The pulmonary rehabilitation team, have long dreamed of expanding their services to multiple community based programmes and the 20 000 Days campaign has given us an opportunity to not only expand our current services, but make sure these services are community specific and targeted to meet the needs and wants of various groups.
Pulmonary Rehabilitation programmes are not new for Counties Manukau Health and for the past 10 years, the Pulmonary Rehab Team have been successfully running programmes, for people with COPD (chronic obstructive pulmonary disease) and other chronic respiratory conditions.
While the programme continues to achieve good results i.e. patients are managing their symptoms a lot better, some participants were finding it difficult to make the twice weekly trip to Middlemore Hospital.
Pukekohe and Howick were two areas where transportation was an issue so a decision was made to pack up our equipment and our team and run the 6 week pulmonary rehabilitation programme in these communities.
Whilst this was a fun change of scenery, it was also time consuming, took people away from their jobs at the Hospital and only allowed for a very small group to be seen.
With the demand for pulmonary rehabilitation increasing and referral rates going from 20 to 50 people a month, it was clear we needed to come up with a better and different way of reaching people who needed our services the most.
This is where the Better Breathing Programme comes into play – an 8 week programme based in Otara within easy reach of participants who live in the neighbouring community.
We chose the Otara Leisure Centre to hold our programme as it has multiple rooms for the different components of the programme and a large space for exercise. Once we had all of our bookings and days and times sorted our next challenge was getting approval for the purchase of the exercise equipment. The equipment needed to be heavy duty and commercial grade, and while the equipment was readily available the process for approval took time. Word to the wise give yourself ample time for all the paperwork!
The next step was to look at our referral process and the way patients were being contacted. We work with a culturally diverse community with English being a second language for many participants. We also knew we were working with a group for whom attendance at Middlemore Hospital was not optimal. So we reviewed our current processes and enlisted the help of community support workers who visited patients and their families in their own homes and explained the benefits of participating in the programme and why it was important for them to attend. They also offered ongoing support in the way of transportation and phone calls. These people played a vital role in the success of our programme – we couldn’t have done it without them.
We also educated the primary care team in the structure, organisation and benefits of the Better Breathing programme. We have done this in several different ways. We presented to large groups of GPs and nurses in CME sessions, we visited GP practices at lunch times and had small group discussions about the programme and suitable participants to refer, and we invited members of the primary care team to pop in and observe a programme. We have been delighted with the large number of health professionals who have visited us in action in Otara.
Before participants begin the programme they complete an assessment with the physiotherapist and respiratory nurse. This appointment takes one and half hours and allows an individualised treatment plan to be developed for each participant. It also ensures the person gets the right management plan for them in order to achieve the best results. Assessments for the Otara Better Breathing Group started in late June.
We opened the classes on 16 July with a Powhiri to welcome the programme to the community. Participants, Counties Manukau Health staff, and members of the community were invited. The first 8 week programme had 12 participants. A second group started two weeks later.
The classes have been well attended and enjoyed and after the first group completed the course we held a prize giving with special guest, Brad Mika. Brad is a member of the Auckland Blues team, and an ambassador for the Middlemore Foundation Brad joined in an exercise session before congratulating participants and handing out scarfs and socks to participants.
Many of our participants are diabetic and as the classes ran across lunch time we started offering biscuits with a cup of tea which was greatly appreciated by the group. With advice from the dietician this has developed into a healthy light snack.
Participants are also encouraged to exercise an additional two to three times per week at home and a home based programme is drawn up between the patient and physiotherapist on the second week of classes. We are hoping to include pedometers in a future programme as a form of feedback to increase motivation and adherence. On completion of the programme we encourage participants to join a community based programme and many of our Otara graduates carry on with the Getting Started programme run by the Otara Health and Charitable Trust which is held in the leisure centre also. This helps to ensure the benefits are sustained.
Education sessions have involved a wide range of disciplines from the community and DHB. We aim to keep the educations sessions small and interactive to allow participants time to ask their questions. The focus of all the presenters and topics is on self management strategies. We aim to empower participants with a greater understanding of their health condition, how to monitor their symptoms and take appropriate action if they deteriorate, recommending adherence with medical regimes, and understanding how to stay well through lifestyle and nutrition choices. We are grateful to the many members of the team who have enthusiastically offered their time and knowledge to this component.
Our plans for the future include the development of programmes in other localities. Our next goal is Pukekohe and we would like to get this programme running this calendar year, however we are currently restricted in our staffing resources. Ideally we would offer continuous programmes in multiple communities to ensure the programme is accessible to all members of our organisation. We will continue to work toward making the programmes community specific.
For more information on the Better Breathing Programme, watch the video below:
Pulmonary Rehabilitation Coordinator