Pulmonary Rehabilitation Programs in Saudi Arabia - Essay Example

? of the Paper) Chronic obstructive pulmonary disease which is commonly referred to as (COPD), is a disease that is mainly characterized by the presence of airflow obstruction. The disease has been classified into two types: chronic bronchitis and emphysema. COPD is defined by the American thoracic society as “A preventable and treatable diseases state characterized by air flow limitation that is not fully reversible. The flow limitation is found to be usually progressive and is commonly associated with an abnormal inflammatory response seen to affect the lungs as a result of various noxious particles or even gases. This is primarily through cigarette smoking” (ref: EGANS p504 don’t worry about, I will reference latter). COPD is a particularly common disease and it has widely been classified among the ten most lethal diseases both in Saudi Arabia and a myriad of different countries spread out in different regions globally. A relatively large number of Saudi nationals are diagnosed and treated for COPD every day leading to a few scholars conducting studies estimating the prevalence and incidence rate of COPD in the country. Al Ghobain et al. conducted a study involving 501 patients who were more than 40 year of age, were smokers and attended primary health care clinics at the three biggest cities in the kingdom of Saudi Arabia. This study revealed that out of the 501 patients that were engaged and participated in the study, 71 patients were diagnosed with COPD. This number represented 14.2 percent of the study population and was similar to the prevalence rate reported in many parts of the world. (refe annals of thoracic). Al Ghobain et al. also suggested that the incidence rate of COPD will increase in the future due to several factors among which includes the increasing number of teenage smokers, the increasing number of both female and male water pipes (Hookah) smokers, and exposure to biomass fuel substances such as wood for cooking and coal. These are found to be particularly common in some villages in the country. (refe annals of thoracic). Another study was done at king Abdulaziz University Hospital in Jeddah, Saudi Arabia which sought to establish the prevalence rate of respiratory diseases among hospitalized patients in the years ranging between 1996 through to 2000. The result of the review of 810 patients’ records’ showed that respiratory diseases mostly affected the 46-65 years age group at (41.8%). About 55% of these patients were males while 45% were females. Additionally, this review showed that asthma (38.6%), COPD (17.2%) and pneumonia (11.5%) are the most common respiratory diseases in Saudi Arabia. (refe 3). Additionally, another retrospective study was conducted by Alaithan et al. at King Abdulaziz National Guard Hospital, Al Hasa, Saudi Arabia. The study focused on assessing the intensive care unit (ICU) and in- hospital results of patients admitted with COPD execration. The study also sought to identify the contributing prognostic factors. The study variously included 119 different patients who had been successfully admitted to the ICU while generally displaying signs of acute respiratory failure caused by COPD exacerbation. The mean age for those patients was 72 13 years and 44 (37%) of these patients were females. The study results showed that thirty- nine (33%) of the admitted patients received mechanical ventilation whose median duration was 2.6 (1-42) days. The study successfully identified infection as the main cause of respiratory failure and established the results of ICU mortality rate at 6% while the hospital mortality stood at 11%. The scholars also suggested that high in hospital mortality rates could be seen in patients with low Glasgow Coma Scale on admission, were intubated, had a long duration of mechanical ventilation, were current smokers, and had conditions such as tracheostomy, cardiopulmonary arrest, and had developed acute renal failure. Finally, the authors firmly emphasized that there was a need to conduct further studies investigating the long-term mortality rate after the hospital discharge (ref4). Comparing data from the study conducted by Alaithan et al. with data that was drawn from a similar study done in the Netherlands on 171 COPD patients, The in-Hospital mortality rate in Saudi is found to be slightly more than the in-hospital mortality rate of the Netherlands Hospital which was 8%. Furthermore, the authors of the Netherlands study, listed completely different risk factors associated with the higher in -hospital mortality rate. These factors were long-term use of oral corticorstoride, higher PaCO2, and older age. (ref 5). Since COPD has been recognized as one of the deadliest diseases in many countries, a number of different approaches have been established around the world to manage COPD and COPD execrations. These approaches include medications such as short and long acting bronchodilators, maintenance chortiecostorieds, supplemental oxygen in severe cases, antibiotics to treat infections, vaccinations, and physical and educational training such as pulmonary rehabilitation programs (PR) and smoking cessation programs. (ref6 egans). All of these approaches except Pulmonary Rehabilitation have been considered by Saudi Arabian hospitals as possible methods of manage COPD patients. Although a number of studies have established evidence behind the benefits of pulmonary rehabilitations programs especially to COPD patients (refe 6 tery toster) few hospitals around Saudi Arabia actually recognize the benefits of PR programs and have established PR programs. Part two: On searching the literature, I only found one study that has been done to investigative the benefits and feasibility of PR programs in Saudi Arabia. The study was conducted by a Saudi researcher who did a study to investigate the benefits of the first established rehab program at king abdulaiziz medical city in Riyadh Saudi Arabia. This study included 89 patients who suffered from chronic lung disease (CLD), of which 38 of these patients did not adherent to the PR program for a number of reasons such as difficulties in transportation, admission to hospitals and others for nonspecific reasons. Patients were instructed to participate in two to three exercise-training sessions per week for an eight to 12 weeks period. In addition to the exercise training sessions, all patients will receive professional educational and nutritional advice. The result of this study showed implementing a PR program in Saudi Arabia was feasible and led to noticeable improvement in the patient physical and social performance. (ref 7). As a result of the researcher listing relative difficulty in transportation as being a reason for patients choosing not to attend the PR program, there is an emerging urge to start a PR program in every city in the country. Saudi Arabia is widely perceived to be one of the richest countries in the gulf region and therefore, we can hypothesize it would be very feasible to start preliminary programs in the major cities at the very least. However, the financial and human resources are not the only things Saudis should be concerned about. In my opinion there exists a lack of education among many Saudi nationals on the importance of PR programs to respiratory patients. To overcome this obstacle other Saudi respiratory organizations should invest time in educating the public on the benefits of PR programs. The designing and placing of brochures in every pulmonary clinic that can be read by Saudi nationals regardless of their educational background explaining to them the importance of PR programs and can be used as a starting method. In addition, the intended organizations such as the Saudi Society for Respiratory Care, should develop programs, advertisement material and present them in the digital and social media to raise the public awareness. In my personal experience working as a respiratory therapist at the Prince Sultan Medical City at Riyadh, I have noticed that as respiratory therapists we came across a large number of COPD patients every day. Most of those patients’ explain that their conditions have deteriorated from being mild cases to becoming more severe and that they are no longer able to participate in social activities or personally perform even the basic daily activities. Therefore, PR programs can make a huge difference in improving not only the physicals performance of Saudi patients but also contribute towards improving the quality of their lives. The Prince Sultan medical city is a government-funded hospital. It serves a large number of both Saudi citizens and non-citizens. The hospital patients’ attendance estimated to be about 1,700,000 patients, which is considered the highest number of hospital attendance in the Riyadh area. Additionally, prince sultan medical city has an ideal location because it is located at the city center. (ref the hospital website). Therefore, it is easy for most patients to commute to this hospital. Moreover the launching of a PR program at this hospital will be ideal as, judging from its large number of its hospital attendance; many respiratory patients will be benefited from this PR program. To successfully launch an effective and comprehensive pulmonary rehabilitation program, the PR program should include the following components: an exercises training sessions, educational sessions, psychological and nutritional services, carer support, smoking cessation program, and various effective tools to evaluate each patient. (pulmonary foundation Australia). It is important to consider several key factors before the rehabilitation program can be started. First, the program funding; the proposed PR program will be a hospital based PR program since the hospital is itself supported by the government, this factor causes the PR program to consequently be supported by the government as well. The second factor is the program’s location, which will be at one of the buildings inside the medical city. The location should be relatively close to a patient’s car parking area. For the patient who do not have their own transportation vehicles, taxi services will be arranged in cooperation with a taxi company. Thirdly, The program staffing will be done through the hospital human resources department. The program staff will consist of: a program director, medical director, medical coordinator and a group of professional team members. The role of program director can be filed by any knowledgeable and experienced chest physician. A medical director will be responsible for recommending strategies for patient involvement and ensuring good medical care is being provided to patients. The program coordinator role can be filled by a qualified nursing practitioner and he or she will be responsible for communication between refereeing professionals and the PR program to ensure the program in operating effectively. Finally a group of professional team members such respiratory therapist, physiotherapist, occupational therapist, psychologist, nutritionist will form the rest of the PR staff members. (Australian lung association). The Fourth factor is that the referral system will comprise of a referral form sent from the patient’s respiratory physician. This form will also be sent to the PR program coordinator. After the program coordinator receives the form, an invitation will then be sent to the patient via a text message or a phone call. This invitation will include a brief notification explaining that the concerned patient has been referred to participate in the PR program as well the location and, the start date of the program. (refPulmonary rehbiltation toolkit). When the patient arrives at his first PR session, the PR nurse will conduct an interview to ask the patient about their smoking history, medications, whether the patient has any other medical illness, the nurse will also review the patients spirometeic data, and nutritional status and thereafter, refers patients who may need further nutritional support to the PR nutritionist. Afterwards, the respiratory therapist will conduct an initial assessment to establish a patient’s base line. This assessment will include three steps, first the respiratory therapist will assess the patient’s physical performance by using a six-minute walk test (6MWT) this test widely used to measure the exercise capacity of COPD and heart patients by measuring the farthest possible distance the person can walk on a flat surface for six minutes. (ref manual of PR). Another test can also be used to measure the exercise capacity is the incremental shuttle walk test (ISWT). In this test, the patient should be instructed to walk very slowly and then accelerate every minute between two cones to set an auditory peeps played on CD. The patients will be instructed to walk until they are breathless. To estimate the patient walking capacity each lap will represent a distance of ten meters. The second step will be an assessment of the patients’ respiratory health related quality life outcomes. This will be done by instructing the patient to take a self administered Arabic version of 50 items of the St. George's Questioner, and a 20 questions of the chronic respiratory disease questioner. (ref rehblitation toolkit).Thirdly, an assessement of the patients shortness of breath which can be done by using the modified BORG scale. (ref rehabilitation toolkit). The establishment of a base line of these assessments will help the health care professionals in the determination of the patient’s progress. After the actual initial assessment, the patients will then be ready to start on the PR program. An average of about 15 patients should be allowed to start the PR program. However, the rest of the other potential candidates will be effectively placed on a wait list. The duration of the PR program will be 2 to 3 sessions per week each containing a 30 minutes exercises training every three or two days and a 25 minutes educational session once a week for up to 8 weeks (ref manual.au). Additionally, Carer educational session for 30 minutes will be provided once every two weeks. The educational sessions will be provided by the PR nurse, the occupational therapist and the respiratory therapist. The components of these educational sessions will include lectures, short duration videos, and active participation. The lectures material will vary each week, the lecture topics will include: the role and the correct use of medications, information about the disease (e.g. what part of the respiratory system the COPD mainly affect), nutrition and healthy eating habits, coping with COPD, sputum clearances. The occupational therapist will be responsible for educating the patients on energy conservation methods while the respiratory therapist will teach the patients about different breathing techniques (e.g. pursed lip breathing and diaphragmatic breathing techniques). (refe manual) On the other hand, the Carer educational sessions will be a series of lectures providing information on the disease as well as group discussions discussing the different obstacles the Carer faces in addition to finding possible ways of overcoming these obstacles. (ref rehabilitation toolkit). Another important factor to focus on while implementing a PR program is supervised exercise training. Three-experienced physiotherapists will be responsible for the exercising part of the program. Each patient should receive a tailored respiratory prescription to meet the patient specific needs. An exercise prescription should include an intensity, duration, frequency, type (e.g. continuous or interval), mode (e.g. walking, arm exercise), and progression. To determine what is the best exercise prescription for each COPD patient the initial results from the 6 MWT and ISWT tests will be used. The PR exercise component will include: upper limb endurance training, which can be done by using unsupported arm exercises with or without added weight, lower limb endurance training by using a treadmill or stationary bicycle, and upper and lower strength training which is done by using weights and resistance machines. While the patients are performing the physical exercises, the physiotherapist will be closely monitoring the patients’ heart rate and oxygen saturation by using a pulse oximeter, as well as measure the blood pressure using sphygmomanometers and stethoscopes each time the patients finish an exercise. Finally, at the end of the exercise sessions the patients will be given a home exercise prescription as maintenance measures to help the patient to keep physical fitness. Patient who are referred to the PR nutritionist will receive advice on how to mange their obesity of they are over weight or how to support their body nutrition if they are under weight by formulating tailored diets to meet each patient specific needs. The nutritionist will also continue to monitor the patients’ progress every week. On the other hand, the patients suffering from signs of depression and anxiety they will receive professional advice from the PR psychologist on how to cope with the disease condition and help them to eliminate any fears or concerns they might have. Furthermore, a smoking cessation program will be provided to patients who smoke in an effort to help them quit smoking. In the smoking cessation program, a nursing practitioner will review the medical files of patients with a smoking history and inform the patient that the PR program is offering a smoking cessation program that can help them to quit. The nurse will educate patients on the impact of smoking on their. Then she or he will motivate the patient to try to quit smoking. If the patient displays an interest in quitting smoking, the nurse will develop a quit plan that has coping strategies e.g. if the patient feel the urge to smoke they can replace that using a cigarette by drinking water or chewing a gum. The nurse also will offer assistive medication like nicotine replacement therapy (e.g. nicotine patches and nasal spray) to help the patient in the process of quitting. Afterwards, they will start a follow up plan to reassess the treatment goals and make new goals as the patient progresses. (refe manual of PR). Finally, to effectively evaluate the overall PR program, a final assessment which will have a number of similar aspects with the initial assessment will be done, evaluating the effects of the PR program on the patients’ physical performance and quality of life. Additionally, patient surveys will be conducted at the end of each PR period to evaluate the patient satisfaction rate (ref tool kit). In conclusion establishing a PR programs in Saudi will help provide new meaning in the lives of patients with COPD by improving their physical performance and the quality of life outcomes. Therefore, many public and private hospitals in Saudi should invest in establishing PR programs, as the program portrays great benefits in reducing the health care costs through stabilizing the systemic manifestations of the disease. (manul of respiratory care au.). Read More