Assessing the first pulmonary rehabilitation programme in primary care in Greece: A FRESH AIR implementation science study

Introduction: Pulmonary rehabilitation (PR) is an evidence-based, low-cost, non-medical treatment approach for patients with chronic respiratory diseases. Greece has been struggling from consecutive economic recessions which have particularly affected health and care for respiratory patients. This study aimed to establish and assess feasibility, acceptability and impact of a PR programme on health and quality of life of respiratory patients, for the first time in primary care in Greece and, specifically, in a low-resource rural setting. Method: This was an implementation study with before-after outcome evaluation and qualitative patient and stakeholders' interviews. In a rural healthcare centre of Crete, Greece, patients with COPD and/or chronic asthma were recruited. PR intervention comprised of 6 weeks of exercise and education sessions, supervised by a multidisciplinary health team. Patient outcomes (Clinical COPD Questionnaire (CCQ), COPD Assessment Test (CAT), St. George's Respiratory Questionnaire (SGRQ), Patient Health Questionnaire-9 (PHQ-9), Incremental Shuttle Walking Test (ISWT)) were analysed descriptively. Qualitative outcomes (feasibility, acceptability) were analysed using thematic content analysis. Results: Overall, 40 patients initiated (24 with COPD and 16 with asthma) and 31 completed PR (19 with COPD and 12 with asthma). Clinically important improvements in all outcomes were documented [mean (95% CI) differences for CCQ: -0.53 (-0.81, -0.24), CAT: -5.93 (-8.27, -3.60), SGRQ: -23.00 (-29.42, -16.58), PHQ-9: -1.10 (-2.32, 0.12), ISWT: 87.39 (59.37, 115.40)]. The direct PR benefits in patients’ physical as well as psychological health, along with the necessity of implementing similar initiatives in remote areas were highlighted by both patients and stakeholders during the qualitative evaluation. Discussion: This study provided evidence about the multiple impacts of a PR programme, indicating that it could be both feasible and acceptable in low-resource, primary care settings of Greece. Disclaimer: This abstract has been partially presented in other IPCRG conference and its full study has been published here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6864042/