Addressing health inequalities in pulmonary rehabilitation
Why change was needed
South Warwickshire University NHS Foundation Trust (SWFT) found that a proportion of the local population were not accessing pulmonary rehabilitation health services, which would positively impact their existing health condition, because of where they lived.
Data showed that only 10% of those discharged from hospital with a diagnosis of COPD accessed pulmonary rehab. This triggered a review by the Physiotherapy department to better understand the reasons for this. Using the Quality and Outcomes Framework (QOF) data which looked at rates of COPD per 1000 population, derived from the Trust strategy unit review of respiratory care and equity of healthcare provision undertaken in March 2021, it was noted there was a significant difference in prevalence within our Stratford district with higher rates in our population residing in more rural areas.
A change in the way that the pulmonary rehab service is delivered to be more local, and therefore more accessible to those with chronic obstructive pulmonary disease (COPD) living in rural areas was needed to provide better care and reduce health inequalities.
What we did
The data review led the team to consider that historically pulmonary rehab had been delivered in population hubs which may have been difficult to access from a rural area, thus increasing health inequalities when accessing the services. The current cost of living crisis and rise in fuel rates also has the potential to impact further on access. Also, the physical difficulties people with COPD often experience such as breathing difficulties that can limit normal activities mean that services closer to home would encourage those with a COPD diagnosis to attend pulmonary rehab.
As a Trust, SWFT are passionate about addressing health inequalities in their service provision and were allocated national funding from the Respiratory Network to develop a model to address this health inequality.
The model subsequently developed by the physiotherapy team seeks to address the issue of limited access using a two-pronged approach. First, the team go into GP practices offering 1:1 consultations with those identified as requiring pulmonary rehab. Baseline tests such as lung function tests can be performed, and this approach also gives the patient the opportunity to ask any questions and address any concerns to improve uptake of pulmonary rehabilitation. Secondly, the pulmonary rehab classes are located within the PCNs either in GP surgeries or local community premises, bringing care directly to the individuals.
This multi-faceted, person-centred approach is an excellent example of how we are seeking to address health inequalities in Coventry and Warwickshire by using data to identify a need for our population and using it to develop a strategy and plan to address it.
The strategy will be evaluated to see if the proactive approach of bringing consultations and pulmonary rehab closer to those that would benefit has had a positive impact on uptake. It has the potential to be applied to other health and care services to bring joined up care closer to home for our population.