Authors (including presenting author) :
Tsui AYY, Wong EYW, Chan BSC, Kong ISY, Leung PPY, Chau RMW
Affiliation :
Physiotherapy Department, Kowloon Hospital
Introduction :
In Hong Kong, the prevalence of stable COPD was about 7.7% in which 16.1% of them had severe symptoms. The frequent re-admission of COPD patients contributed to around 30,000 hospitalizations each year in HA hospitals (Hospital Authority Statistical Report, 2013-2017). Pulmonary Rehabilitation is the standard of non-pharmacological treatment for COPD patients to lower the rate of hospitalization and reduce exacerbation. Recently, Physiotherapy Practice Guidelines on Pulmonary Rehabilitation was approved by Coordinating Committee-Grade (Physiotherapy) and issued on 30 November 2018 under Hospital Authority Head Office (HAHO). Successful implementation of clinical guidelines and the change of practices to reflect current evidence are important to ensure evidence-based quality services.
Objectives :
The aim of the study was to evaluate the provider compliance of Physiotherapy Practice Guidelines on Pulmonary Rehabilitation in Kowloon Hospital.
Methodology :
It was a retrospective analytical cross-sectional survey design. The clinical records of patients receiving pulmonary rehabilitation were reviewed between June and November 2018. Formal assessments and prescribed practices were assessed using a Task To-Do Checklist with reference to Physiotherapy Practice Guidelines on Pulmonary Rehabilitation.
Result & Outcome :
30 clinical records (15 inpatient records and 15 outpatient records) of pulmonary rehabilitation program (PRP) were reviewed by Senior Physiotherapist in-charge in Respiratory Medicine. Full compliance was observed in Pre-PRP assessment, Post-PRP assessment and Pre-discharge Management. For core interventions, full compliance was observed in dyspnoea management, bronchial hygiene, exercise training and ambulatory oxygen therapy. Indicated patients with comorbidity management (43%), use of respiratory devices (Positive Expiratory Pressure devices, 40%; Inspiratory Muscle Trainer, 30%) and psychosocial management (27%) were handled according to the guidelines. Current smokers (20%) were advised to quit smoking and referred to Smoking Counselling and Cessation Centre. In the category of ‘Other strategies to enhance exercise training’, Non-invasive Ventilation, oxygen supplementation during exercise and Neuromuscular Electrical Stimulation were timely initiated to patients who showed poor response to conventional PRP training. The use of Whole Body Vibration and the collaboration with dietitian in weight management for enhancement of exercise training were not commonly detected locally. High compliance on the guidelines was observed by and large in this audit site in ensuring the standard of PRP. Barriers/ constraints of equipment & limited manpower for PRP were identified for further follow up by concerted multi-disciplinary effort.
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