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How
to Match POCs to Patients' Need
Jul 01, 2009
[Portable Oxygen Concentrators]
As providers look for ways to transition to a
non-delivery oxygen business
model, and patients demand systems that give them
more mobility, the demand for portable concentrators
is on the rise. However, matching POCs to patient
needs is an in-depth process.
Determining needs starts with the provider assessing
the activity level and
lifestyle of the patient. That will determine how
much oxygen the patient is
going to need during his or her long-term oxygen
therapy. Moreover, the
oxygen patient is going to be using their oxygen
equipment at a variety of
settings each day.
There are basically four realms of oxygen use: at
home, exercising, while
sleeping and at altitude. The majority of the day
might be spent at home
either sedentary or doing light house keeping, which
would require one
setting. Or there patients will be engaged in
exercise, and will thusly have
higher oxygen needs. The third type of need is
during sleep, when each
patient's respiratory patterns change. Lastly,
whether or not the patient
travels to altitude, as that will affect their
oxygen needs, too.
Keeping these different types of use in mind, what
are the various factors
providers should consider when trying to match POCs
to their patients'
needs?
What are the patient's respiratory mechanics?
From the clinical side, providers must be more
mindful of patients'
respiratory mechanics. Specifically, how long it
takes a patient to inhale.
With a pulse dose setting, the device will be
introducing the oxygen bolus,
or volume, during the initial part of their
inhalation, which might last a
fraction of a section. How quickly that bolus is
delivered is important. For
example, for some patients, a bolus of 20 ml
delivered at 400 milliseconds
might not be quick enough; the bolus might have to
be delivered in 300
milliseconds.
This is determined via oximetry, but the RT also has
to know what the bolus
delivery times are for each unit in order to dose it
to the patient's
respiratory mechanics. This means providers and RTs
must coordinate even
more closely as oxygen dosing grows all the more
sophisticated.
What is the patient's liter flow?
There are some POC systems on the market now that
can deliver up to three liters of continuous flow.
Will the patient need something that robust, or does
he or she require a smaller liter flow. Find out
factors such as the
patient's flow when they at when resting, exercising
and sleeping when in
continuous flow. If they are in pulse setting, what
is their setting for
resting and exercise?
How severe is the patient's disease state?
For instance the patient might be on two liters
right now but his or her
disease state is quickly progressing, and the
patient might have to move to
four or five liters in the next six months.
Obviously, the provider wouldn't
want to put that patient on a POC instead of a
device that will be able to
scale to their future needs.
Does the patient travel? Patients that travel,
especial "snowbirds" who
regularly engage in seasonal travel to sunnier
climates in order to escape
winter cold, must be supported by the HME provider,
according to Medicare
guidelines, regardless of whether that patient
travels far from the
provider's usual service area. Needless to say, a
POC would be ideal for
such a patient, and the provider, too. They can
simply get on a plane and go
(assuming the device is approved by the airline, of
course).
Can the patient sustain on a POC?
Some POCs on the market are pulse only, which might
not be enough for some patients. So determine
whether or not the patient needs a continuous flow
device. Oximetries need to be performed on the
patient both while they are resting and while
exercising.
Can they walk or exercise on a pulse setting?
A lot of patients are enamored with the pulse only
POCs, because they come in such a small form factor.
The device might perform well while they are sitting
at home, but the minute they get up and start
exercising and their respiratory rate gets above 15
to 25 breaths per minute, those devices have to
start cutting their bolus size and thusly the device
is not delivering
the same amount of oxygen as during a resting
respiratory rate. Therefore,
the patient's saturation decreases when he or she
needs the oxygen the most.
Are they in a pulmonary rehab program?
This is an important question to ask because the
provider will want patients
exercising with the device that has been put on
them. Often patients will go
to a pulmonary rehab program and are instructed to
stow their POC and are
given a separate device provided by the program. So,
patients exercise on a different device that
provides a different amount of oxygen. The patient
must exercise on their device instead.
Can they lift the POC?
With higher, continuous flow POCs, the devices are a
little heavier,
weighing in the 16- to 22-pound range, roughly. In
order to use the device,
the patient needs to be able to lift that kind of
weight at least two feet
of the ground so that he or she can get the POC into
and out of the car.
Points to take away:
o The demand for POCs will increase as patients want
them for more
mobility and providers need them to transition to
non-delivery.
o Providers must assess patients' activities levels
and lifestyles in
order to determine their needs.
o How quickly patients inhale the oxygen dose and
how big that does is are
important in determining the right POC.
o Other factors to consider include the patient's
liter flow, disease
state, travel habits, ability to lift a heavier POC
into a car, their
ability to sustain on a POC, and whether or not they
are in pulmonary rehab.
http://hme-business.com/Articles/2009/07/01/Match-POCs-to-Patients-Needs.aspx
 A
specific home care program improves the survival of
patients with chronic obstructive
pulmonary disease (COPD) receiving long term oxygen
therapy (LTOT).
April 2009
OBJECTIVES:
To analyze the influence of a home care (HC) program
on outcomes of patients with chronic obstructive
pulmonary disease (COPD) receiving long-term oxygen
therapy (LTOT) in comparison with outcomes of
patients receiving standard care (SC).
DESIGN: A 10-year follow-up study with 2 parallel
cohorts (HC vs SC).
SETTING: University hospital.
PARTICIPANTS: One hundred and eight patients in the
HC program and 109
patients managed conventionally.
INTERVENTIONS:
The HC program consisted of outpatient clinical and
functional evaluations
every 6 months, and domiciliary assessments by a
specific team including a
pneumologist, a respiratory nurse, and a
rehabilitation therapist every 2 to
3 months or more, as needed.
MAIN OUTCOME MEASURES: Mortality; exacerbation,
hospital and intensive care unit admission rate.
RESULTS:
One hundred and eight patients entered the HC
program and 109 patients were managed
conventionally. The 2 groups of patients did not
differ for age, sex, body mass index, COPD severity
or comorbid conditions. The overall mortality during
the follow-up was 63% and the median survival was
96+/-38 months. The survival curves for HC and SC
patients were statistically significantly different
(log-rank, -16.04; P=.0001). In the Cox proportional
hazards model, inclusion in the HC program was
associated with an increased survival rate, whereas
comorbid conditions and requirement of mechanical
ventilation during the follow-up were associated
with a decreased survival rate. During the entire
follow-up, HC patients had a lower number of
exacerbations/year than SC patients.
CONCLUSIONS:
A disease-oriented HC program is effective in
reducing mortality and
hospital admissions in COPD patients requiring LTOT.
Arch Phys Med Rehabil. 2009 Mar;90(3):395-401.
http://www.ncbi.nlm.nih.gov/pubmed/19254602
Assessing
patients on long term O2 therapy (LTOT)
A model of quality assessment in patients on
long-term oxygen therapy.
Gustafson T, Löfdahl K, Ström K.Department of
Medicine, Skellefteå Hospital, SE-931 86 Skellefteå,
Sweden.
BACKGROUND: The difficulty of implementing
guidelines for long-term oxygen therapy (LTOT) has
been recognized. We performed this analysis to
evaluate the impact of a national quality assurance
register on the quality of LTOT and to suggest
indicators with levels for excellent quality LTOT.
METHODS: Based on national register data on
Swedish LTOT patients in 1987-2005, we measured nine
quality indicators and the achievement levels of the
participating counties in fulfilling these treatment
criteria.
RESULTS: There were improvements in the following
eight quality indicators: access to LTOT, PaO(2) <
or = 7.3 kPa without oxygen, no current smoking, low
number of thoracic deformity patients without
concomitant home mechanical ventilation, >16 h of
oxygen/day, mobile oxygen equipment, reassessment of
hypoxemia when LTOT was not started in a stable
state of chronic obstructive pulmonary disease
(COPD) and avoidance of continuous oral
glucocorticosteroids in COPD. There was decline in
the quality indicator PaO(2) > 8 kPa on oxygen.
After improvements, three criteria were fulfilled by
> or = 80% of the counties in 2004-2005.
CONCLUSIONS: We found improvements in eight of
nine quality indicators. We suggest these indicators
with levels for excellent quality for use in quality
assurance of LTOT based on our results.
http://www.ncbi.nlm.nih.gov/pubmed/18980837
"Vicious
Circle" Theory in COPD Flare-ups
Dec 2008
Described by UB Researchers in New England Journal
of Medicine
BUFFALO, N.Y. -- In treating flare-ups in chronic
obstructive pulmonary
disease (COPD), a major cause of disability and the
fourth leading cause
of death in the U.S, what was old is important
again.
http://www.buffalo.edu/news/9809
Duh! That should have been a no-brainer. What do
they teach them in medical schools?--Vlady
Advance for Managers of Respiratory Care, Vol. 17 .
Issue 10 . Page 53
LOTT Looks for
Answers
Jan. 6, 2009
Long-term oxygen therapy trial set to start patient
recruitment
The start of the Long-term Oxygen Therapy Trial has
been delayed, but its
lead researchers expect the study to be fully
operational by the beginning
of 2009.
Frank Visco is editorial assistant of ADVANCE.
fvisco@advanceweb.com.
http://respiratory-care-manager.advanceweb.com/Editorial/Content/Editorial.aspx?CC=189799
Become an Expert in Spirometry
Jan 23, 08
Spirographic indices: an overview with 14
sections.
>http://www.spirxpert.com/indices.htm
FDA Okays Rapid Test for Four
Common Respiratory Viruses
Jan 23, 08
The test employs a multiplex platform that allows
several tests to be processed using the same sample
to detect influenza A virus, influenza B virus, and
respiratory syncytial virus A and B (RSV) -- a
quartet of viruses that are among the leading causes
of lower respiratory tract infections.
>http://www.medpagetoday.com/ProductAlert/DevicesandVaccines/dh/8030
More
to know about COPD: Disputing the myths about an
underdiagnosed disease
Jan 16, 08
This condition is often missed or misunderstood.
Experts urge more awareness and newer diagnostic
tools.
>http://www.ama-assn.org/amednews/2008/01/07/hlsa0107.htm |
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