GPs 'can lead lung rehabilitation services'

Running COPD rehabilitation in GP surgeries could improve patient access where hospital-based services have long waits, research suggests.

Spirometry: research shows GPs can lead lung rehab (photo: P. Marazzi/Science Photo Library)
Spirometry: research shows GPs can lead lung rehab (photo: P. Marazzi/Science Photo Library)

Pulmonary rehabilitation with structured education for COPD is 'feasible' in primary care and could improve quality of life for more patients than hospital support alone, the trial found.

The findings were presented at the European Respiratory Society Annual Congress 2013 in Barcelona last week.

In 2011, a Cochrane review found that one life is saved for every six patients with COPD exacerbations completing a course of pulmonary rehabilitation.

Services are usually provided in hospitals but some are organised in the community or in GP surgeries. However, little is known about how well such programmes work when organised in primary care.

A GP investigation in 2011 found access varied 42-fold across England, with large differences in investment by PCTs. The GPC has called on CCGs to prioritise funding to reduce unnecessary hospital admissions.

Now, an RCT from researchers at the National University of Ireland in Galway suggests such a scheme could be an effective alternative to existing hospital-based programmes.

Researchers recruited 32 general practices in Ireland and 350 patients with moderate to severe COPD. Patients were randomised to a practice-led rehabilitation service or to usual care as a control group. Around 20% dropped out before the end for reasons including non-attendance and illness.

Practice nurses were trained for three days to deliver the service, and worked alongside a physiotherapist, who received one day of training.

Each week for eight weeks, patients in the rehabilitation service attended an hour of education to help them self-manage their condition and an hour of exercise. The format followed NICE guidelines on pulmonary rehabilitation.

A total of 143 patients in the intervention arm and 134 in the control group completed the Chronic Respiratory Questionnaire (CRQ) at the start of the study and after 12-14 weeks. The CRQ is a seven-point scale that measures health-related quality of life in patients with respiratory conditions.

Patients in rehabilitation saw on average a 1.1-point increase in total CRQ scores, including improved scores in questions about breathlessness and physical ability.

There was a large variation in how patients responded to the programme, but the research suggests referring seven patients would yield a clinically important improvement in total CRQ score in one patient.

Lead author Dr Dympna Casey from the National University of Ireland said: 'Based in primary care, this programme is feasible and may increase the overall accessibility to people with moderate and severe COPD.'

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