An evaluation of patient outcomes from an innovative clinic delivering care in bronchiectasis in a regional centre

The interdisciplinary clinic intervention: The interdisciplinary clinic includes appointments with a respiratory nurse practitioner and a physiotherapist with expertise in respiratory disease. The clinic offers appointments for initial assessment (new clinic patients), three and 12 month reviews in the first year, with additional appointments if clinically indicated (patients with recurrent infection or requiring additional education in self-management techniques). A new clinic appointment is 60 minutes and a review clinic appointment 45 minutes in length. The study duration will be 14 months to allow for the collection of data after the 12 month clinic review appointment, and to account for a participant having an exacerbation, which will delay data collection until they are well. Patients will receive a follow up telephone call two weeks after the initial assessment from the physiotherapist to answer any questions from the bronchiectasis action plan developed. Patients will also be encouraged to contact the work telephone number of the physiotherapist if they have further questions prior to the scheduled three month review appointment. The targeted evidence-based interventions of the clinic will depend on patient need and will include any of the following: a medication action plan, an airway clearance plan, referral to pulmonary rehabilitation or home exercise prescription, physical activity (PA) and sedentary behaviour (SB) advice according to the Australian PA guidelines, and education relating to smoking cessation, avoidance of environmental airborne pollutants, hydration, the management of co morbidities such as sinusitis, and musculoskeletal pain and strategies for breathlessness and infection control. The medication action plan will be commenced by the respiratory physician prior to referral to the clinic, and then completed by the respiratory nurse practitioner at the clinic, along with education on medication timing and technique. The airway clearance therapy plan will be developed by a physiotherapist with expertise in respiratory disease and will involve the use of a range of possible techniques including the active cycle of breathing technique, positive expiratory pressure (PEP) devices (oscillating and non-oscillating), patient positioning, forced expiratory technique (FET), percussion/vibrations and inhalation therapies. Education on hydration will involve targeting the colour of urine to achieve optimal hydration of secretions to improve airway clearance. Sinusitis management will assess the need for sinus wash out and/or ongoing medications to minimize the effect of sinus discharge into the respiratory tract. Musculoskeletal pain will be evaluated for its role in affecting cough and airway clearance therapy effectiveness. Pain profiles will influence the components/techniques used in the airway clearance therapy plan. If breathlessness at rest or during activity is a feature of the presentation, specific advice on activity pacing, positioning, relaxed breathing techniques and fan therapy will be tailored to the individual. All patients will be given infection control advice relating to general respiratory hygiene and the cleaning of any airway clearance equipment or nebulisers used to minimize the potential for recurrent infection. The medication action plan will be combined with the airway clearance therapy plan to form an individualized bronchiectasis action plan that has strategies suggested for when the patient is well and unwell.