If there was an option between attending a group class that was one or two blocks away from your home versus a class that requires you to get dressed, get into your car, maybe make a stop to fill up your empty petrol tank and then try to find parking in a busy hospital carpark, there is no doubt that the latter option will be less popular amongst all individuals alike. There is strong evidence supporting the benefits of rehabilitation programs worldwide such as pulmonary rehabilitation, however it is estimated that <5% of eligible people actually receive any form of treatment (Cox, Oliveira, Lahham & Holland, 2017). This low rate of delivery is partly due to limited availability and access to rehabilitation services (Cox et al., 2017). In addition to patient specific barriers, there are also barriers to access within the systems level as well; with lack of access to environmental and physical resources to run these programs, reduced availability of qualified staff, and reduced advocacy for exercise rehabilitation, with these factors being exacerbated in rural settings (Johnston, Maxwell & Alison, 2015).
Suggested facilitators include providing education and training to all healthcare professionals that are experts in the particular field e.g. Cardiovascular disease. This will help to increase confidence when advocating to patients regarding the benefits of rehabilitation whether you are a physiotherapist, a speech pathologist, a doctor, or a nurse. Interdisciplinary education is an effective means of not only leading successful change (Sander et al., 2016) but engaging patients; one of the aspects of the health LEADS model. It requires health professionals from all disciplines to align with, believe in and be engaged in what they are promoting; the benefits of rehabilitation.
As access to rehabilitation is influenced by the complex interplay between individuals, the environment and social expectations, the health LEADS model identifies that it is important to use a systems thinking approach in an attempt to try and build relationships and engage with all stakeholders involved in the field of exercise rehabilitation (Health Workforce Australia, 2013). Therefore, there is a need to reach out to patients, the government health care sector, health professionals, and even the transport industry in an attempt to address all the aforementioned barriers. Focus groups should be encouraged and should call upon a randomised sample of individuals requiring rehabilitation, representatives from government bodies, and a few health care professionals. This will aim to create an alliance between all stakeholders in an attempt to create a shared vision to work towards. This will be beneficial for the government in particular as it will help re-direct the budget towards areas that are meaningful to everybody involved in the rehabilitative setting, whether it focuses on providing half price taxi vouchers to patients, providing professional development sessions for healthcare professionals, or whether they set up a second-hand equipment shop to access pulse oximeters, blood pressure cuffs and gym equipment required for rehabilitation.
Therefore the need for a focus group cannot be emphasised enough as it will no doubt provide a tangible solution (a.k.a. Redirection of funding) for such a tangible barrier!
Cox, N. S., Oliveira, C. C., Lahham, A., & Holland, A. E. (2017). Pulmonary rehabilitation referral and participation are commonly influenced by environment, knowledge, and beliefs about consequences: a systematic review using the Theoretical Domains Framework. Journal of Physiotherapy, 63(2), 84-93.
Health Workforce Australia (2013, July). Health LEADS Australia: the Australian Health Leadership Framework. Retrieved from https://www.aims.org.au/documents/item/352
Johnston, C. L., Maxwell, L. J., & Alison, J. A. (2015). Establishing and delivering pulmonary rehabilitation in rural and remote settings: The opinions, attitudes and concerns of health care professionals. Australian Journal of Rural Health.
Sander, O., Schmidt, R., Rehkämper, G., Lögters, T., Zilkens, C., & Schneider, M. (2016). Interprofessional education as part of becoming a doctor or physiotherapist in a competency-based curriculum. GMS journal for medical education, 33(2).