MediServe Blog » Respiratory

Care Empowerment!

vgravley — Thu, 05 Apr 2012 15:41:32 +0000

Knowledge is power! Education is empowerment! Empowering the COPD patient to self-manage their disease is imperative to improved wellness, decreased readmissions and realized cost savings. The respiratory therapist in the STACH is uniquely positioned to empower their patients through disease education and management strategy. These efforts need to be resourced with a view that extends beyond the patient hospital stay. A working understanding of the patient’s routine activities of daily living, their home environment, drug availability and care assets along with self-management training and skills, once assessed, should be incorporated into a personalized intervention strategy and action plan. Regular patient follow-up which references the personalized plan is also essential. And finally, with each return hospital visit the strategy and plan are reviewed and tweaked. The success of our efforts will be realized by our patient’s capacity to self-manage their own health and wellness and the fact that we see them so infrequently.

Habits Begin at Home

vgravley — Thu, 29 Mar 2012 15:27:38 +0000

While catching up on my reading, I came across an excellent study titled “Effects of 2 Exercise Training Programs on Physical Activity in Daily Life in Patients With COPD” (Respiratory Care, November 2011 / Volume 56 / Number 11). The study set out to ascertain whether high intensity versus low intensity exercise for pulmonary rehabilitation had more of an effect on “the level of physical activity in daily life” in COPD patients. The study concluded that, while patients in both groups “report improvements in their self-perceived efficiency on performing their daily tasks”, at the end of the program (twice a week for 12 weeks) there was no effect on the “the level of physical activity in daily life;” none, zip, nada! May I observe: ‘A program does not a habit make.’ Habits begin at home. Habits are hard to break. And COPD patients, like all of us, are creatures of habit. I believe this highlights the comprehensive, even organic approach that must be undertaken to achieve a return to wellness. Pulmonary rehabilitation must, at some point, move beyond outpatient programs to in-home cooperatives between patient and clinician designed to break old habits and make new ones. Only then will any impact be made in “daily life.”

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The Human Touch

vgravley — Mon, 19 Mar 2012 15:25:28 +0000

In his mobile heath predictions for 2012, Travis Good, M.D., makes this statement; “I think human touch points, especially when it comes to health, are imperative.”

I believe the good doctor has put his finger on one of the key frustrations of healthcare providers today. Dr. Good further clarifies, “Just providing technology, without connected services and non-virtual contact, is not a viable solution for healthcare.”

Healing and wellness will only be realized through the human touch. It demands real face-to-face interaction between members of the healthcare team and most importantly with their patients. Health information technology can and does support clinical decision making and care service coordination, and holds much promise for improving our healthcare system.

But in the final analysis, meaningful use is a function of the competence, compassion and caring of the warm-blooded men and women of healthcare. To borrow a phrase; technology was made for man, not man for technology.

Learn about the solutions MediServe provides to help your respiratory organization

Retooling Pulmonary Rehabilitation

vgravley — Fri, 09 Mar 2012 16:34:52 +0000

Fostering wellness with the end goal of reducing costs requires that meaningful care must be provided outside of the Short Term Acute-care Hospital (STACH). Goals of therapy need to go beyond remedy of symptoms to rehabilitation of underlying disease states. For the COPD patient and others with persistent lung conditions, pulmonary rehabilitation programs are key to meeting these goals. On their website, the AARC reports the release of a Pulmonary Rehabilitation Tool Kit will happen in spring 2012. It is designed to “serve as a resource and educational document for hospitals to use to accurately report their charges to Medicare for services furnished as part of a hospital outpatient pulmonary rehabilitation (PR) program.” Despite the recent reimbursement reduction as of January 2012 by the CMS, we must find ways and means to support outpatient pulmonary rehabilitation. The burden falls to us who are responsible for respiratory care to cast the vision. We must convince key decision makers of the short and long-term care and cost benefits of retooling for pulmonary rehabilitation.

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Metamorphosis

vgravley — Thu, 16 Feb 2012 15:14:41 +0000

Holding patient’s more accountable for their own health. How do we, as respiratory therapists, motivate our patients to put into action the lifestyle changes needed to maintain and improve their own health? A radical new vision of our profession is required. Moving beyond the traditional role of “therapist” we must recast ourselves as agents of health and change. As partners and allies with our patients, we must not just help them breath, but also learn how to inspire them to embrace their own wellbeing. This metamorphosis requires at least the following:
Time. The investment of time with our patients conveys caring and wins confidence. In today’s health care arena, time is measured in dollars. This will change. Time will be valued not in dollars but by the measure of wellness achieved by time spent.
Heart. Care and Courage! We must care for the whole person; those factors in their lives that impact personal wellness. Also, the courage to enter their journey toward personal wellness as part of the health care team.
Intelligence. Not just clinical expertise but social and emotional intelligence; that intuitive interpersonal quality that fosters understanding, patience, encouragement and cooperation.
Before we can motivate our patients we must first reshape ourselves as agents of health and change. Once we embrace our own need to change then we will be better prepared to assist our patients to take the steps they need. More on that next time.

ACO: Accountable Care Obligations (part 2)

vgravley — Tue, 24 Jan 2012 17:44:40 +0000

Here are a couple of definitions from Webster’s Online Dictionary:

Accountable 1: subject to giving an account : ANSWERABLE 2 : capable of being accounted for : EXPLAINABLE

Responsible 1a : liable to be called on to answer b (1) : liable to be called to account as the primary cause, motive or agent

With the advent of Accountable Care Organizations there will be an unfolding interplay between the accountable and the responsible. In the ACO model those accountable for the dollars spent or saved on health care will also be those responsible for care and health delivered. This is a good development and very well may reduce the cost of health care. I quipped in my last post that the next chapter in accountable care will be entitled “Patient, Heal Thyself!” As the story unfolds we will begin seeing providers, who are accountable to the government, in turn holding their patient’s more accountable for their own health, complete with rewards and penalties. At some point the onus for health and wellbeing must be obligatory for the individual. I conclude with a quote from Edmund Burke; “Society cannot exist unless a controlling power upon will and appetite be placed somewhere, and the less of it there is within, the more there is without.”

Accountable Care (Part 1)

vgravley — Wed, 04 Jan 2012 16:30:02 +0000

Hello 2012! Welcome ACOs! As part of the Affordable Care Act, Accountable Care Organizations are set to begin springing up by Spring of this year. As I read it, the desired end of the story is pretty much the same as it has been: “and the cost of healthcare decreased and they all lived happily ever after!” In the previous version of the story this was the end that the Health Maintenance Organization (HMO) and other managed care organizations was to have achieved. Alas, the sick remained sick and the cost of healthcare only went up. So what if the burden is shifted from those paying for healthcare (the HMO) to those providing healthcare: doctors, hospitals, home health companies etc., and incentivize quality care as well as cost savings. What if wellness saves money? Enter the ACO, an organization consisting of all the necessary pieces and parts of the healthcare continuum with a single goal: Improve and/or maintain the wellness of our patients with the minimum required expenditure to do so. Hmmm…this just may achieve the long awaited epilogue. Still, it may open a whole new chapter entitled “Patient, Heal Thyself!” There’s more on the topic in Accountable Care (Part 2).

So Long Epinephrine Inhaler!

vgravley — Fri, 23 Dec 2011 16:34:56 +0000

Farewell 2011. So long Primatene® Mist! As of Dec. 31, the FDA has banned this over-the-counter epinephrine inhaler used by so many to treat asthma. I remember watching the TV ads as a young boy, so this stuff has been around a long time. Hitting the market in 1963, in many ways it was a pioneer in the treatment of patients with bronchospasm and a predecessor of the modern day metered dose inhaler. It was portable, accessible, affordable and easy to use. Many of my patients have pulled it from their purses and pockets over the years. Now, due to its use of CFC’s, it has gone the way of many other medical dinosaurs and will soon be a fossil in annals of medical history. Many will say; “good riddance” and rightly so. There is such a variety of better pharmaceuticals for the treatment of asthma today. I daresay many, however, who relied on this “old clunker”, and who could not easily afford the more racy alternatives, will mourn its passing. As respiratory therapist we must be ready to help our Primatene® patient’s make this transition by instructing them in the use of better treatment regimens and advocating on their behalf for affordable access to the medicines they need. Happy New Year to all! Breathe easy!

Competing Trends

vgravley — Mon, 12 Dec 2011 16:09:13 +0000

Chronic obstructive pulmonary disease (COPD) is being identified as the third leading killer in the U.S. and is on the rise. Some of this increase can possibly be attributed to increased awareness and reporting, indicating the disease has been more prevalent than it appears. On the other hand, according to a Centers for Disease Control and Prevention report, cigarette smoking has declined by an estimated three million people from 2005 to 2010. Even though the CDC report laments that the trend is not extensive enough to meet stated goals, the plain fact remains that smoking is a leading indicator of future COPD statistics. While COPD will likely always be around at some level due to environmental factors, genetic predisposition and the freedom to choose, I find this to be a very encouraging juxtaposition of facts. Essentially they say; “As goes smoking, so goes COPD!” Working tirelessly behind the mathematical demographics are countless respiratory therapists and others committed to the health and well-being of the individuals and communities they serve. Rock on!

Taking the Field as Innovators

vgravley — Mon, 28 Nov 2011 16:56:43 +0000

Innovation. It is the Hallmark of respiratory care as a profession, and will continue to be our singular saving grace. In order to position ourselves for success in the new industry of wellness we must embrace change, be willing to let go of long protected turf, demonstrate our value and redefine ourselves, our work and even our profession. Because of our innate innovative approach we are well suited to the task. We must continue to dominate our own field of expertise and simultaneously take and/or break new ground. Let me just throw out some ideas within the acute care setting: COPD case management, dialysis, echocardiogram technician, IV/line technician, cardiopulmonary bypass, cardiopulmonary rehab. Some of these are really way outside of the box! Yet, as respiratory therapists we are uniquely qualified in all areas cardiopulmonary and renal. We can demonstrate our expertise and value in these areas while providing real cost savings for our respective institutions. Beyond the walls of the hospital we can position ourselves at the front line against hospital readmission by defining and implementing best practice solutions for pulmonary patient follow up, evaluation and care. More importantly through support of current legislative efforts (S 343/HR 1077 and HR 941) we must see a return of the respiratory therapist to the home care setting and expand our skills to other outpatient arenas.