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 reveal the geographic areas where this type of care is most lacking and illustrate the potential of telemedicine to help bridge the gap, the researchers say.
The study was published in February. 5 inches JAMA Network Open.
Pulmonary rehabilitation is a multidisciplinary program that incorporates exercises and strategic techniques to improve the quality of life and overall health of patients with respiratory conditions 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 strategies that can help them better manage their illness on a day-to-day basis, such as energy conservation, supplemental oxygen therapy, and coping strategies. During periods of high energy.
It has been demonstrated across almost all pulmonary medicine to improve patient health and patient-reported outcomes. Through these programs, patients not only gain a more comprehensive understanding of their condition, but also improve their exercise tolerance in a meaningful way.”
Dr. Peter Kahn, a pulmonary and critical care fellow at Yale School of Medicine and lead author of the study.
However, despite the demonstrated importance of critical pulmonary rehabilitation, many people in the United States must travel long distances to access the programs.
For the study, the researchers used massive geographic data sets and computational infrastructure to calculate millions of travel times.
Technologies that enable large-scale travel time calculations are not only innovative but transformative, providing us with nuanced insights into national data sets previously unavailable to researchers.”
Dr. Walter Mathis, senior author, is a psychiatrist and health services researcher at Yale School of Medicine
Nearly 80% of Americans live within a 30-minute drive of 10 million pulmonary rehabilitation programs, the researchers found, more than 14 people -; Most live in the western and midwestern parts of the country -; They have to travel more than an hour away to access the nearest offer.
They also uncovered racial disparities in access to pulmonary rehabilitation. For example, about 30% of the American Indian and Alaska Native populations live more than an hour away from the nearest program.
“Access to programs within a reasonable amount of travel time is key,” Kahn said. “First, many patients with chronic respiratory conditions require supplemental oxygen. Long commutes may mean they need multiple oxygen tanks or batteries, causing patients to forgo treatment. Second, because exercise intolerance is a symptom of these diseases, long-term travel is incredibly difficult. Can be taxing and act as a barrier to participation.
Kahn said telemedicine and virtual rehabilitation may help bridge this gap in the short term, although the long-term effectiveness of these approaches in different diseases still needs further evaluation.
More accessible private rehabilitation options will be needed to help patients in the long term, he added. This will require collaboration between policy makers and healthcare providers, and different approaches to insurance reimbursement.
“Insurance providers, both public and private, do not adequately reimburse people for pulmonary rehabilitation programs, the equipment and supplies needed to run them effectively,” Kahn said. That represents a barrier to offering this program. Equally important, insurance limits how many rehab sessions a patient can attend, he adds.
“If you’re someone with a chronic respiratory condition like advanced COPD, you really need ongoing therapeutic sessions,” he added. “But right now, payers limit patients to a small number of lifetime sessions compared to the long-term burden of the disease. And that needs to change.”
Kahn, P.A., & Mathis, W.S. (2024). Accessibility of pulmonary rehabilitation in the United States. JAMA Network Open. doi.org/10.1001/jamanetworkopen.2023.54867.