title: Does delivery of a training program for healthcare professionals increase access to pulmonary rehabilitation and improve outcomes for people with chronic lung disease in rural and remote Australia?
abstract: OBJECTIVE
  Access to pulmonary rehabilitation (PR), an effective management strategy for people with chronic respiratory disease, is often limited particularly in rural and remote regions. Difficulties with establishment and maintenance of PR have been reported. Reasons may include a lack of adequately trained staff. There have been no published reports evaluating the impact of training programs on PR provision. The aim of this project was to evaluate the impact of an interactive training and support program for healthcare professionals (the Breathe Easy, Walk Easy (BEWE) program) on the delivery of PR in rural and remote regions.
  
  
  METHODS
  The study was a quasi-experimental before-after design. Data were collected regarding the provision of PR services before and after delivery of the BEWE program and patient outcomes before and after PR.
  
  
  RESULTS
  The BEWE program was delivered in one rural and one remote region. Neither region had active PR before the BEWE program delivery. At 12-month follow-up, three locally-run PR programs had been established. Audit and patient outcomes indicated that the PR programs established broadly met Australian practice recommendations and were being delivered effectively. In both regions PR was established with strong healthcare organisational support but without significant external funding, relying instead on the diversion of internal funding and/or in-kind support.
  
  
  CONCLUSIONS
  The BEWE program enabled the successful establishment of PR and improved patient outcomes in rural and remote regions. However, given the funding models used, the sustainability of these programs in the long term is unknown. Further research into the factors contributing to the ability of rural and remote sites to provide ongoing delivery of PR is required.
authors.affiliation: Discipline of Physiotherapy, School of Health Sciences, The University of Newcastle, Callaghan, NSW 2308, Australia.
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Johnston
authors.affiliation: School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, North Sydney, NSW 2060, Australia. Email:
authors.forename: Lyndal J
authors.initials: LJ
authors.lastname: Maxwell
authors.affiliation: Baker IDI Central Australia, Alice Springs, NT 0871, Australia. Email:
authors.forename: Graeme P
authors.initials: GP
authors.lastname: Maguire
authors.affiliation: Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW 2141, Australia. Email:
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Alison
mesh_terms: D002908:Chronic Disease; D006282:Health Personnel / Q000193:education*; D006297:Health Services Accessibility; D006801:Humans; D008171:Lung Diseases / Q000534:rehabilitation*; D009517:New South Wales; D017063:Outcome Assessment, Health Care; D012047:Rehabilitation Centers; D019035:Rural Health Services