2004 OPEN FORUM Abstracts
IMPACT OF THE RESPIRATORY CARE SPECIALIST IN DIAGNOSIS AND MANAGEMENT OF MULTIPLE RESPIRATORY CONDITIONS IN A SENIOR CENTER POPULATION
Brown RN, BSN, Jason Allen, RRT, Rose Boehm, RRT, Mary Hart
RRT , Mark Millard, MD, Don Kennerly, MD PhD Baylor
Health Care System, Dallas, Texas
Background: The Baylor Martha Foster Lung Care Center employs RN’s and RRT’s who receive special training from pulmonary specialists and provide much of the direct care for patients with various pulmonary conditions using flexible protocols. Effectiveness of these respiratory care specialists (RCS) has been previously shown for asthma in a primary care Internal Medicine office in a cost-neutral to income enhancing basis. Objective: To evaluate the effectiveness of these RCS’s caring for patients with multiple respiratory conditions managed at outpatient senior care clinics.
Methods: 148 adult patients with asthma, COPD, unexplained dyspnea, or nicotine dependency were referred for RCS-augmented care at three local senior centers’ primary care practices. This supplementary service includes evaluation, treatment recommendations to the primary care provider (PCP) based on the GOLD and NAEPP guidelines, and patient education. Diagnostic testing included patient appropriate spirometry, pulse oximetry, 6-minute walk, and allergen skin testing. Treatment change is defined as anyone who had a change in medication, patient education, or was started on oxygen therapy.
Results: The effectiveness of this program was assessed using a pre-post design that utilized chart audit and several survey instruments for patients who received the RCS intervention. Spirometry for diagnosis and assessment of respiratory symptoms was increased from 4% prior to RCS intervention, to 100% after RCS intervention. Adherence to GOLD and NAEPP guidelines were 33% initially. There was a 48% change in diagnosis and a 76% change in treatment following RCS intervention. 74% of current smokers received smoking cessation education.14% of the assessed group was found to be hypoxic (at rest or with exertion) and of those, 86% subsequently had oxygen therapy initiated. 32% patients were referred for additional testing or to specialists. Of the patients who returned for a follow-up visit, 88% reported a reduction in symptoms. A preliminary economic analysis suggested services provided were cost-neutral as well. Both physician and patient satisfaction surveys of the RCS intervention was positive.
Conclusions: This results of this study indicate that an RCS-based augmentation of respiratory care for patients with a variety of respiratory diagnoses improve the accuracy of diagnosis and compliance with GOLD and NAEPP guidelines in an ambulatory senior care center. Significant improvements in diagnostic accuracy and guideline-based treatments, provided on a cost-neutral basis, validate the use of respiratory care specialists in the adult primary care setting.