Lay health workers in pulmonary rehabilitation-recruitment and training of COPD patient volunteers.

Conference: 
Talk Code: 
EP1A.03
Presenter: 
Patrick White
Co-authors: 
L. Hogg (2), R. Tuffnell (3), S. J.C. Taylor (4), S. Lewin (5), N. S. Hopkinson (6), A. J. Wright (1), P. White (1).
Author institutions: 
1King’s College London, 2 Guy’s and St Thomas NHS FT (Foundation Trust), 3 King’s College Hospital NHS FT, 4Queen Mary University London, 5Global Health Unit, Norwegian Knowledge Centre for Health Services, Norwegian Institute of Public Health, and Health Systems Research Unit, South African MRC, 6 NIHR Respiratory BRU at Royal Brompton and Harefield NHS FT and Imperial College London

Problem

Pulmonary Rehabilitation (PR) is the most effective treatment for the symptoms of COPD. Patients referred by general practitioners are the least likely to complete PR. Despite the known benefits less than half of referred patients complete PR. Lay health workers (LHWs) have improved uptake of healthcare interventions in other settings but have not previously been used in PR. Aim:To test the feasibility of using COPD patients, trained as LHWs, to enable other COPD patients to benefit from PR.

Approach

Patients successfully completing PR were invited to volunteer as LHWs. LHW training was delivered by the Royal Society for Public Health. It included confidentiality, role boundaries and the learning and application of behaviour change techniques to address known barriers to PR attendance. Smart phones were provided to record interactions between LHWs and supported patients. Patients newly referred for PR were invited to accept LHW support by letter, phone and face to face interaction.

Findings

Twenty three (21%) of 110 patients approached applied to become LHWs. Fifteen (14%) completed 3 training days and joined a mentored group prior to supporting newly referred patients. Reasons for non-completion of training included health and social issues and concerns about impact on benefit eligibility of payments for research participation. Letters and information leaflets were ineffective in recruiting newly referred patients for LHW support (< 1% response). Telephone and face to face recruitment (at initial assessment) by the PR teams were effective (20 – 25% response in three different NHS Trusts). This became the main recruitment mode.

Consequences

COPD patients can be recruited and trained as LHWs to encourage participation in PR. Personal contacts were the most effective method of recruiting patient participants for LHW support. The effectiveness of LHWs will be tested in a definitive clinical trial following this feasibility study. Using LHWs in a trial setting looks feasible and may offer the possibility of improved access to services in a range of settings relevant to primary care.

Submitted by: 
Gill Gilworth
Funding acknowledgement: 
NHS National Institute for Health Research