Jenny Broe Prince of Wales Hospital jenny.broe@sesiahs.health.nsw.au

1. The Health Roundtable New Zealand Future Role of Allied Health The Role of Home Based Physiotherapy within a Respiratory Coordinated Care Program Acknowledgements: Prince of Wales Hospital RCCP team – Jane Neill CNC, Susan Pola CNS, Kate Frampton CNS, Mary Santos Physiotherapist. Jenny Broe Prince of Wales Hospital jenny.broe@sesiahs.health.nsw.gov.au

2. Key Problem • Worsening respiratory disease • House bound patients reduced access to support at home • decreased ability to cope with disease • increased hospital admissions • longer lengths of stay

3. Intervention Starts

4. Key Strategies / Ideas Implemented • Formation of RCCP multidisciplinary team with physiotherapy component providing: • Home based pulmonary rehabilitation 6 week program • Domiciliary physiotherapy follow up 2nd weekly • Availability of physiotherapist to intensify treatment at home during exacerbation • Emphasis on “staying well” at home • Facilitates earlier discharges and avoidable admissions

5. Timelines & Resources • Program began April 2008 • Data analysis 1 year pre & post RCCP in progress • Physiotherapy component • 1FTE @ $ 74,224 pa • Cars available from hospital car pool • Mobile phone $200 • Equipment bag with thermometer, BP manometer, distance measuring wheel, spirometer, O2 saturation monitor, exercise equipment e.g. boxing gloves, stop watch - total $ 6,000

6. Key Outcomes Achieved • 9 patients completed 6 week Rehab Program, 4 patients ongoing • 6 minute walk test • 78% improved • 22% maintained • Hospital Anxiety & Depression Scale • No significant change • St George’s Respiratory Questionnaire • Mean improvement of -3 points (significant at -4 points.) • Readmission • 78% no readmission in the following 12 months • Cost savings ~$52,000

7. Lessons Learnt • Ensure environmental safety for staff member • Be aware that environment is patient’s own place • Keep appropriate phone nos. handy • Be familiar with community support services • Ensure exercises are appropriate, fun, challenging • Be creative, involve family, encourage diary use • Be prepared to go outside physiotherapy role • Focus on “staying well” at home

8. What would you have done differently with the benefit of hind sight? • Extend to 8 week rehabilitation program • Ability for patients to be admitted directly to Resp Medical Assessment Unit instead of via ED • Redeploy or add following staff -domiciliary • 0.5FTE respiratory registrar • 0.5 FTE Occupational therapy • 0.25 Clinical Psychology • Factor in Annual leave component • Adequate office space • Car dedicated to RCCP • Physio in ED