Many older adults with COPD have poor access to pulmonary rehabilitation
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Two-fifths of Medicare beneficiaries with COPD in the U.S. have poor or limited access to pulmonary rehabilitation centers, according to research presented at the American Thoracic Society International Conference.
“Pulmonary rehabilitation is known to improve quality of life and decrease hospitalization rates. It’s very cost-effective, yet is underutilized not only by the patient population, but also by health care providers,” Gargya Malla, MD, MPH, PhD, postdoctoral fellow in the department of epidemiology at the University of Alabama at Birmingham, said during a presentation. “Studies have shown that adults living farther from the center are less likely to receive rehab services.”
Researchers evaluated nearly 63 million Medicare beneficiaries from the Chronic Conditions Summary and Beneficiary Summary files and identified 10,289,209 adults with COPD (mean age, 74.4 years; 55.8% women; 79.6% non-Hispanic white; 10.2% Black; 6.4% Hispanic) with Medicare coverage in 2018.
Each individual met ICD-9 and ICD-10 codes for COPD at least once from 1999 to 2018.
The researchers established that the U.S. has 1,696 pulmonary rehabilitation centers. They then matched beneficiary zip codes with the centers.
The mean distance was 12.4 miles between residents and the nearest center pulmonary rehabilitation center.
The proportion of Medicare beneficiaries with COPD who had a pulmonary rehabilitation center within 10 miles was 61.7%. Nearly 12% lived within a 10- to 15-mile radius, 13.4% within a 15- to 25-mile radius, 10.7% within a 25- to 50-mile radius and 3% more than 50 miles, according to the results.
There was one pulmonary rehabilitation center per 4,300 among the one-fourth of the beneficiaries with COPD who lived in micropolitan and/or small town/rural areas.
Mean distance to the nearest pulmonary rehabilitation center was 8.6 miles for patients living in metropolitan areas, 20 miles for those in micropolitan areas and 26.6 miles for those in small town/rural areas. Nearly 73% of patients living in metropolitan areas had access to a pulmonary rehabilitation center within 10 miles, compared with 38.2% living in micropolitan areas and 17.1% living in small town/rural areas, according to the results.
Between the residents and the closest pulmonary rehabilitation center, the mean distance was 8.6 miles in metropolitan areas, 20 miles in micropolitan areas and 26.6 miles in small town/rural areas. Compared with 38.2% of individuals in micropolitan areas and 17.1% of individuals in small town/rural areas, 72.8% of individuals living in metropolitan areas had a pulmonary rehabilitation center available within a 10-mile radius.
“This deficit is heightened in rural areas and Southern states,” Malla said. “Other cost-effective methods like tele-rehab, home-based rehab and web-based rehab should be considered.”