scott Montgomery; Christer Janson; Björn Ställberg; Karin Lisspers Journal: Int J Chron Obstruct Pulmon Dis Date: 2017-06-08