VIrtual PulmonAry Rehabilitation (VIPAR)
Pulmonary rehabilitation (PR) is a well-documented, safe, and effective multi-disciplinary course designed for people with a range of lung conditions. PR improves symptoms, quality of life, exercise capacity and reduces the number and length of hospital admissions. Despite Grade A evidence and recommendations of all National and International Guidelines in 2014 only 34% of eligible patients in Wales were offered it and less so in semi-rural communities with Hywel Dda having the lowest uptake in Wales (<30%).
We faced two main barriers to more uptake and completion: recruitment and retention of enough trained staff and travel for participants to attend hospital-based courses.
VIPAR – Virtual Pulmonary Rehabilitation provided two virtual “spoke sites”, Tregaron (via rural community village hall) and Llanelli (a community wellbeing centre) sites; these were lived-linked to the main hospital “hub” site in Carmarthen via large TV screens. The same expert staff provided 3 classes simultaneously by video link (with a single exercise observer in each spoke sight), increasing the number /capacity of classes. It also reduced the distance travelled by disabled participants and provided care closer to home. We tested:
- Hywel Dda University Health Board
Partners: Bevan Commission, Comcen, Polycom
Funding: Respiratory Health Implementation Group, Hywel Dda UHB (University Health Board)
- Full Project Report
- Lessons learnt
1. February 2017
Funding for equipment agreed by RHIG
2. May-September 2017
Project planning and equipment set-up and testing
3. September-Nov 2017
Pulmonary rehabilitation course, x2 weekly for 7 weeks (1 hub Carmarthen, 1 spoke Tregaron)
4. January-March 2018
2nd Pulmonary rehabilitation course, x2 weekly for 7 weeks (1 hub Carmarthen, 1 spoke Llanelli)
5. March-April 2018
PROM and PREM collection & group discussion (thematic analysis)
Staff questionnaires & group discussion (thematic analysis)
8. November 2019
1-year outcomes (comparing hospital admission data 1 year prior to 1 year post VIAPR)
9. December 2019
Project End and write up
VIPAR’s aims were a proof-of-concept:
- Check the safety of the participants – particularly in the “spoke” sites.
- Test the feasibility (acceptability, uptake, and completion rates) of each course with a view to “scaling up.”
- Evaluate the short and medium effectiveness by measuring standard PROMS for all participants
- Estimate travel and environmental savings
- Estimate cost-effectiveness
- Report PREMS and staff evaluations, especially exploring the barriers and facilitators to scale-up
- VIPAR is safe, feasible, reduces inequality in care, provides care closer to home, saves large environmental impact, is effective and cost effective.
- Patient co-production is vital in the design of the model.
- Full staff “buy in” and involvement is required to allay fears and produce workable solutions.
- Technology must be kept as simple as possible to ensure success.
- £100K of recurring funding to invest in VIPAR and other community-hospital rehab projects was awarded by the HB
We demonstrated a safe, effective, and more cost-efficient model of increasing the number of patients in NHS (National Health Service) Wales attending Pulmonary Rehabilitation courses. We showed statistically significant and clinically important improvements in exercise tolerance, quality of life at least as good as standard Pulmonary Rehabilitation with halving of hospital admissions. Additional benefits included saving over 6400 miles travel in just 2 programmes!
- Team of the Month Hywel Dda 2018
- Winner NHS Collaboration with Industry, Mediwales 2018
- Longlisted RCP UK Innovations in Health 2018
- Poster presentation: One Health Summit, Edinburgh (WHO) 2018
- 1st Prize Digital Innovation, International Foundation for Integrated Care (San Sebastian) 2019
- NHS Wales Award for Improving Health & Wellbeing & Reducing Inequalities 2019
www.youtube.com/watch?v=cGId4h_aMBY (patient experience)
Health Psychol Behav Med. 2021;9(1):527 (patient views whilst on the PR waiting list)
BMJ Open Resp Res 2021;8:e000800 (patient views)
Int J Chron Obstruct Pulm Dis. 2019;14:775 (clinical outcomes)