RESUMO
BACKGROUND: The mechanical insufflator-exsufflator (MIE) is effective in assisting cough and in helping to avoid unplanned hospitalizations, tracheostomy and long-term ventilation in patients with neuromuscular disease or spinal cord injury. Despite this, the availability and usage of the device in Canada is unknown. OBJECTIVE: To investigate practice patterns and availability of the MIE in Ontario hospitals. METHODS: A cross-sectional, self-administered mail survey was sent to a random sample of 400 respiratory therapists practicing in 96 Ontario hospitals. RESULTS: A total of 114 (28%) completed surveys were returned from 62 (65%) hospitals. Twenty (32%) hospitals had a MIE. The respiratory therapist was the predominant health care provider using the MIE. The device was most commonly used in the intensive care unit, and medical/surgical units in patients with neuromuscular diseases or spinal cord injuries. Optimal pressure spans of 35 cmH2O to 40 cmH2O were used by 54% of respondents. Fourteen of the 20 hospitals with an MIE had policies or guidelines in place, and four of these hospitals had established staff competencies. Measurements of peak cough flow, maximal inspiratory/expiratory pressure and vital capacity were reported to be infrequently performed. CONCLUSIONS: The present study demonstrated that the MIE device is not widely available in Ontario hospitals and there are variations in how the devices are applied, possibly resulting in suboptimal therapy. A comprehensive educational program about MIE devices that incorporates best practices and a practical component is recommended for current providers as well as for inclusion in student curricula.
HISTORIQUE: L'insufflateur-exsufflateur mécanique (IEM) est efficace pour soulager la toux et éviter des hospitalisations non planifiées, des trachéotomies et une ventilation prolongée chez des patients ayant une maladie neuromusculaire ou un traumatisme médullaire. Pourtant, on ne sait pas quel est l'accès à l'IEM et quelle en est l'utilisation au Canada. OBJECTIF: Examiner les modes de pratique et l'accès à l'IEM dans les hôpitaux ontariens. MÉTHODOLOGIE: Un sondage transversal autoadministré a été posté à un échantillon aléatoire de 400 inhalothérapeutes qui exerçaient dans 96 hôpitaux ontariens. RÉSULTATS: Au total, 62 hôpitaux (65 %) ont remis 114 sondages remplis (28 %). Vingt hôpitaux (32 %) avaient un IEM. L'inhalothérapeute était le principal dispensateur de soins à l'utiliser. L'appareil était surtout utilisé à l'unité de soins intensifs, et aux unités médicales et chirurgicales auprès de patients ayant une maladie neuromusculaire ou un traumatisme médullaire. De plus, 54 % des répondants utilisaient des intervalles de pression optimaux de 35 cm d'eau à 40 cm d'eau. Quatorze des 20 hôpitaux ayant un IEM s'étaient dotés de politiques ou de lignes directrices, et quatre avaient établi des compétences pour le personnel. Le débit de toux de pointe, la pression inspiratoire ou expiratoire maximale et la capacité vitale étaient peu mesurés. CONCLUSIONS: La présente étude démontre que l'accès à l'IEM n'est pas généralisé dans les hôpitaux ontariens et que l'utilisation de cet appareil varie, ce qui s'associe peut-être à un traitement sous-optimal. Il est recommandé de préparer un programme de formation complet sur les IEM, qui allierait les pratiques exemplaires et un volet pratique, qui serait offert aux dispensateurs en exercice et qui serait intégré au cursus d'étude.
RESUMO
BACKGROUND: Pulmonary rehabilitation (PR) is a comprehensive intervention of exercise training, education, and behaviour change to improve the physical and psychological condition of people with chronic respiratory disorders, such as chronic obstructive pulmonary disease (COPD) and to promote long-term adherence to health-enhancing behaviours. Although PR is considered the standard of care for patients with COPD who remain symptomatic despite bronchodilator therapies, current evidence suggests that only 1.15% of COPD patients across Canada have access to PR facilities for care. OBJECTIVES: The objectives of this study were to identify the number of health care facilities across Ontario providing PR services for patients with COPD, describe the scope of those services, and determine the province's current capacity to provide PR services relative to need, for the province as a whole and by local health integration network (LHIN). METHODS: The Pulmonary Rehabilitation Programs in Ontario (PRO) Survey was a province-wide, descriptive, cross-sectional survey of health care facilities (hospitals, family health teams, and community health centres). It was distributed to 409 facilities to collect information on various aspects of PR services in the province. RESULTS: Between April 2013 and February 2014, 187 facilities responded to the survey (46% response rate). Most responding centres (144) did not offer PR services, and only 43 were full PR sites providing a comprehensive program. Hospital-based programs made up the majority of sites offering full PR services (67%), followed by programs based at family health teams (19%) and community health centres (14%). More than 90% of PR programs are outpatient-based. The average wait time for outpatient PR was 6.9 weeks, and 58% of programs provide services 5 days per week. More than 80% of patients attending PR complete the full program. Across all program types, the total estimated provincial capacity for PR outpatient care is 4,524 patients per year, or 0.66% to 1.78% of patients with COPD, depending on the estimated prevalence of disease. LIMITATIONS: These results are representative of 12 of the 14 LHINs in Ontario due to low response rates in facilities in 2 LHINs. CONCLUSIONS: Although some increase in capacity has occurred since a similar survey in 2005, PR resources in Ontario are insufficient to support the delivery of care to people with COPD in accordance with clinical practice guideline recommendations.