Digitally enhanced pulmonary rehabilitation

In 2018, Southend University Hospital introduced a new menu-based pulmonary rehabilitation delivery model to provide options for patients who were unable to attend the traditional centre-based classes. The new model was designed to address the challenges faced with service capacity and completion rates.

Situation

Pulmonary rehabilitation (PR) is one of the most cost-effective treatments for chronic obstructive pulmonary disease (COPD) patients and should be available within every clinical commissioning group (CCG) respiratory pathway in the UK (National Institute of Health and Care Excellence (NICE), 2016).

However, there are challenges to the uptake and delivery of traditional models of PR with less than 10% of eligible patients completing PR and 40% of patients waiting longer than 90 days to access a programme (NHSE Long Term Plan, 2019; NACAP, 2019).

Recognising the importance of this treatment option for patients, NHS England aims to increase referral rates to PR from 13% to 60% by 2023. To cater for this increased demand, services must explore other modes of delivery.

Aspiration

In August 2018 the Digitally Enhanced Pulmonary Rehabilitation Programme (DEPR) was launched by Southend University Hospital.

The programme offers a menu-based approach and aims to:

• increase service capacity
• increase completion rates
• maintain parity of care across all menu options

Solution and impact

The Southend DEPR model offers a flexible approach, allowing patients to complete either centre- or home-based rehab, or a combination of the two, using the myCOPD app to enhance usual care, as well as providing remote service delivery.

All patients received an initial and end assessment with a choice of three modes of delivery for their programme:

1. Centre-based - 12 sessions delivered over six weeks face-to-face with myCOPD, or paper-based materials to support
2. Hybrid option - six sessions delivered over six weeks face-to-face, with the remaining six sessions conducted at home using either myCOPD or paper-based resources
3. Home-based - all 12 sessions conducted at home, either online using the myCOPD app or using paper-based exercise manuals
   

Functionality

myCOPD is a web-based application designed by clinical experts to support patients’ self-management of their condition and enhance clinical teams’ ability to deliver effective care. myCOPD can be accessed through almost any device that connects to the internet providing access 24/7 to support and enhance care received face-to-face. The app is listed in the NHS Apps Library.

Capabilities

myCOPD offers a digital therapeutic solution through digital pulmonary rehabilitation and education delivery, to improve patient access and adherence, whilst increasing service capacity. The comprehensive 6-week safety-gated and graduated home rehabilitation programme has been shown to deliver parity of care with face-to-face delivery Trooper study.

There are a range of features within myCOPD designed to support patient empowerment and optimise self-management, including:

• a comprehensive education course
• risk factor tracking
• lifestyle modification support
• a tailored self-management plan
• inhaler instruction to optimise technique
• weather and air quality forecasts and information

The information entered by the patient can then be reviewed by the clinical team via the clinical user interface supporting remote review and management and enabling clinical teams to deliver new models of care at a population scale.

Further research has shown that myCOPD can lead to:

• improved inhaler technique
• improved rate of recovery, post exacerbation
• reduced risk of exacerbation
• reduced readmission rates
• improved disease control

The Southend pulmonary rehabilitation service conducted a review (RESCUE trial) at the end of the first year of using the DEPR model, which revealed:

• increased service capacity
• increased completion rates
• parity of care had been maintained across all modes of delivery

The results support the outcomes seen in Trooper study (MMH-R01) and provide a strong example of a new service delivery model for pulmonary rehabilitation, maintaining standards of care whilst increasing accessibility.

Another benefit of this model has become apparent in 2020 in light of the COVID-19 pandemic. In March 2020, face-to-face pulmonary rehabilitation sessions were suspended resulting in many services pausing all service delivery. However, the Southend DEPR model has allowed tremendous flexibility and the team was able to suspend the face-to-face elements of their service but move all patients onto a remote delivery mode, thereby continuing to support them.

As services have been able to start to reinstate face-to-face interactions, but still required to maintain social distancing, the hybrid option has allowed classes to be split over the week (attending once a week instead of twice a week) ensuring the team meets the current requirements and safety measures.

The Southend DEPR model is an exemplar of innovation which has demonstrated an ability to rise to increasing service demand, maintain service delivery quality and provide resilience in the face of unforeseen events, such as COVID-19.

Find out more

For more information, visit the My mhealth website

Read the Trooper study here - British Medical Journal Trooper study (MMH-R01)

Read about the RESCUE trial here - Nature.com website - RESCUE trial (MMH-R02)

Key contact

Jane Stokes – rehabilitation and engagement lead

jane.stokes@mymhealth.com

Mark Bramley, PMO manager, Mid and South Essex HCP

mark.bramley@nhs.net