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Alupo P, Baluku J, Bongomin F, Siddharthan T, Katagira W, Ddungu A, Hurst JR, van Boven JFM, Worodria W, Kirenga BJ. Overcoming challenges of managing chronic obstructive pulmonary disease in low- and middle-income countries. Expert Rev Respir Med 2024:1-10. [PMID: 39268898 DOI: 10.1080/17476348.2024.2398639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 07/24/2024] [Accepted: 08/27/2024] [Indexed: 09/15/2024]
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) ranks among the top three global causes of death, with 90% of fatalities concentrated in low- and middle-income countries (LMICs). The projected rise in COPD burden, especially in LMICs, emphasizes the need to address the challenges for effective control and reversal of this trend. We aimed to provide an overview, and propose potential solutions to these challenges. AREAS COVERED We highlight the challenges faced in managing COPD in LMICs and put forward the potential approaches to mitigate the same. EXPERT OPINION In LMICs, the effective management of COPD encounters numerous barriers. These include limited access to critical diagnostic services, inadequately trained healthcare personnel, shortages of inhaler medications, oxygen therapy, insufficient access to vaccines, and pulmonary rehabilitation programs. Compounding the above challenges is the late presentation due to misdiagnosis by health workers, and limited access to vital diagnostics. Moreover, the pharmacological armamentarium for optimal COPD therapy, notably inhaled therapies, face constraints in both access and affordability. We propose multi-level and multifaceted interventions to address the urgent need for enhanced respiratory care, human resource capacity building, relevant diagnostic approaches, increased access to medications, government, regional and global efforts to achieve optimal COPD management in LMICs.
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Affiliation(s)
- Patricia Alupo
- Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Clinical Pharmacy & Pharmacology, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, Groningen, Netherlands
| | - Joseph Baluku
- Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
- Division of Pulmonology, Kirruddu National Referral Hospital, Kampala, Uganda
| | - Felix Bongomin
- Department of medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
- Department of Internal Medicine, Gulu Regional referral Hospital, Gulu, Uganda
| | - Trishul Siddharthan
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Miami, Miami, FL, USA
| | - Winceslaus Katagira
- Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ahmed Ddungu
- Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
| | - Job F M van Boven
- Department of Clinical Pharmacy & Pharmacology, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, Groningen, Netherlands
| | - William Worodria
- Mulago National Referral Hospital, Ministry of Health, Kampala, Uganda
| | - Bruce J Kirenga
- Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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Waterworth CJ, Smith F, Kiefel-Johnson F, Pryor W, Marella M. Integration of rehabilitation services in primary, secondary, and tertiary levels of health care systems in low- and middle-income countries: a scoping review. Disabil Rehabil 2024:1-12. [PMID: 38376099 DOI: 10.1080/09638288.2024.2317422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 02/06/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE Integration is a concept that seeks to strengthen the delivery of services to ensure people receive a continuum of care across the health system. We conducted a scoping review to explore how rehabilitation services have been integrated into health systems in low- and middle- income countries (LMICs). MATERIALS AND METHODS We conducted a scoping review using Valentijn's Rainbow Model of Integrated Care (RMIC) as an organising framework. The key enablers of integration of rehabilitation were extracted, charted and summarised according to the RMIC framework. RESULTS Of 4667 articles identified, 44 met inclusion criteria. Most studies focused on rehabilitation within secondary and tertiary level facilities, and described service models incorporating clinical, professional and functional integration characteristics. The geographical and clinical scope of rehabilitation models that demonstrate elements of integration from LMICs is limited. CONCLUSION The key enablers identified highlight the important role of responsive multidisciplinary care plans, and interdisciplinary guidelines, protocols and interprofessional education to support an integrated rehabilitation service model in LMICs.
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Affiliation(s)
- Christopher James Waterworth
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
- Department of Audiology and Speech Pathology, University of Melbourne, Melbourne, VIC, Australia
| | - Fleur Smith
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Felix Kiefel-Johnson
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Wesley Pryor
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Manjula Marella
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
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Habib GMM, Uzzaman N, Rabinovich R, Akhter S, Ali M, Sultana M, Pinnock H. Exploring the perceptions of patients with chronic respiratory diseases and their insights into pulmonary rehabilitation in Bangladesh. J Glob Health 2024; 14:04036. [PMID: 38299780 PMCID: PMC10832548 DOI: 10.7189/jogh.14.04036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024] Open
Abstract
Background Chronic respiratory diseases (CRDs) require holistic management which considers patients' preferences, appropriate pharmacotherapy, pulmonary rehabilitation, and integrated care. We aimed to understand the perceptions of people with CRDs about their condition and pulmonary rehabilitation in Bangladesh. Methods We conducted semi-structured interviews with a maximum variation sample of people with CRDs who had participated in a feasibility study of pulmonary rehabilitation in 2021/2022. A multidisciplinary team transcribed the interviews verbatim and analysed them in Bengali using a grounded theory approach. Results We interviewed 15 participants with chronic obstructive pulmonary disease, asthma, or post-tuberculosis. The analysis revealed three themes. The first encompassed understanding CRDs: Patients characterised their condition by the symptoms (e.g. 'Hapani' meaning 'breathlessness') rather than describing a disease entity. Some believed occupation, previous infection, or family history to be a cause. The second theme included perceptions of pulmonary rehabilitation: Exercise was counterintuitive, as it exacerbated the breathlessness symptom that defined their disease. Views varied, though many acknowledged the benefits after a few sessions. Even with home-based programmes, participants described practical barriers to finding time for the sessions and adopted strategies to overcome the challenges. The third theme focused on implementation: Participants highlighted the need for raising awareness of CRDs and the potential of pulmonary rehabilitation in the community, adapting to the local context, and establishing an accessible resourced service. Conclusions Understanding how patients and their communities perceive their condition and the barriers (both conceptual and logistical) to acceptance is the first step to embedding this highly effective intervention into routine health care services in Bangladesh with potential benefits for the increasing number of people living with CRDs in low- and middle-income countries.
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Affiliation(s)
- GM Monsur Habib
- Community Respiratory Centre, Khulna, Bangladesh Primary Care Respiratory Society (BPCRS), Bangladesh
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Nazim Uzzaman
- Community Respiratory Centre, Khulna, Bangladesh Primary Care Respiratory Society (BPCRS), Bangladesh
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Roberto Rabinovich
- ELEGI/Colt laboratory, Centre for Inflammation Research, Queen's Medical Research Institute (QMRI), University of Edinburgh, Edinburgh, UK
| | - Sumaiya Akhter
- Community Respiratory Centre, Khulna, Bangladesh Primary Care Respiratory Society (BPCRS), Bangladesh
| | - Mohsin Ali
- Community Respiratory Centre, Khulna, Bangladesh Primary Care Respiratory Society (BPCRS), Bangladesh
| | - Mustarin Sultana
- Community Respiratory Centre, Khulna, Bangladesh Primary Care Respiratory Society (BPCRS), Bangladesh
| | - Hilary Pinnock
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, University of Edinburgh, Edinburgh, UK
| | - RESPIRE Collaboration
- Community Respiratory Centre, Khulna, Bangladesh Primary Care Respiratory Society (BPCRS), Bangladesh
- ELEGI/Colt laboratory, Centre for Inflammation Research, Queen's Medical Research Institute (QMRI), University of Edinburgh, Edinburgh, UK
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, University of Edinburgh, Edinburgh, UK
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Sahasrabudhe SD, Orme MW, Borade S, Bhakare M, Modi M, Pina I, Ahmed Z, Padhye R, Barton A, Steiner MC, Salvi S, Singh SJ. A survey exploring the needs, preferences, and challenges of the key stakeholders for participating in and developing pulmonary rehabilitation in Pune, India. Chron Respir Dis 2024; 21:14799731241267305. [PMID: 39075037 PMCID: PMC11289815 DOI: 10.1177/14799731241267305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 05/21/2024] [Indexed: 07/31/2024] Open
Abstract
Considering a huge burden of chronic respiratory diseases (CRDs) in India, there is a need for locally relevant Pulmonary rehabilitation (PR) services. This cross-sectional survey was aimed to explore the interest, needs and challenges among various stakeholders for PR in Pune city, India. At the outpatient respiratory medicine department of a multi-speciality hospital in Pune, India, 403 eligible people with CRDs were invited to participate in the survey, of which 370 (92%) responded and agreed to participate. (220 males, mean ± SD age 56 ± 15 years). Out of the 370, 323 (87%) people with CRDs were keen to attend PR. In a multiple selection question, there was inclination towards paper-based manuals home-based (70%) and web-based (84%) programs. 207 healthcare providers (HCPs), including physicians, pulmonologists and physiotherapists involved in the care of people living with CRDs across Pune city were invited to participate in the survey. Out of the 207, (80%) of the HCPs believed that PR was an effective management strategy and highlighted the lack of information on PR and need for better understanding of PR (48%) and its referral process. The surveyed stakeholders are ready to take up PR, identifying specific needs around further knowledge of PR, modes of delivery, and referral processes, that could potentially feed the development of relevant PR programs in the Indian healthcare settings.
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Affiliation(s)
- Shruti D Sahasrabudhe
- Clinical Research Department, Symbiosis University Hospitals and Research Centre, Symbiosis Medical College for Women, Symbiosis International (Deemed) University, Pune, India
| | - Mark W Orme
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Suryakant Borade
- Clinical Research Department, Symbiosis University Hospitals and Research Centre, Symbiosis Medical College for Women, Symbiosis International (Deemed) University, Pune, India
| | - Meenakshi Bhakare
- Department of Respiratory Medicine, Symbiosis Medical College for Women, Symbiosis International (Deemed) University, Pune, India
| | - Mahavir Modi
- Pulmonology Department, Ruby Hall Clinic, Pune, India
| | - Ilaria Pina
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Zahira Ahmed
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Rashmi Padhye
- Clinical Research Department, Symbiosis University Hospitals and Research Centre, Symbiosis Medical College for Women, Symbiosis International (Deemed) University, Pune, India
| | - Andy Barton
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Michael C Steiner
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Sundeep Salvi
- Clinical Research Department, Symbiosis University Hospitals and Research Centre, Symbiosis Medical College for Women, Symbiosis International (Deemed) University, Pune, India
| | - Sally J Singh
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK
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Ingenhoff R, Robertson N, Munana R, Bodnar BE, Weswa I, Sekitoleko I, Gaal J, Kirenga BJ, Kalyesubula R, Knauf F, Siddharthan T. Challenges to Implementation of Community Health Worker-Led Chronic Obstructive Pulmonary Disease (COPD) Screening and Referral in Rural Uganda: A Qualitative Study using the Implementation Outcomes Framework. Int J Chron Obstruct Pulmon Dis 2023; 18:2769-2783. [PMID: 38046984 PMCID: PMC10693197 DOI: 10.2147/copd.s420137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 10/30/2023] [Indexed: 12/05/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is the third leading cause of death globally. The burden of COPD is expected to increase in low- and middle-income countries (LMICs). COPD screening and diagnostics tools are often inaccessible in rural settings of LMICs. To contribute to the growing body of evidence on the effectiveness of Community Health Worker (CHW) interventions, this study aims to understand the facilitators and barriers of implementing a CHW-led COPD screening and referral program in rural Uganda. Methods This qualitative study was conducted from September to October 2022 to explore Community Members, CHWs, and Healthcare Providers (HCPs) perceptions on the challenges of CHW-delivered COPD programming in Nakaseke, rural Uganda. In total, we held eight individual in-depth interviews with CHWs, ten in-depth interviews with HCPs and six focus group discussions with 34 Community Members. Research assistants audio-recorded and transcribed interviews verbatim. The implementation outcomes framework guided the thematic analysis. Results Implementation acceptability was constrained by a lack of COPD awareness, a lack of perceived utility in COPD screening as well as stigma around the diagnostic process. Limited spirometry adoption was also attributed to Community Member accessibility and willingness to participate in the COPD diagnostic referral process. The high patient volume and the complex, time-consuming diagnostic and referral process hindered successful implementation. To enhance program sustainability, all participants suggested increasing CHW support, medication access, decentralizing COPD care and upscaling follow-up of Community Members by CHWs. Conclusion CHW-led interventions remain a potentially critical tool to alleviate barriers to treatment and self-management in settings where access to care is limited. While community-based interventions can create sustainable infrastructure to improve health outcomes, formative assessments of the potential barriers prior to intervention are required. Evidence-based, localized approaches and sustained funding are imperative to achieve this.
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Affiliation(s)
- Rebecca Ingenhoff
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Charité Center for Global Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Richard Munana
- School of Public Health, Makerere University College of Health Sciences, Makerere University, Kampala, Uganda
- African Community Center for Social Sustainability, Nakaseke, Uganda
| | - Benjamin E Bodnar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ivan Weswa
- African Community Center for Social Sustainability, Nakaseke, Uganda
| | - Isaac Sekitoleko
- MRC/UVRI and LSHTM Uganda Research Unit, Kampala, Uganda
- London School of Hygiene and Tropical Medicine, London, UK
| | - Julia Gaal
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Robert Kalyesubula
- African Community Center for Social Sustainability, Nakaseke, Uganda
- Department of Physiology, Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Felix Knauf
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Trishul Siddharthan
- Department of Pulmonary, Critical Care and Sleep Medicine, University of Miami, Coral Gables, FL, USA
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Padhye R, Sahasrabudhe SD, Orme MW, Pina I, Dhamdhere D, Borade S, Bhakare M, Ahmed Z, Barton A, Modi M, Malcolm D, Salvi S, Singh SJ. Perspectives of Patients With Chronic Respiratory Diseases and Medical Professionals on Pulmonary Rehabilitation in Pune, India: Qualitative Analysis. JMIR Form Res 2023; 7:e45624. [PMID: 37934558 PMCID: PMC10664007 DOI: 10.2196/45624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Chronic respiratory diseases (CRDs) contribute significantly to morbidity and mortality worldwide and in India. Access to nonpharmacological options, such as pulmonary rehabilitation (PR), are, however, limited. Given the difference between need and availability, exploring PR, specifically remotely delivered PR, in a resource-poor setting, will help inform future work. OBJECTIVE This study explored the perceptions, experiences, needs, and challenges of patients with CRDs and the potential of and the need for PR from the perspective of patients as well as medical professionals involved in the referral (doctors) and delivery (physiotherapists) of PR. METHODS In-depth qualitative semistructured interviews were conducted among 20 individuals diagnosed with CRDs and 9 medical professionals. An inductive thematic analysis approach was used as we sought to identify the meanings shared both within and across the 2 participant groups. RESULTS The 20 patients considered lifestyle choices (smoking and drinking), a lack of physical activity, mental stress, and heredity as the triggering factors for their CRDs. All of them equated the disease with breathlessness and a lack of physical strength, consulting multiple doctors about their physical symptoms. The most commonly cited treatment choice was an inhaler. Most of them believed that yoga and exercise are good self-management strategies, and some were performing yoga postures and breathing exercises, as advised by friends or family members or learned from a televised program or YouTube videos. None of them identified with the term "pulmonary rehabilitation," but many were aware of the exercise component and its benefits. Despite being naive to smartphone technology or having difficulty in reading, most of them were enthusiastic about enrolling in an application-based remotely delivered digital PR program. The 9 medical professionals were, however, reluctant to depend on a PR program delivered entirely online. They recommended that patients with CRDs be supported by their family to use technology, with some time spent with a medical professional during the program. CONCLUSIONS Patients with CRDs in India currently manage their disease with nonguided strategies but are eager to improve and would benefit from a guided PR program to feel better. A home-based PR program, with delivery facilitated by digital solutions, would be welcomed by patients and health care professionals involved in their care, as it would reduce the need for travel, specialist equipment, and setup. However, low digital literacy, low resource availability, and a lack of expertise are of concern to health care professionals. For India, including yoga could be a way of making PR "culturally congruent" and more successful. The digital PR intervention should be flexible to individual patient needs and should be complemented with physical sessions and a feedback mechanism for both practitioners as well as patients for better uptake and adherence.
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Affiliation(s)
- Rashmi Padhye
- Clinical Research Department, Symbiosis Medical College for Women, Symbiosis University Hospitals and Research Centre, Symbiosis (Deemed University), Pune, India
| | - Shruti D Sahasrabudhe
- Clinical Research Department, Symbiosis Medical College for Women, Symbiosis University Hospitals and Research Centre, Symbiosis (Deemed University), Pune, India
| | - Mark W Orme
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Ilaria Pina
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Dipali Dhamdhere
- Clinical Research Department, Symbiosis Medical College for Women, Symbiosis University Hospitals and Research Centre, Symbiosis (Deemed University), Pune, India
| | - Suryakant Borade
- Clinical Research Department, Symbiosis Medical College for Women, Symbiosis University Hospitals and Research Centre, Symbiosis (Deemed University), Pune, India
| | - Meenakshi Bhakare
- Department of Respiratory Medicine, Symbiosis Medical College for Women, Symbiosis (Deemed University), Pune, India
| | - Zahira Ahmed
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Andy Barton
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Mahavir Modi
- Pulmonology Department, Ruby Hall Clinic, Pune, India
| | - Dominic Malcolm
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Sundeep Salvi
- Clinical Research Department, Symbiosis Medical College for Women, Symbiosis University Hospitals and Research Centre, Symbiosis (Deemed University), Pune, India
- Pulmonary Research and Education Foundation, Pune, India
| | - Sally J Singh
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
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McDonnell J, Orme M, Houchen–Wolloff L, Baxter N, Barnard A, Correia de Sousa J, Tsiligianni I, Gardiner N, Akylbekov A, Mirzalieva G, Mademilov M, Sooronbaev T, Kasiita R, Katagira W, Kirenga B, Wimalasekera S, Amarasekara T, Sooriyakanthan M, Karunatilake R, Ishrat R, Ahmed O, Hanif H, Dixit P, Talwar D, Sahasrabudhe S, Bhakare M, Salvi S, Singh SJ. The RECHARGE-IPCRG ‘Teach the Teacher’ programme: building capacity for pulmonary rehabilitation in low- and middle-income countries. JOURNAL OF GLOBAL HEALTH REPORTS 2022. [DOI: 10.29392/001c.39598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction Chronic respiratory diseases are the most common causes of morbidity and mortality globally. Pulmonary rehabilitation (PR) is a low-cost, high-impact intervention with patient education and exercise at its core. Although supported by a well-established evidence base, demand greatly exceeds capacity in low- and middle-income countries (LMIC), including limited workforce training opportunities to support PR development and implementation. The International Primary Care Respiratory Group’s (IPCRG) Teach the Teacher (TtT) is an established education programme designed to build sustainable local clinical teaching and delivery capacity. Methods A collaboration between the National Institute for Health and Care Research (NIHR) funded Global RECHARGE Group for PR and IPCRG to deliver a ‘Teach the Teacher’ (TtT) programme for PR capacity building. Our Tier 1 TtT programme combined educational and PR service development concepts with core clinical content adapted for RECHARGE partners in India (Pune and Delhi), Sri Lanka, Kyrgyzstan and Uganda. Due to the severe acute respiratory syndrome coronavirus-2 (SARS‑CoV‑2) pandemic, the programme was adapted to a digital environment using online platforms such as Zoom video conferencing and Google Classroom. We used an adapted framework to evaluate professional learning and its impact. Findings Fifteen Tier 1/local leader participants attended a sixteen-hour online programme in September-October 2021. Participants included nurses, physiotherapists, doctors and early career health professionals/researchers. As local leaders in PR, participants created a tiered teaching programme for developing a critical mass of PR expert teachers, contextualised to their local healthcare systems and cultures. Participants also explored how to engage and influence multiple professional groups and stakeholders to support the widespread sustainable implementation of PR. Conclusions The RECHARGE-IPCRG TtT programme provided a clear education and service development framework to support PR capacity development in LMIC. We address a lack of empirical evidence concerning capacity-building initiatives by being explicit about the programme’s learning design, management and evaluation. A whole system perspective to PR allowed consideration of health systems, culture, referral pathways and scalability. Sustainable national PR education programmes will require additional resources and a long-term strategy, potentially aligning with the TtT three-tier cascade model.
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Affiliation(s)
| | - Mark Orme
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom; Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Linzy Houchen–Wolloff
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom; Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | | | - Amanda Barnard
- International Primary Care Respiratory Group (IPCRG), London, UK; Charles Strut University and Australian National University, Canberra, Australia
| | - Jaime Correia de Sousa
- International Primary Care Respiratory Group (IPCRG), London, UK; Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga Portugal. ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Ioanna Tsiligianni
- International Primary Care Respiratory Group (IPCRG), London, UK; Department of Social Medicine, University of Crete, Crete, Greece
| | - Nikki Gardiner
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Azamat Akylbekov
- Republican Research Center of Pulmonology and Rehabilitation, Ministry of Health, Bishkek, Kyrgyzstan; National Centre for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Gulzada Mirzalieva
- Republican Research Center of Pulmonology and Rehabilitation, Ministry of Health, Bishkek, Kyrgyzstan; National Centre for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Maamed Mademilov
- Republican Research Center of Pulmonology and Rehabilitation, Ministry of Health, Bishkek, Kyrgyzstan; National Centre for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Talant Sooronbaev
- Republican Research Center of Pulmonology and Rehabilitation, Ministry of Health, Bishkek, Kyrgyzstan; National Centre for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | | | | | | | | | - Thamara Amarasekara
- Faculty of Allied Health Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | | | | | - Rubia Ishrat
- Metro Centre for Respiratory Disease, Metro Hospital and Heart Institute, Uttar Pradesh, India
| | - Obaidullah Ahmed
- Metro Centre for Respiratory Disease, Metro Hospital and Heart Institute, Uttar Pradesh, India
| | - Humaira Hanif
- Metro Centre for Respiratory Disease, Metro Hospital and Heart Institute, Uttar Pradesh, India
| | - Prajjwal Dixit
- Metro Centre for Respiratory Disease, Metro Hospital and Heart Institute, Uttar Pradesh, India
| | - Deepak Talwar
- Metro Centre for Respiratory Disease, Metro Hospital and Heart Institute, Uttar Pradesh, India
| | - Shruti Sahasrabudhe
- Symbiosis Medical College for Women and Symbiosis University Hospitals and Research Centre, Symbiosis International (Deemed) University, Pune, India
| | - Meenakshi Bhakare
- Symbiosis Medical College for Women and Symbiosis University Hospitals and Research Centre, Symbiosis International (Deemed) University, Pune, India
| | - Sundeep Salvi
- Symbiosis Medical College for Women and Symbiosis University Hospitals and Research Centre, Symbiosis International (Deemed) University, Pune, India
| | - Sally J Singh
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom; Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
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8
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Perera ACH, Jayamaha AR, Jones AV, Yusuf ZK, Wijayasiri KDCU, Amarasekara T, Seneviratne A, Miah R, Barton A, Steiner MC, Wimalasekara SW, Orme MW, Singh SJ. Developing Appropriate Pulmonary Rehabilitation Services in Sri Lanka: Assessment of People Living with COPD and Healthcare Providers in Urban and Semi Urban Areas in Sri Lanka. Int J Chron Obstruct Pulmon Dis 2022; 17:631-641. [PMID: 35386389 PMCID: PMC8977868 DOI: 10.2147/copd.s316555] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 01/24/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, corresponding to 5% of all deaths globally, with more than 90% occurring in low- and middle-income countries (LMIC). Pulmonary Rehabilitation (PR) is a routine clinical service for COPD management, often used in western countries. At present, there is no formal PR in Sri Lanka; a culturally appropriate programme is required that considers the views of adults living with COPD and healthcare providers (HCPs) who would be involved in the referral or delivery of PR. Purpose The study assessed the attitudes and preferences of Sri Lankan adults living with COPD and attitudes and barriers of HCPs making PR referrals to inform an appropriate PR programme. Methodology A descriptive cross-sectional study was conducted with the ethical clearance of Colombo south teaching hospital ERC committee (ERC Application No. 674), among adults living with COPD and HCPs in Colombo district, Sri Lanka. Adults living with COPD were enrolled August 2018–December 2018 using systematic random sampling from Colombo South Teaching Hospital and were assessed using a pre-tested interviewer administered questionnaire. HCPs were recruited from Colombo South Teaching Hospital and Jaffna Teaching Hospital between August 2018 and November 2018 and assessed using self-administered questionnaire. Results Responses from 138 adults living with COPD (53% male, 52% aged ≥60 years) and 277 HCPs were collected. The majority of adults living with COPD were interested in participating in PR (80%) and would prefer PR to be delivered in a supervised, group-based, setting with hospital-based (49%). Adults living with COPD were mostly (73%) willing to spend between 30 minutes and 2 hours per day for PR-related activities. Among HCPs, 234 (83%) were nurses, 29 (11%) were hospital doctors and 14 (4%) were family physicians. The majority of HCPs stated that they were unsure about referring adults with COPD for PR (86%) and 61% stated considerable uncertainty regarding the availability of resources for PR. Nearly half of the HCPs (45%) felt they were not adequately prepared to refer adults living with COPD to PR programmes. Most HCPs (92%) reported that PR is worthwhile for COPD management. Conclusion Adults living with COPD in Sri Lanka are willing to attend PR and would prefer group-based programmes delivered in hospitals, under the supervision of qualified personnel. Awareness about PR is poor and there is a lack of readiness to refer to PR amongst HCPs. There is an urgent need to train HCPs on PR and develop effective referral strategies to support PR uptake and delivery for adults living with COPD in Sri Lanka.
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Affiliation(s)
- A Chamilya H Perera
- Department of Respiratory Science, University of Leicester, Leicester, UK
- Faculty of Nursing, KIU, Colombo, Sri Lanka
- Correspondence: A Chamilya H Perera, Email
| | - Akila R Jayamaha
- Department of Respiratory Science, University of Leicester, Leicester, UK
- Faculty of Nursing, KIU, Colombo, Sri Lanka
| | - Amy V Jones
- Department of Respiratory Science, University of Leicester, Leicester, UK
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Zainab K Yusuf
- Department of Respiratory Science, University of Leicester, Leicester, UK
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Thamara Amarasekara
- Faculty of Allied Health Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | | | - Ruhme Miah
- Department of Respiratory Science, University of Leicester, Leicester, UK
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Andy Barton
- Department of Respiratory Science, University of Leicester, Leicester, UK
| | - Michael C Steiner
- Department of Respiratory Science, University of Leicester, Leicester, UK
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Mark W Orme
- Department of Respiratory Science, University of Leicester, Leicester, UK
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Sally J Singh
- Department of Respiratory Science, University of Leicester, Leicester, UK
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK
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Lahham A, Holland AE. The Need for Expanding Pulmonary Rehabilitation Services. Life (Basel) 2021; 11:1236. [PMID: 34833112 PMCID: PMC8622005 DOI: 10.3390/life11111236] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/05/2021] [Accepted: 11/11/2021] [Indexed: 11/16/2022] Open
Abstract
Pulmonary rehabilitation is a strongly recommended and effective treatment for people with chronic lung disease. However, access to pulmonary rehabilitation is poor. Globally, pulmonary rehabilitation is accessed by less than 3% of people with chronic lung disease. Barriers to referral, uptake and completion of pulmonary rehabilitation are well documented and linked with organizational, practitioner and patient-related factors. Enhancing the knowledge of health care professionals, family carers, and people with chronic lung disease about the program and its benefits produces modest increases in referral and uptake rates, but evidence of the sustainability of such approaches is limited. Additionally, initiatives focusing on addressing organizational barriers to access, such as expanding services and implementing alternative models to the conventional center-based setting, are not yet widely used in clinical practice. The COVID-19 pandemic has highlighted the urgent need for health care systems to deliver pulmonary rehabilitation programs remotely, safely, and efficiently. This paper will discuss the pressing need to address the issue of the low accessibility of pulmonary rehabilitation. It will also highlight the distinctive challenges to pulmonary rehabilitation delivery in rural and remote regions, as well as low-income countries.
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Affiliation(s)
- Aroub Lahham
- Department of Immunology and Pathology, Monash University, Melbourne 3800, Australia;
| | - Anne E. Holland
- Department of Immunology and Pathology, Monash University, Melbourne 3800, Australia;
- Institute for Breathing and Sleep, Melbourne 3084, Australia
- Department of Physiotherapy, Alfred Health, Melbourne 3004, Australia
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