Although no specific competencies are associated with program organization, overall administrative competence is essential to a successful PR program. PR programs share essential features with variability found in available resources, program setting, structure, personnel, and age of the program. The optimal length of PR is unclear, yet longer programs have been associated with greater improvement and maintenance of benefits.2
Historically, PR has been underutilized, with barriers to enrollment including challenges to the patient's schedule, travel, transportation, parking, cost and insurance coverage, lack of endorsement by health care providers, and lack of perceived benefit. Noncompletion of PR may be due to illness, comorbidities, travel and transportation issues, lack of perceived benefits, smoking, depressive symptoms, and lack of support. Contraindications to PR include any condition that could impact safe exercise or provision of PR.10 Pulmonary rehabilitation can be provided in inpatient and outpatient settings, whereas exercise training also can be provided in the individual's home with adequate resources in place.
Health care utilization and costs are reduced after PR, including hospital admissions, hospital days, and emergency room visits.11 PR during or immediately after chronic obstructive pulmonary disease exacerbation reduces hospitalizations and possibly improves survival.12 Challenges to providing PR include regulatory coverage of services, costs, and access. Patients impacted by limited access include those who are homebound or live in rural or remote areas. Technology may offer future options for satellite or alternatives to PR.
We have developed a revised list of core competencies for PR professionals. No individual health care provider is likely to be proficient at everything on this list. In addition, smaller programs may not have the resources for competence in all areas. We propose the components in this document be used as goals for programs to strive for within the context of available resources.
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