Physio works: improving outcomes for COPD patients

The CSP has launched a new tool to help calculate the impact that physiotherapy can bring to people with COPD. Stuart Palma, head of CSP’s Physiotherapy Works programme, reports.


Why is COPD such an important issue?

Figures from the British Lung Foundation put lung disease as a whole as the fourth most costly disease area to the UK, after mental health conditions, musculoskeletal diseases and heart disease. An estimated 1.2 million people are living with diagnosed COPD. 

What can we do about it?

Research shows that pulmonary rehabilitation (PR) is an important intervention in the management of COPD.  It can improve the physical and psychological condition of people with chronic respiratory disease and help to promote the long-term adherence of health-enhancing behaviours. It can also improve exercise capacity, health status, physical activity, activities of daily living, muscle strength, and self-efficacy. Overall, it can improve quality of life.

What is the CSP trying to do to raise the profile of PR?

The society has invested in devising an economic tool, with input from health economists and clinical experts, which will help to demonstrate the value and impact of PR to commissioners and others. This is in line with NICE quality statements (updated 2016) which endorse the use of PR for people with either stable COPD or an acute exacerbation.

Why is it important to do this?

Given the ever-changing healthcare economy, there has been a greater need for members to be able to demonstrate their value and impact.  
Since 2013, the CSP’s corporate strategy has focused on developing and promoting evidence of physiotherapy’s clinical and cost effectiveness at a local and national level, as well as strengthening the public profile, reputation and influence of the profession.
Building on the success of the CSP Falls Prevention Economic Model, this latest tool is part of the Physiotherapy Works programme at the CSP. 

What is COPD PR tool?

It is an online tool available on the CSP’s website, rather like the CSP falls tool. It allows you to put in your local data and  trust’s own specifications, the number of patients you could treat, and value and impact of a high quality physiotherapy-led PR programme to COPD patients.
The tool is based on a Microsoft Excel programme, using an impact/economic model. It was developed in collaboration with Imperial College London, with input and guidance from an expert steering group with backgrounds in clinical service delivery, management, research, and health economics.

What will it achieve?

The CSP expects that by using the tool and service related information:
  • physiotherapists will have the evidence to demonstrate the positive economic impact of their service for people with COPD to patients and the public
  • physiotherapists will be able to talk confidently with decision makers about services for COPD patients and the impact they have on key performance indicators (KPIs)
  • physiotherapists will be able to demonstrate the value and impact of their service. 

How has this tool been developed?

The model uses a range of the data sources on the COPD epidemiology, exacerbations, service costs and impact of PR.
These include: 
  • the Clinical Practice Research Datalink (CPRD), 
  • Quality Outcome Framework (QoF), 
  • randomised controlled trials (RCTs), 
  • Public Health England (PHE) population prevalence models and 
  • the latest British Thoracic Society PR audit data. 
While RCTs are frequently referred to as the ‘gold standard’, they can represent a ‘standardised world’, which at times cannot be compared to ‘real world’ practice. Imperial College has therefore combined RCT data with other data sources (as outlined above).  

What clinical approaches are they recommending?

The model includes recommendations for best practice. These are based on gold standard interventions, outlined in an attachment to the information available on the CSP’s website. These ensure services are designed and delivered to achieve maximum impact for both patients and services.

What can the COPD PR tool demonstrate? 

The national benchmark for how many eligible patients in England are referred to a physiotherapy-led PR programme annually is only 15 per cent. 
The model is based on the belief that if every eligible COPD patient in England were referred to a physiotherapy-led pulmonary rehabilitation programme annually, patients and services will experience the following benefits:
  • a reduction of a third in exacerbations in this patient population, meaning 150,924 fewer exacerbations, and freeing up this number of appointments in primary care 26,633 avoided hospital admissions 06,532 hospital bed days saved*  
Additionally there are several other further positive impacts of PR across the wider health and social care economy:  
  • Four per cent of patients admitted to hospital with a COPD exacerbation are discharged to either a residential or nursing homes
  • Wider financial and non-financial impacts of programmes, organisations and interventions, including the wellbeing of individuals and communities, social capital and the environment.  (For example, simply attending a class with other people encourages social interaction, reducing loneliness and isolation.)  However due to data limitations, the current model does not account for these. 

Who should use the tool?

A range of stakeholders involved in the direct delivery, management and commissioning of PR programmes. They would benefit from the information generated by the tool and the best practice guidelines. 
Knowing your local data can help you to produce an informed forecast of the impact and value and impact of high quality physio led PR in your local area. The tool can also be used to compare local performance to other areas across England.

What changes, improvements and impact do we expect from the use of the tool?

The CSP believes there will be a range of benefits:
  • will be able to demonstrate the benefit of physiotherapy for this patient group
  • by working to the best practice guidelines for PR delivery, they could reduce the rate of non-completion by patients, improving health quality and reducing cost
  • will be able to increase the promotion of physiotherapy as a treatment of choice for this patient group
  • will be able to collect and provide evidence to inform commissioning decisions
  • will be able to help increase commissioning of physiotherapy services for this patient group 
  • will experience the benefits of PR, including a reduced risk of hospital admission
  • will experience improved care through the production of targeted resources, including online resources, and recommendations for service provision leading to a better experience for patients. 
Decision makers
  • will be better informed of the benefits of physiotherapy for COPD patients
  • will be able to understand the value of physiotherapy
  • will have the evidence to demonstrate the value and impact of physiotherapy 

Where can I find out more?

Go to the COPD page
*(based on BTS/RCP National Clinical Audit Report 2015, where the average length of stay per COPD exacerbation admission is four days).
Stuart Palma project manager, CSP’s Physiotherapy Works

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