Recent research conducted by Yale University has revealed that access to crucial pulmonary rehabilitation programs is restricted for millions of Americans suffering from chronic respiratory diseases. The study highlights the potential of telemedicine in bridging this care gap by identifying regions in need and providing solutions to improve access, as published on February 5th in JAMA Network Open.
Pulmonary rehabilitation is an essential multidisciplinary program that offers exercise regimens and strategic techniques to enhance the overall health and quality of life for patients with respiratory conditions such as chronic obstructive pulmonary disease (COPD), interstitial lung disease, or pulmonary hypertension. These programs typically include a structured exercise component supervised by nurses and/or exercise specialists and educational sessions to equip patients with techniques to manage their illnesses in daily life, such as energy conservation, supplemental oxygen therapy, and coping strategies during periods of higher energy consumption.
Evidence across the pulmonary medicine spectrum demonstrates improvements in patient health and outcomes as a result of these programs. Patients not only gain a comprehensive understanding of their condition, but also significantly enhance their endurance,“ said Dr. Peter Kahn, Fellow in Pulmonary and Critical Care Medicine at the Yale School of Medicine and lead study author.
Dr. Peter Kahn
Despite the proven importance of pulmonary rehabilitation, many people in the United States face significant challenges in accessing these programs. To investigate this issue, researchers utilized vast geographical datasets and a computer infrastructure to calculate hundreds of millions of travel times.
Technologies enabling large-scale travel time calculations are not just innovative, but transformative, providing us with nuanced insights into national datasets that were previously unavailable to researchers,“ stated Dr. Walter Mathis, lead author, psychiatrist and health researcher at the Yale School of Medicine.
Dr. Walter Mathis
The study found that while approximately 80% of Americans live within a 30-minute drive of a pulmonary rehabilitation program, over 14 million individuals—mostly residing in the western and midwestern regions of the country—must travel more than an hour to access the nearest program.
Furthermore, the research uncovered disparities in access to pulmonary rehabilitation based on race. Nearly 30% of Native American and Alaskan Native populations live over an hour away from the nearest program.
„Accessibility to programs within a reasonable travel time is crucial. Firstly, many patients with chronic respiratory diseases require supplemental oxygen. Lengthy commutes may mean they have to transport multiple oxygen tanks or battery supplies, potentially leading to patients forgoing treatment. Secondly, given that endurance intolerance is a long-term symptom of these diseases, travel can be incredibly exhausting and act as a barrier to participation,“ said Kahn.
To address the issue, Dr. Kahn suggested that telemedicine and virtual rehabilitation can, in the short term, help close this gap, though further assessment of their long-term efficacy across different diseases is needed. He emphasized the necessity of improved and accessible in-person rehabilitation opportunities to aid patients in the long run. This would require collaboration between policymakers, healthcare providers, and diverse approaches to insurance reimbursement.
„Insurers, both public and private, inadequately cover the people, equipment, and materials necessary for the effective implementation of pulmonary rehabilitation programs, hindering the provision of these programs. Equally important is the fact that insurance companies limit the number of rehabilitation sessions a patient can attend, which does not meet the long-term strain of the disease, especially for someone with a chronic respiratory condition such as advanced COPD. This needs to change,“ added Kahn.
Kahn, PA, & Mathis, WS (2024). Accessibility of Pulmonary Rehabilitation in the United States. JAMA-Network Open. doi.org/10.1001/jamanetworkopen.2023.54867.