title: Pulmonary Rehabilitation in Ontario: A Cross-Sectional Survey.
abstract: 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.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Programs for Assessment of Technology in Health (PATH) Research Institute, St. Joseph's Healthcare Hamilton and Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
authors.forename: James M
authors.initials: JM
authors.lastname: Bowen
authors.affiliation: Programs for Assessment of Technology in Health (PATH) Research Institute, St. Joseph's Healthcare Hamilton and Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Kaitryn
authors.initials: K
authors.lastname: Campbell
authors.affiliation: Programs for Assessment of Technology in Health (PATH) Research Institute, St. Joseph's Healthcare Hamilton and Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Simone
authors.initials: S
authors.lastname: Sutherland
authors.affiliation: Firestone Institute for Respiratory Health, St. Joseph's Healthcare Hamilton and McMaster University School of Nursing, Faculty of Health Sciences, Hamilton, Ontario, Canada.
authors.forename: Ann
authors.initials: A
authors.lastname: Bartlett
authors.affiliation: Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Toronto, and West Park Healthcare Centre, Toronto, Ontario, Canada.
authors.forename: Dina
authors.initials: D
authors.lastname: Brooks
authors.affiliation: Programs for Assessment of Technology in Health (PATH) Research Institute, St. Joseph's Healthcare Hamilton and Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Riaz
authors.initials: R
authors.lastname: Qureshi
authors.affiliation: Department of Medicine, Department of Physical Therapy, Faculty of Rehabilitation Medicine University of Toronto and West Park Healthcare Centre, Toronto, Ontario, Canada.
authors.forename: Roger
authors.initials: R
authors.lastname: Goldstein
authors.affiliation: Division of Respirology, Sunnybrook Health Sciences Centre, Institute for Clinical Evaluative Sciences and Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Andrea S
authors.initials: AS
authors.lastname: Gershon
authors.affiliation: St. Joseph's Hospital, Thunder Bay, Ontario, Canada.
authors.forename: Shelley
authors.initials: S
authors.lastname: Prevost
authors.affiliation: Physiotherapy Department, Providence Care - St. Mary's of the Lake Hospital, Kingston, Ontario, Canada.
authors.forename: Lorelei
authors.initials: L
authors.lastname: Samis
authors.affiliation: Family Physician Airways Group of Canada and Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Alan G
authors.initials: AG
authors.lastname: Kaplan
authors.affiliation: Programs for Assessment of Technology in Health (PATH) Research Institute, St. Joseph's Healthcare Hamilton and Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Robert B
authors.initials: RB
authors.lastname: Hopkins
authors.affiliation: Programs for Assessment of Technology in Health (PATH) Research Institute, St. Joseph's Healthcare Hamilton and Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Craig
authors.initials: C
authors.lastname: MacDougald
authors.affiliation: Programs for Assessment of Technology in Health (PATH) Research Institute, St. Joseph's Healthcare Hamilton and Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Erica
authors.initials: E
authors.lastname: Nunes
authors.affiliation: Programs for Assessment of Technology in Health (PATH) Research Institute, St. Joseph's Healthcare Hamilton and Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Daria J
authors.initials: DJ
authors.lastname: O'Reilly
authors.affiliation: Programs for Assessment of Technology in Health (PATH) Research Institute, St. Joseph's Healthcare Hamilton and Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Ron
authors.initials: R
authors.lastname: Goeree
mesh_terms: D000553:Ambulatory Care; D003430:Cross-Sectional Studies; D019538:Health Care Surveys; D006296:Health Services; D006297:Health Services Accessibility; D006801:Humans; D009864:Ontario; D029424:Pulmonary Disease, Chronic Obstructive / Q000534:rehabilitation*