December 27, 2021
TOPIC: Respiratory Care
TYPE: Original Investigations
PURPOSE: To understand the percentage of patients at an initial home evaluation who only have a SABA Rx, and who later receive long acting bronchodilators/ICS to meet GOLD Medication guidelines.
METHODS: General: 9,091 home based COPD patients were managed over the course of their disease from January 2018 to May 2021 using a goal based, assessment driven COPD Software [Nexus, Encore Healthcare, Livingston TN], administered by a respiratory therapist via in home or telemed visits. The patients accessed the program as part of a prescription for Non Invasive Ventilation from their HME provider. The program deploys objective & subjective assessments to populate an individualized plan of care with a risk/acuity based schedule of visits and goals. The 9,091 patients have received over 278,000 assessments and analytics from the database have processed over 10 million datapoints.
Detailed: On the initial home respiratory therapist visit, patients on home (NIV) ventilation were assessed both their hospitalization history and Dyspnea (CAT and/or mMRC) to determine the GOLD Grouping. The RT then assessed the prescribed respiratory medications (class, name, brand). Additionally they provided training and education on delivery skills and general understanding of the drug's purpose. Points for Rx/Group, delivery skills and understanding were all summed into a Medication Best Practices score.
RESULTS: In a population of severe, stage 3 & 4, group B, C, D patients, 23% of patients had a Rx for only a SABA, without a prescription for some type of preventative/longer acting medication. The RT was able to identify these patients to the physician resulting in the additon of a long acting RX to 41% of the SABA only group. The RT was able to help the patient avoid overuse of SABA meds, and train on proper delivery techniques while helping patients understand each drug's purpose and how often to use.
CONCLUSIONS: Home based COPD management programs led by respiratory therapists using a protocol based software with plan of care goals, can alert physicians and assist patients to meet GOLD Medication Guidelines per their GOLD Grouping. For patients with 2 or more exacerbations per year and/or CAT score >=10, GOLD guidelines recommend long acting therapies.
CLINICAL IMPLICATIONS: Understanding prior hospitalizations, current risk factors, and selecting HME providers with post discharge and home based care management programs can support physician and patient outcomes. This demonstrates the opportunity for greater collaboration between physicians, discharge programs and Home Medical Equipment providers to significantly improve COPD management.
DISCLOSURES: Owner/Founder relationship with Encore Healthcare, LLC
Please note: 1/1/2016 - 4/30/2021 Added 04/29/2021 by Zach Gantt, source=Web Response, value=Salary
No relevant relationships by Frederic Seifer, source=Web Response
© 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.