Implementation of digitally-supported self-management and pulmonary rehabilitation in people with chronic respiratory disease

Intervention: The Perx-R digital platform is a cutting-edge digital therapeutic platform designed to enhance self-management (Perx-R self-management program) or support pulmonary rehabilitation (Perx-R Rehab program) through a mobile application. Participants will have access to Perx R for 6 months. During this period, they may use the app to support their usual self management at home (Perx-R self-management) or to participate in an app based pulmonary rehabilitation program delivered at home or in a hybrid model alongside centre based PR. Participants with chronic respiratory diseases will either self onboard to the Perx R app or be assisted by clinicians during setup. Both Perx R program’s (Perx-R self-management and Perx-R Rehab) provide a personalised schedule (tasks) to support chronic respiratory disease self management, including medication reminders, self management education, including airway clearance techniques, health goals, remote monitoring, and health surveys. For patients using the Perx R Rehab program as part of a pulmonary rehabilitation program, an exercise program, prescribed by the physiotherapist based on the initial assessment will also be added as a “task” to the Perx-R program. Exercise prescriptions will be tailored to each individual based on their initial assessment and will include endurance and resistance training, adjusted to the patient’s baseline capacity and goals. The physiotherapist at the participating site will provide weekly reviews, conducted either in person or via telehealth. These reviews will include discussion of the patient’s symptoms during the previous week, their use of the Perx R app, and their adherence to the prescribed exercise program and discussion regardinf progression of exercises. . The pulmonary rehabilitation physiotherapist will monitor patient progress through a dedicated clinical care portal. Adherence to the Perx-R program tasks in both the Perx-R self-management and Perx-R Rehab programs will be monitored through the Perx data analytics team. There will be two phase to this study: Phase 1: Engagement with clinicians. · Education: Multi-disciplinary clinicians (e.g, medical, nursing, allied health, will receive education about the Perx-R platform. The education will be delivered by a study investigator during a 30-45 min face-to-face presentation with the opportunity for attendee’s to ask questions. · Focus groups and Interviews: Following the education sessions, any clinician who attended will be invited to take part in a focus groups and/or semi-structured interview. Focus groups and Interviews will take place within 30 days of the initial education session and will be structured to discuss their perceptions of the Perx-R program and identify barriers and facilitators to implementing Perx-R in real-world clinical practice. Phase 2 – Implementation • Strategy development: Implementation strategies to support use of Perx-R in clinical settings (e.g., resources, training and clinical champions) will be developed based on Phase 1 findings and provided to clinicians. Prior to commencing intervention delivery, clinicians will receive training on the use of Perx-R. During the training clinicians will be provided with an introduction to Perx-R, an overview of how the Perx-R app works, a live app demonstration, and a demonstration of the Clinician Portal during a 1-hour presentation. Clinicians will be supported during implementation by a site clinical champion and provided with resources and training to support the implementation of the intervention in their clinical settings. • Implementation: Following completion of the training, clinicians will be able to offer the Perx-R self management program, to eligible patients from inpatient settings and outpatient respiratory clinics at Royal North Shore Hospital to support chronic respiratory disease self management. Eligible patients will also be offered access to the Perx-R Rehab program following a pulmonary rehabilitation assessment at the outpatient programs at Royal North Shore Hospital, Hornsby Ku-ring-gai hospital and Mona Vale Community Health Centre. Recruitment sites (e.g., inpatient settings, outpatient clinics, and pulmonary rehabilitation programs) will be activated using a stepped-wedge approach, allowing insights gained from early implementation sites to inform and improve implementation at subsequent sites.