School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Westpark Healthcare Centre, Toronto, Ontario, Canada; Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; IBiMED - Institute of Biomedicine, University of Aveiro, Aveiro, Portugal.
Westpark Healthcare Centre, Toronto, Ontario, Canada.
Respir Med. 2021 Sep;186:106532. doi: 10.1016/j.rmed.2021.106532. Epub 2021 Jul 8.
Rehabilitation after acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is beneficial, but its feasibility is questionable. Feasibility is potentiated by stakeholder involvement during program development. We aimed to explore the perspectives of various stakeholders towards an innovative rapid access rehabilitation (RAR) program for patients immediately following hospitalization for an AECOPD.
Semi-structured interviews were conducted with patients recently hospitalized for AECOPD, healthcare professionals (HCP) and policymakers providing care for such patients. Thematic analysis was performed.
Three patients (1 female; 62-89 years; GOLD D), ten HCP (3 females, 31-71 years) and three policymakers (3 females, 38-55 years) participated. Patients, HCP and policymakers shared similar visions for the development of a RAR program. Five main themes and ten subthemes were identified. They comprised: Pre-RAR aspects (Management properties, Eligibility), RAR program (Outcomes, Structure, Components), RAR optimization (Referral, Uptake), Partnership (Collaboration, Dedicated Coordinator) and COVID-19 (Adaptations). Essential elements included: identifying clear eligibility criteria, addressing patients' needs at the time of hospital discharge, having a structured education and self-management program and modifying to respond to unexpected events (e.g., COVID). Suggestions to optimize referrals included a clear referral pathway, improving program awareness, assigning dedicated care coordinators to provide patient support throughout the program and establishing strong partnerships among different care settings and providers.
Identifying the essential program elements and approaches to optimize referrals, were considered to be key design approaches for success in establishing RAR.
慢性阻塞性肺疾病（COPD）急性加重（AECOPD）后的康复是有益的，但可行性值得怀疑。在方案制定过程中让利益相关者参与可以增强可行性。我们旨在探讨各利益相关者对 COPD 患者急性加重住院后立即接受创新快速康复途径（RAR）方案的看法。
对最近因 AECOPD 住院的患者、为这类患者提供治疗的医疗保健专业人员（HCP）和决策者进行了半结构式访谈。采用主题分析法进行分析。
共纳入 3 名患者（1 名女性，62-89 岁；GOLD D）、10 名 HCP（3 名女性，31-71 岁）和 3 名决策者（3 名女性，38-55 岁）。患者、HCP 和决策者对 RAR 方案的制定有相似的设想。确定了 5 个主要主题和 10 个次主题，包括：RAR 前阶段（管理特性、资格）、RAR 方案（结果、结构、组成部分）、RAR 优化（转诊、接受率）、合作关系（合作、专门协调员）和 COVID-19（适应）。基本要素包括：明确资格标准、满足患者出院时的需求、制定结构化的教育和自我管理方案，并针对意外事件（如 COVID-19）进行调整。优化转诊的建议包括明确转诊途径、提高方案知晓率、为患者提供全程支持并建立不同护理环境和提供者之间的牢固合作关系。
确定基本的方案要素和优化转诊的方法，被认为是成功建立 RAR 的关键设计方法。
