Flexible delivery of pulmonary rehab stacks up


By Mardi Chapman

27 Nov 2017

Home-based pulmonary rehabilitation for COPD patients not only has clinical equivalence to centre-based programs but has also been shown to be as cost effective.

The Asian Pacific Society of Respirology (APSR) Congress in Sydney heard direct healthcare costs per patient in the 12 months following home-based rehab were about $16,000 compared to $21,000 for centre-based rehab.

Ms Angela Burge, a physiotherapist at the Alfred Hospital and PHD candidate at Latrobe University, said costs included GP and hospital outpatient appointments, emergency department presentations and admissions, investigations and medications.

As previously reported in the limbic, the home-based program was found to be more effective at keeping patients out of hospital.

“Even though it’s not statistically significant, ED and hospital admissions following home-based rehab were less than a third of the centre-based group.”

The research also found home rehab completion rates were about twice that of the centre based program. The costs of delivering the two programs were similar.

“By providing evidence of clinical and cost effectiveness and improved completion rates, there is a pretty strong case to be made for people to set up this type of service.”

“It’s not that you’re pushing the costs somewhere else because patients didn’t get what they needed from pulmonary rehab.”

Ms Burge told the limbic that the flexibility of home-based rehab programs could appeal to many patients who were never going to come to a centre-based program.

They included people still in the workforce, those who had other commitments including caregiving and those who could not travel.

“This is a way for us to tap into that group we aren’t servicing at the moment. From a decision makers point of view, this provides evidence that it’s not going to cost more to set up and it’s not going to cost more to run but that we will be able to access people we’ve never been able to before.”

“We’re quite confident that the benefits are at least equivalent and perhaps better.”

The structured program includes one home visit and weekly phone calls.

“It’s not unsupervised; its just not directly supervised. There are different ways of doing things and we need to be responsive to what people actually need in terms of the way we deliver pulmonary rehab.”

Australian and New Zealand Pulmonary Rehabilitation Guidelines recommended that home-based or community-based programs ‘of equivalent frequency and intensity as hospital-based programs’ can be offered as an alternative to patients with COPD.

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