Study reveals limited access to pulmonary rehabilitation for millions of Americans

Pulmonary rehabilitation, an essential component of care for patients with chronic respiratory conditions, is difficult for millions of Americans to access, a new Yale study finds. The findings, the researchers say, reveal geographic areas where this type of care is most lacking and illustrate the potential for telemedicine to help bridge that gap.

The study was published on February 5 in JAMA Network Open.

Pulmonary rehabilitation is a multidisciplinary program that incorporates exercise and strategic techniques to improve quality of life and general health for patients with respiratory diseases such as chronic obstructive pulmonary disease (COPD), interstitial lung disease, or pulmonary hypertension. Programs typically include a structured exercise component supervised by nurses and/or exercise specialists, as well as educational sessions that teach patients techniques that can help them better manage their disease on a day-to-day basis, such as energy conservation, supplemental oxygen therapy, and capitalization methods during times of higher energy.

It has been shown across nearly all of pulmonary medicine to improve patient health and patient-reported outcomes. Through these programs, patients not only gain a more complete understanding of their condition, but also improve their exercise tolerance in a meaningful way.”

Dr. Peter Kahn, pulmonary and intensivist fellow at Yale School of Medicine and lead author of the study

However, despite the proven importance of critical pulmonary rehabilitation, many people in the United States must travel long distances to access programs.

For the study, the researchers used massive sets of geographic data and computing infrastructure to calculate hundreds of millions of travel times.

The technologies that enable travel time calculation on a massive scale are not just innovative but transformative, giving us fine-grained insights into national datasets previously unavailable to researchers.”

Dr. Walter Mathis, senior author, psychiatrist and health services researcher at Yale School of Medicine

While about 80% of Americans live within a 30-minute drive of a pulmonary rehabilitation program, researchers found that more than 14 million people -? who live mainly in the western and midwestern regions of the country -? they have to travel more than an hour away to access their nearest offer.

They also revealed racial disparities in access to pulmonary rehabilitation. For example, nearly 30% of the American Indian and Alaska Native population live more than an hour away from the nearest program.

“Access to programs within reasonable travel time is key,” said Kan. “First, many patients with chronic respiratory conditions require supplemental oxygen. Long commutes may mean they have to carry multiple oxygen tanks or battery supplies, which can cause patients to drop out of treatment. Second, because exercise intolerance is a symptom of these diseases, travel can be incredibly taxing and also act as a barrier to participation.”

Telemedicine and virtual rehabilitation can help bridge that gap in the short term, Kahn said, although the long-term effectiveness of this approach in various diseases still needs additional evaluation.

Helping patients long-term will require more affordable personal rehabilitation options, he added. This will require collaboration between policy makers and health care providers and different approaches to reimbursement.

“Insurance companies, both public and private, do not adequately reimburse pulmonary rehabilitation programs for the people, equipment and supplies needed to run them effectively,” said Kan. This is a barrier to offering these programs. . Just as important, insurance limits how many rehab sessions a patient can attend, he added.

“If you’re someone with a chronic respiratory condition like advanced COPD, you really need ongoing treatment sessions,” he added. “But right now, payers are limiting patients to a small number of sessions in their lifetime relative to the long-term burden of the disease. And that needs to change.”