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What is the challenge your project is going to address and how does it connect to your chosen theme?

Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of death and disability in the UK. Pulmonary Rehabilitation (PR) is an NHS-delivered outpatient service which teaches people with COPD to self-manage their condition. It is delivered over six weeks in a group setting, and includes physical exercise and education about managing the consequences of COPD. PR is effective at reducing symptoms and improving quality of life, and is cost-effective. However many people who could benefit from the service are not referred, do not attend, or do not complete the course. Two contributing factors to this are lack of knowledge / perceived benefit among people with COPD, and healthcare professionals (HCPs) under-referring due to inadequate knowledge about PR.

The current project fits within the outpatient service redesign theme as it will investigate use of an information video to increase referrals into PR, reduce failed attendances, and increase the proportion of patients who complete PR

What does your project aim to achieve?

We will investigate whether a 2-minute video (created by PR staff and COPD patients) could be used to increase knowledge of PR for patients and HCPs, and increase referral to, uptake of and completion of PR. Service evaluation of a 7-minute version showed that it was well-liked and could increase PR referrals in the region, although a shorter version could be used more flexibly.

Evaluation objectives:

–          Monitor PR referral rates before and after introducing the 2-minute video

–          Determine whether showing the video during PR assessment increases PR completion

–          Explore HCPs’ and patients’ views towards the video and considerations around its use in practice

We will show whether a low-cost digital intervention could improve referral to and completion of PR, and thus lead to more people with COPD learning self-management skills and benefiting from improved health and quality of life. The results will be applicable to COPD patients and PR programmes across the UK

How will the project be delivered?

The 2-min video will be promoted through NHS networks. A video link will be included in PR referral letters, and the video will be shown to all patients attending PR assessment. Monthly referral rates and completion rates for Sheffield’s PR service will be monitored before and after introducing the video. Qualitative interviews will be conducted with members of the PR team and referring HCPs in the region, to explore views towards the videos and service-level implications of using the videos (e.g. waiting lists).

The project will be overseen by Dr. Steven Ariss, a Q Community member who is experienced in evaluation of complex health interventions. Claire Bentley is an experienced healthcare researcher responsible for data collection, analysis, and delivery of the project. Cath O’Connor is a respiratory physiotherapist who works with the PR team in Sheffield. The video was co-designed with Sheffield’s Breathe Easy support group, and we will continue to work with them during the project.

What and how is your project going to share learning throughout?

The results will be shared with the Q Community, both online and through networking events. Findings will be shared with Sheffield’s PR team, NHS Sheffield contacts, and other PR services. We will also link with Matthew Halkes, a Q member involved in evaluating NHS healthcare videos.

Findings will be shared with the Breathe Easy support network. The results will be written up in an academic journal article, and presented at relevant conferences/events. Sheffield’s clinical commissioning team funded development of the video, and are keen to learn from and act on the findings of any research. We will seek to make the video available to other PR services, and the findings may inform bids for roll-out and evaluation across the UK.

The results of the project are applicable to people with COPD and to PR services across the UK. The video could lead to increased use of a highly effective outpatient service, and thus lead to better health and quality of life for people with COPD across the UK

How you can contribute

  • All comments and contributions are welcome
  • Any information about similar interventions

Plan timeline

29 Feb 2020 Project set up: Ethics, Evaluation registration, Briefings
31 Mar 2020 Project set-up:Approvals in place, Briefings with PR team
30 Apr 2020 2-min video launched
30 Apr 2020 Recruitment for HCPs, PR staff and patients
30 Apr 2020 Video linked in referral letters throughout project
30 Apr 2020 Video shown at assessment throughout remaining project
31 May 2020 Conduct workshops / interviews
31 May 2020 Recruitment for HCPs, PR staff and patients
30 Jun 2020 Conduct workshops / interviews
31 Jul 2020 Analyse data from workshops / interviews
31 Aug 2020 Analysis of results
31 Aug 2020 Extract referral and PR completion data
30 Sep 2020 Analysis/write up of results
30 Sep 2020 Dissemination of findings
31 Oct 2020 Dissemination of findings

Comments

  1. This is a great idea.  One thought - a major hurdle to PR is patient uptake prior to attending for the course assessment.  Might this be a resource to use in primary care (or secondary care) to encourage patients to take up referral?

    Often there is resistance to the idea and this could improve referral rates by that means.

    Apologies is this is something you have considered and trialled previously.

    1. Hi Charlie, sorry for the delay, and thanks very much for your interest in the idea.

      I completely agree that the video intervention has a number of possible uses in various settings, and this upstream application will be very interesting to explore further. The possibility of usefulness in various settings was a driver for the development of the shorter video, which can be used more flexibly, depending on local needs and particular organisational environments. Hopefully, if we are funded, we will be able to look into this in more detail.

       

      Thanks again.

  2. Dear Steven, Dimple and Tony,

    Your comments exactly mirror our experience of using video here in Torbay and South Devon. They have potential impact and benefit along the entire clinical pathway:

    • Prevention: supporting healthy choices
    • Self care: Enabling management of minor issues independently
    • Health navigation: Helping identify services that can support patients and carers and how to access them. This isn't restricted to NHS and can include peer support / voluntary sector etc. It is also important that expectations are managed in terms of what the service may provide and what the patients input will be. (This is what I see your video is trying to achieve Steven and like you its as much about educating the referring staff as the patients).
    • Effective consultation / Shared Decision Making / Consent: All facilitated by providing digital information (ideally beforehand) with some initial evidence that this can focus the consultation of the personal news of that patient, save time and increase satisfaction.
    • Preparing for and recovering from therapeutic interventions: These maybe medical eg understanding drug therapies to increase compliance or surgical procedures. We have shown decreased demand on MSK services post shoulder surgery by providing patients with videos describing the exercises they need to undertake / removal of need for follow up appointments post nail surgery (patient does the dressing change themselves)
    • Avoiding the need for admission / enhancing discharge: Through avoiding crisis by better understanding their condition and / or enhanced compliance. Saving time in discharge processes by basic information being provided through video enabling a more personalised discharge discussion (and information readily available for ongoing reference)

    The latter touches on Dimple's point re driving people into a service that then struggles to cope. This can be offset by the efficiencies gained / capacity generated by implementing the other steps above. For example our cardiology team have had 25% uptake of video based preparation for angiography and those that do come in have a group session where the video is played followed by Q+A. In combination this has saved significant staff time. Our Healthy Lifestyles team have added a completely digital offer (app based videos) for diabetes and weight management to enable them to reach more patients with the same resource.

    Interestingly we have just been approached by our CCG re trialing video based pulmonary rehabilitation - so another point of overlap. myCOPD is also being used in Devon (to some extent). The work the CCG wants to undertake isn't a comparison of one vs other, but more wanting to understand the impact of each approach and where the best fit is for each approach. Feels like a lot of potential for collaboration here.

    Many thanks

     

    1. Hi Matthew,

      thanks for your comments and sharing your experiences. There are some very interesting points and observations. I like the consideration that efficiency savings can offset increased uptake of services. This whole-system approach and finding balance across the pathway to reach more people, more effectively is very important to bear in mind.

      This connects to your final point about not comparing one approach to another but finding the best fit. I'm so pleased to see that the CCG are embracing this approach to evaluation, which aligns with my interests in evaluation of complex interventions and finding what works, for whom, in what circumstances and in what ways.

      Definitely lots of potential for collaboration and shared learning.

      Thanks.

  3. Hi Steven,

     

    Such an important initiative; access to PR has many proven benefits for patients.

     

    One 'challenge' I'd like to raise - assuming the videos meet one of their goals and raise awareness of PR and increase referrals into the service - is the service set up to cope with the increasing volume? I've heard of extremely long waiting lists in some areas and this infrastructure needs to be able to manage the demand to help patients get the best out of pr. I'm sure you've thought of this but possibly worth highlighting in your proposal?

    I came across another proposal about a framework for evaluating videos. It's a slightly different angle and focuses on the questions patients may have pre clinic, but I wondered if it might helpful to connect you both to share learning?

     

     

    https://q.health.org.uk/idea/2019/impact-evaluation-framework-for-patient-information-videos/

    Good luck with the bid.

    Thanks

    Dimple

    1. Thanks Dimple,

      this is an important concern that deserves a mention in the proposal. I recently evaluated a falls risk assessment project, which overloaded the local falls prevention team, so am very familiar with the issues.

      One of the main problems is lack of completion of the course (possibly due to patients not knowing what to expect when they arrive), so courses are run with spare capacity. However, increased numbers would also be an expected outcome.

      I've had a look at the other video project, and it seems that there are lots of potential applications and potential to collaborate on evaluation methods.

      Thanks!

  4. Hi,

    I like this project. Y&H AHSN has a project in development on Personalisation of care in Respiratory disease and your work could well inform that.

    Do you already use MyCOPD?

    Tony

    1. Hi Tony,

      it would be good to have a chat about how this might fit in with other AHSN work on respiratory disease.

      Linking up with MyCOPD, especially for people that are more suited to or prefer a more self-directed approach to their rehab is a great idea!

      Thanks.

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