Adherence to pulmonary rehabilitation during a 12-month period 95 Implications The current study demonstrates that adherence to pulmonary rehabilitation remained constant during 12 months of prolonged pulmonary rehabilitation in patients with COPD. This means that people in this target group, who are nonadherent remained so without intervention, as did patients who are adherent. This finding has important clinical implications and indicates that target services can be delivered and that universal services are not always necessary, leading to differing levels of reduced health service utilization and possibly more affordable health care [11]. A significant proportion of the unnecessary health care utilization costs and poor health outcomes associated with the treatment of chronic diseases result, in large part, from the failure of patients to effectively self-manage their condition in response to recommended medical therapy [8]. Since exercise adherence of COPD patients with prolonged pulmonary rehabilitation was constant over 12 months, counselling can possibly focus on patients who need it the most, the ones who are non-adherent. Patients who are adherent require less counselling; their selfmanagement ensures stable health outcomes. Both healthcare providers and patients gain substantial benefits; less time and costs spent and placing the patients central to address their needs leading to improved health behaviors, health outcomes, and quality of life. According to the results of this study, improvements in adherence (RAdMAT-NL scores) should coincide with subsequent improvements in health outcomes (6MWD and HRQL). Conclusions Adherence is constant over a period of 12 months in patients with COPD receiving prolonged pulmonary rehabilitation in a primary physiotherapy practice in The Netherlands and Belgium. Also, the health outcomes 6MWD and HRQL were constant in this same period. By determining whether someone is adherent or nonadherent, care may be better tailored over 12 months. Follow-up research on adherence and/or health outcomes in patients with COPD can also take advantage of the fact that the course of adherence is constant over 12 months in this target group. References 1. Jakab, M., J. Farrington, L. Borgermans, and F. Mantingh, Health system respond to noncommunicable diseases: time for ambition. 2018, Denmark: WHO Regional Office for Europe. 2. Winkelmann, J., G.A. Williams, M. Rijken, K., Polin, and C.B. Maier, Chronic conditions and multimorbidity: skill-mix innovations for enhanced quality and coordination of care, in Skill-mix Innovation, Effectiveness and Implementation:
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