Narasimhan Divya, Simpson Jane, Stewart Duncan
Whittington Health NHS Trust, London, UK.
London Metropolitan University, London, UK
BMJ Open Qual. 2025 Jan 22;14(1):e003002. doi: 10.1136/bmjoq-2024-003002.
Chronic obstructive pulmonary disease (COPD) is a collection of conditions that cause permanent damage to the lungs. Among a range of treatment options, patients can benefit from pulmonary rehabilitation (PR) programmes involving physical exercises and education.The risk of developing COPD is higher for substance misusers than the general population. Substance misusers with COPD have more severe symptoms and poorer health outcomes than other COPD patients, and experience inequalities in accessing PR services.This project aimed to work with a local substance misuse service to increase the referrals of patients with COPD with a history of drug and/or alcohol problems to a PR programme in the London Borough of Islington. Quality improvement methods were used to explore barriers to accessing PR and to identify ways of making referral to PR easier. A series of change ideas were implemented and tested sequentially through plan-do-study-act, including updating referral systems, educating staff and improving access to diagnosis.The primary objective was to achieve 100 eligible referrals during the 14-month project period. In practice, a total of 57 patients were referred to the programme. Sustained engagement with patients was challenging, with significant attrition observed from referral to programme completion. However, there was indicative evidence of clinical improvements in dyspnoea and exercise capacity among PR completers and qualitative feedback of improved health and well-being.Although referrals numbers were less than expected, we have established an innovative respiratory care pathway for substance misusers, founded on a holistic approach to diagnosis and treatment. There are also clear pointers as to how this approach can be sustained and developed further to maximise the benefits for this cohort of patients.
慢性阻塞性肺疾病（COPD）是一组对肺部造成永久性损害的病症。在一系列治疗选择中，患者可从包括体育锻炼和教育的肺康复（PR）计划中受益。药物滥用者患COPD的风险高于普通人群。患有COPD的药物滥用者比其他COPD患者有更严重的症状和更差的健康结果，并且在获得PR服务方面存在不平等现象。该项目旨在与当地的药物滥用服务机构合作，增加有药物和/或酒精问题史的COPD患者被转介到伦敦伊斯灵顿区的PR计划的人数。采用质量改进方法来探索获得PR的障碍，并确定使转介到PR更容易的方法。通过计划-执行-研究-行动依次实施和测试了一系列变革想法，包括更新转介系统、培训工作人员和改善诊断途径。主要目标是在14个月的项目期间实现100例符合条件的转介。实际上，共有57名患者被转介到该计划。与患者保持持续接触具有挑战性，从转介到计划完成期间观察到显著的人员流失。然而，有迹象表明PR完成者的呼吸困难和运动能力有临床改善，并且有关于健康和幸福感改善的定性反馈。尽管转介人数低于预期，但我们为药物滥用者建立了一条创新的呼吸护理途径，该途径基于全面的诊断和治疗方法。对于如何维持和进一步发展这种方法以最大限度地为这一患者群体带来益处也有明确的指示。
