The Science Journal of the American Association for Respiratory Care

2006 OPEN FORUM Abstracts

HOMECARE COPD PATHWAY IDENTIFIES GAPS IN PATIENT NEEDS

James Stegmaier RRT-NPS, RPFT, CCM1, Jacquelyn McClure BS, RRT2,
Gail Varcelotti BS, RRT3
1Allegiant Medical, Lorain , Ohio , 2The MED Group, Lubbock , Texas ,
3Education on the Go, Pittsburgh , Pennsylvania

Background:  Chronic Obstructive Pulmonary Disease (COPD) is the 4th leading cause of death effecting 15 million Americans per year with an annual healthcare expenditure of $15 billion. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) and National Lung Health Education Program (NLHEP) have identified and developed guidelines for diagnosis, monitoring and treatment of COPD.

Methods: A home medical equipment (HME) company based COPD pathway was administered by a respiratory therapist on order of the patient's attending physician.  The pathway was developed based on the GOLD Components of Care: a COPD Management Program. Patients were either previously diagnosed with or identified as high risk for COPD.  The pathway provided environmental and patient assessments, including screening spirometry, pulse oximetry at rest, with activities of daily living and nocturnally, knowledge of disease and current therapies prescribed by their physician and smoking cessation.  Each patient received 2 home visits approximately 2 hours in duration within a 30-day period.  Fourteen females and 11 males between the ages of 39 and 90 participated in the pathway. Five patients were on continuous oxygen prior to beginning the protocol.  Thirteen of the 25 patients were current smokers at the time of enrollment in the pathway.

Results: All data reported as Mean, unless otherwise noted.  All changes (∆) were measured during the second home visit. Nocturnal hypoxemia was identified in 55% (10 out of 18) of the patients. As a result, they were subsequently prescribed nocturnal oxygen therapy.  Two patients declined to be tested nocturnally with pulse oximetry.  Five patients (28%) were referred to a sleep center for evaluation of possible sleep disordered breathing. Nearly half (44%) could not properly administer their metered dose inhalers (MDI) and either required reinstruction and/or a spacer device for proper administration. 8 out of 13 patients (62%) failed to quit smoking during the initial 30 day monitoring period.

Age GOLD Classification ∆ Borg Scale ∆ FEV1 ∆ FVC ∆ FEV1/FVC SpO2 <88%
66.2 Stage 0: 0 Stage 1: 0 Stage 2: 17 Stage 3: 6 Stage 4: 2 ↓15% ↑4.2% ↑3.2% ↑2.1% Rest: 0 ADLs: 1 Nocturnal:10

Conclusions: An HME based COPD pathway identified a number of clinical concerns among a population of at risk patients.  Previously undiagnosed nocturnal hypoxemia and improper MDI technique were identified and the patient's treatment altered. Modest improvements in Borg scale and basic spirometry were observed in all patients, along with the initiation of nocturnal O2 therapy for 55% of the patients.  Further study of an HME-based COPD pathway in conjunction with the physician and payer including long-term outcomes measure is warranted and may prove to be a clinically and financially effective tool in the early identification and management of patients with COPD.

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