At present within NHS Grampian there is minimal Respiratory Physiotherapy provision in primary care. Aberdeenshire is a large geographical area, with the specialist respiratory services based in Aberdeen Royal Infirmary. This requires patients to travel long distances for a Respiratory specialist review. Furthermore due to a lack of standardised pathway for patients with Bronchiectasis, there is an even greater waiting time before they are seen, even in the acute sector.
To add to this, there are ongoing staff recruitment difficulties locally which mean there is only resource for more complex patients to be assessed. With this, a Bronchiectasis toolkit was developed to provide airway clearance advice to all patients in NHS Grampian. The aim of the toolkit is to provide information that is accessible to all patients within the area, to reduce the length of time before they are provided with physiotherapy advice about airway clearance,exercise and improve patient outcomes.
The toolkit was devised, trialled and tested using Quality Improvement methodology. From December 2018, every patient who was referred to the respiratory physiotherapy service in Aberdeen Royal Infirmary was provided with a Bronchiectasis Toolkit.
Initially ten copies of the toolkit were sent out to the first ten patients referred. These patients were also provided with a cover letter to explain the toolkit and how to access the online physiotherapy videos on airway clearance. A four week period was allocated to the patients to allow time for delivery of the toolkits via post and time to read through the material. After four weeks, each patient was phoned as outlined in the letter. Feedback about the toolkit was obtained via qualitative methods using a telephone questionnaire, conducted by a respiratory physiotherapist.
These results are based on the findings of ten patient questionnaires:
- 90% reported to have received the toolkit via post.
- 50% accessed the Aberdeen lungs website. Of those 5 that did not - 2 felt that they were too well to require the resource and 2 did not have the internet.
- 40% accessed the physiotherapy videos.
- 90% reported the information was clear and easy to follow.
- 60% felt the toolkit changed how they clear their chest.
- 40% of patients felt they would benefit from a face to face physiotherapy appointment after receiving the toolkit.
Self management tools can be used to teach people airway clearance techniques. Patients with Bronchiectasis in NHS Grampian can access online videos and use patient information leaflets to aid self management.
Some patients will always prefer to be reviewed by a therapist, and complex patients will benefit from thorough assessment and personalised treatment programme.
Due to the current staffing recruitment difficulties in NHS Grampian, other innovative forms of therapy must be developed to provide people with the advice and guidance required to self manage long term conditions. In this particular group of patients, we have shown that using videos to demonstrate autogenic drainage along with patient information leaflets, provides some patients the tools to understand the importance airway clearance and to carry this out successfully themselves.
No funding was required for this project.
This work was presented at Physiotherapy UK 2019