Bowen James M, Campbell Kaitryn, Sutherland Simone, Bartlett Ann, Brooks Dina, Qureshi Riaz, Goldstein Roger, Gershon Andrea S, Prevost Shelley, Samis Lorelei, Kaplan Alan G, Hopkins Robert B, MacDougald Craig, Nunes Erica, O'Reilly Daria J, Goeree Ron
Programs for Assessment of Technology in Health (PATH) Research Institute, St. Joseph's Healthcare Hamilton and Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Firestone Institute for Respiratory Health, St. Joseph's Healthcare Hamilton and McMaster University School of Nursing, Faculty of Health Sciences, Hamilton, Ontario, Canada.
Ont Health Technol Assess Ser. 2015 Mar 1;15(8):1-67. eCollection 2015.
Pulmonary rehabilitation (PR) is a comprehensive intervention of exercise training, education, and behaviour change to improve the physical and psychological condition of people with chronic respiratory disorders, such as chronic obstructive pulmonary disease (COPD) and to promote long-term adherence to health-enhancing behaviours. Although PR is considered the standard of care for patients with COPD who remain symptomatic despite bronchodilator therapies, current evidence suggests that only 1.15% of COPD patients across Canada have access to PR facilities for care.
The objectives of this study were to identify the number of health care facilities across Ontario providing PR services for patients with COPD, describe the scope of those services, and determine the province's current capacity to provide PR services relative to need, for the province as a whole and by local health integration network (LHIN).
The Pulmonary Rehabilitation Programs in Ontario (PRO) Survey was a province-wide, descriptive, cross-sectional survey of health care facilities (hospitals, family health teams, and community health centres). It was distributed to 409 facilities to collect information on various aspects of PR services in the province.
Between April 2013 and February 2014, 187 facilities responded to the survey (46% response rate). Most responding centres (144) did not offer PR services, and only 43 were full PR sites providing a comprehensive program. Hospital-based programs made up the majority of sites offering full PR services (67%), followed by programs based at family health teams (19%) and community health centres (14%). More than 90% of PR programs are outpatient-based. The average wait time for outpatient PR was 6.9 weeks, and 58% of programs provide services 5 days per week. More than 80% of patients attending PR complete the full program. Across all program types, the total estimated provincial capacity for PR outpatient care is 4,524 patients per year, or 0.66% to 1.78% of patients with COPD, depending on the estimated prevalence of disease.
These results are representative of 12 of the 14 LHINs in Ontario due to low response rates in facilities in 2 LHINs.
Although some increase in capacity has occurred since a similar survey in 2005, PR resources in Ontario are insufficient to support the delivery of care to people with COPD in accordance with clinical practice guideline recommendations.
肺康复（PR）是一种综合干预措施，包括运动训练、教育及行为改变，旨在改善慢性呼吸系统疾病患者（如慢性阻塞性肺疾病（COPD））的身体和心理状况，并促进其长期坚持有益健康的行为。尽管PR被视为对尽管接受了支气管扩张剂治疗仍有症状的COPD患者的标准治疗方法，但目前证据表明，加拿大仅有1.15%的COPD患者能够获得PR护理设施。
本研究的目的是确定安大略省为COPD患者提供PR服务的医疗保健设施数量，描述这些服务的范围，并确定该省目前提供PR服务的能力相对于需求的情况，包括全省及各地方卫生整合网络（LHIN）的情况。
安大略省肺康复项目（PRO）调查是一项针对医疗保健设施（医院、家庭健康团队和社区健康中心）的全省范围的描述性横断面调查。该调查分发至409家设施，以收集该省PR服务各方面的信息。
2013年4月至2014年2月期间，187家设施回复了调查（回复率为46%）。大多数回复中心（144家）未提供PR服务，只有43家是提供全面项目的完整PR站点。以医院为基础的项目占提供完整PR服务站点的大多数（67%），其次是以家庭健康团队为基础的项目（19%）和社区健康中心为基础的项目（14%）。超过90%的PR项目为门诊项目。门诊PR的平均等待时间为6.9周，58%的项目每周提供5天服务。超过80%参加PR的患者完成了整个项目。在所有项目类型中，全省PR门诊护理的总估计能力为每年4524名患者，占COPD患者的0.66%至1.78%，具体取决于疾病的估计患病率。
由于2个LHIN中设施的回复率较低，这些结果仅代表安大略省14个LHIN中的12个。
尽管自2005年进行类似调查以来，服务能力有所增加，但安大略省的PR资源仍不足以按照临床实践指南建议为COPD患者提供护理服务。
