This report outlines a proposed approach to monitoring access to, and utilisation of, pulmonary rehabilitation and long term oxygen therapy, by capitalising on existing data sources and identifying data development opportunities.

Summary

Chronic obstructive pulmonary disease (COPD) is a major cause of death and disability in Australia. About 1 in 13 people aged 40 and over have lung function consistent with a diagnosis of COPD. The disease develops over many years and therefore mainly affects middle-aged and older people. Smoking is its main, but not only, cause.

Current clinical guidelines for the management of COPD (developed by the Thoracic Society of Australia and New Zealand and Lung Foundation Australia) emphasise the importance of care that encompasses both drug and non-drug based interventions designed to improve quality of life and survival.

Pulmonary rehabilitation is a system of care that includes a combination of exercise, education and psychosocial support. It has been shown to have a wide range of beneficial effects, particularly because of its exercise component. Pulmonary rehabilitation implemented after a hospital admission reduces the risk of re-hospitalisation and death, and improves quality of life.

Selective use of long-term oxygen therapy (LTOT)-the provision of supplemental oxygen therapy for 15 hours per day or more for people with COPD who have persistently low levels of oxygen in their blood-has been shown to improve quality of life and improve survival.

Both of these therapies are among the key non-pharmacological interventions recommended in national and international clinical guidelines. Available evidence suggests, however, that pulmonary rehabilitation and LTOT are under-utilised in managing patients with COPD in Australia. The full extent of service provision, utilisation and under-utilisation is not known as there are no national data.

This report outlines:

• proposed indicators relevant to monitoring access to, and utilisation of, pulmonary rehabilitation and LTOT in Australia
• existing data sources that may inform these indicators
• options for data development
• potential challenges in monitoring these therapies.

Improved information about access to, and use of, these interventions among people with COPD would enable:

• identification of opportunities for health improvement
• measurement of the benefits derived from these interventions.

This would form a useful basis for data development to support assessment of the appropriateness of use, barriers to uptake and outcomes of these therapies.

Similar information about the provision of non-inpatient, non-procedural and non- pharmaceutical therapies is also relevant to monitoring other chronic diseases in which these interventions improve quality of life and extend life.

The authors of this report are Guy Marks, Helen Reddel, Elyse Guevara-Rattray, Leanne Poulos and Rosario Ampon of the Australian Centre for Asthma Monitoring (ACAM).