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Pulmonary rehabilitation, an essential component of care for patients with chronic respiratory conditions, is difficult for millions of Americans to access, a new Yale-led study reveals. The findings, researchers say, reveal geographic regions where this type of care is most lacking and illustrate the potential for telemedicine in helping to bridge this gap.
The study was published Feb. 5 in JAMA Network Open.
Pulmonary rehabilitation is a multidisciplinary program that incorporates exercise and strategic techniques to improve quality of life and overall health for patients with respiratory conditions like 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 illness day to day, such as energy conservation, supplemental oxygen therapy, and methods for capitalizing on periods of higher energy.
“It has been demonstrated across almost the entirety of pulmonary medicine to improve patient health and patient-reported outcomes,” said Dr. Peter Kahn, a pulmonary and critical care fellow at Yale School of Medicine and lead author of the study. “Through these programs, patients not only gain a more comprehensive understanding of their condition, but also improve their exercise tolerance in a meaningful way.”
However, despite the demonstrated importance of critical pulmonary rehabilitation, many people in the United States must travel long distances to utilize programs.
For the study, researchers used massive geographic data sets and computational infrastructure to compute hundreds of millions of travel times.
“Technologies enabling travel time computations at a massive scale are not just innovative but transformative, providing us with nuanced insights into national data sets previously unavailable to researchers,” said senior author Dr. Walter Mathis, a psychiatrist and health services researcher at Yale School of Medicine.
While around 80% of Americans live within a 30-minute drive of a pulmonary rehabilitation program, the researchers found, over 14 million people—mostly living in the country’s western and midwestern regions—must travel more than an hour away for access to their nearest offering.
The team also uncovered racial disparities in access to pulmonary rehabilitation. For example, nearly 30% of the American Indian and Alaska Native population lives more than an hour away from the closest program.
“Access to programs within a reasonable amount of travel time is key,” said Kahn. “First, many patients with chronic respiratory conditions require oxygen supplementation. Long commutes may mean they have to transport multiple oxygen tanks or battery supplies, which may cause patients to forgo the treatment. Second, because exertional intolerance is a symptom of these diseases, long travel can be incredibly taxing and also serve as a barrier to participation.”
More information:
Peter A. Kahn et al, Accessibility of Pulmonary Rehabilitation in the US, JAMA Network Open (2024). DOI: 10.1001/jamanetworkopen.2023.54867
Yale University
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Pulmonary rehabilitation is difficult for millions of Americans to access, says new study (2024, February 5)
retrieved 6 February 2024
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