COPD Navigators


Healthcare as we have known it will never be the same. Thirty years ago being sick and in need of care for a few days meant you were hospitalized and treated until you were well and could go home. If you had a relapse you would return to the hospital to seek treatment without the worry of having to pay too much out of pocket.

In today’s world the healthcare model has changed drastically. We are charged as healthcare providers to promote wellness programs, prevention programs, teaching patient self-management, and providing home care that will reduce recidivism and decrease hospitalizations. The goals for such programs are not only to reduce healthcare costs but mainly improve quality of life for patients with chronic diseases. Respiratory therapists (RTs) can make a difference in the management of chronic diseases such as chronic obstructive pulmonary disease (COPD) because of the special training we receive and the experience we bring from dealing with this type of patient throughout the years.

COPD: Third Leading Cause of Death
COPD is a progressive obstructive lung disease that is a major cause of mortality and morbidity in the United States.1 It is now the third leading cause of death behind heart disease and cancer. The cost to treat COPD is in the billions.

Many people – including those diagnosed – do not understand what COPD is or what it means for them. Because of this fact many do not seek the proper treatment that can lead to a better life. There is no cure for COPD, but many patients can have a better quality of life with the right therapy – and that therapy often comes from seasoned RTs.

RTs of the Future
For years we have been treating chronic lung disease in the hospital setting. Now is the time for RTs to think “outside the box” of conventional care and offer a value for our services as COPD educators. We rarely get paid more and are not always reimbursed for the care we provide to improve or prevent COPD exacerbations, but the quality of life benefits for our patients and the lowered cost of healthcare truly outweigh the cost of providing such services.

COPD education has been compartmentalized and generally only offered in pulmonary rehabilitation (PR). Patients with the diagnosis of COPD who do not meet the criteria to attend a formal PR program or who are unable to attend miss out on the individualized focus, holistic care, education, exercise and ongoing support such programs provide. While all patients need not attend a formal PR program, COPD education itself is still very valuable to any individual with the diagnosis. Knowing how COPD affects one’s life and knowing how to best manage it is necessary for anyone with COPD. During the time of discharge there is not enough time to fully evaluate the patient’s understanding of COPD management and educate accordingly. Therefore, patient discharge plans have not been shown to be effective in making much of a difference in patient self-management, improved quality of life or hospital readmissions. But changing a patient’s use of healthcare services may be as simple as explaining to the patient how to properly take their daily medications.

COPD education includes identifying patient needs and providing individualized care. Getting patient buy-in may be the first step, and it may take extra time to discuss the components of COPD care and prevention of exacerbation with the patient.

Some hospitals have been working to develop the RT’s role to include providing COPD education for patients identified as at risk while in the hospital.

COPD Navigator Education
RTs working with patients diagnosed with COPD in acute care facilities, pulmonary rehabilitation, home care, long term care facilities and even physician offices have experience that can only be gained from patient and family contact. COPD navigators must be able to discuss a myriad of issues with patients and their families, including: smoking cessation, medication and delivery management, oxygen therapy and delivery device training, pulmonary rehabilitation evaluations, diagnostic testing and other components of care. Having the skills, confidence and patience to work with patients and their families to provide this level of education is a necessary requirement.
The American Association for Respiratory Care (AARC) and the American Lung Association (ALA) have a COPD Educator program available for clinicians interested in furthering their education and skill development to practice as a COPD navigator.4,6 While there is currently no certification awarded for this specialty, in my opinion, it is only a matter of time until it will be recognized.

Chronic Disease Models & COPD Navigators
Russell Acevedo, MD, medical director at Crouse Hospital in Syracuse, N.Y., developed a program that helps RTs identify patients with COPD at risk and barriers to care. The program also helps RTs provide patient education and ongoing transitional care.2 His innovative approach quickly transformed his department from treatment-driven to a patient-centered model of care. In this primary care model, the COPD patient navigator’s primary focus is educating patients and families, training patients on self-management tools and transitioning patients from acute care to outpatient management.

Patients are assigned an RT COPD navigator during their first hospitalization where disease management begins. The initial diagnosis, patient education, home equipment needs, oxygen assessment, medication management and activities of daily living are just a few of the topics reviewed with patients during their hospital stay – and care doesn’t stop when they are discharged from the hospital. The COPD navigator makes routine phone calls and home visits to assess patients’ and their home environment, which helps decrease the risks of another exacerbation which could lead to another hospitalization or even death. The COPD navigator will continue to follow patients throughout their lifetime.

This model has already shown to be successful in meeting its goals. Acevedo offers the Partners in COPD program to anyone interested in using the model hoping to spread the success and improved patient benefits.

The University of California-Davis (UC-Davis) also has a history of promoting RTs as COPD case managers who provide personalized attention to patients with COPD and integration of services. They used evidence based data – including the COPD GOLD guidelines – to develop their program.4 The UC-Davis RTs also attended the AARC COPD educator course.5 The medical director, Samuel Louie, MD, strongly supports registered RTs as COPD case managers or navigators. In 2012, this model led to a reduction of 30 day hospital readmissions at UC-Davis from 16% to 2.4% just four months after implementation.3 Many other programs already exist and are exhibiting some of the same successes while others are just now in development. Most importantly, these new programs are documenting their research, which will help them share best practices with others.

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Health Promotion Versus Acute Care
The future of healthcare will depend on models of care – such as the COPD navigator – that offer new methods of care to better manage chronic diseases through training for patients, hospitals and communities. Clinicians should begin evaluating their skillset and determining what they will need for the future. The AARC has already identified the skills and methods necessary to improve health and reduce cost in their 2015 and Beyond plan.7 RTs will be expected to manage patient and professional education, develop protocols promoting best practice, promote disease management that teaches self-management skills, work in ambulatory care, and focus on preventive care and risk-factor modulation. These are exciting times for our profession and we now have an opportunity to make a greater difference in the lives of those with COPD. With all the focus on COPD treatment, we must also remember the rewards of health promotion and preventing COPD in those who will never smoke because of the awareness we provided.

Mary Hart is an assistant professor and the director of the Clinical Education in the Department of Respiratory Care at the University of Texas Health Science Center, San Antonio. A fellow of the AARC, she has over 30 years’ experience as a respiratory therapist in all aspects of care. Prior to moving to academia, she practiced in outpatient care for 15 years as a manager for the Lung Disease Management Program at Baylor University Medical Center Dallas. She is currently on the Board for the National Lung Health Education Program, AARC Geriatric Roundtable Chairman and an American College for Chest Physicians Allied Health Network board member.


References

1. Hess D, et al. Respiratory Care Principles and Practice. 2nd Ed. Sudbury, MA: Jones &Bartlett Learning; 2012.

2. American Association for Respiratory Care. Using Respiratory Therapists in a Primary Care Model. AARC TIMES. 2011.

3. RTs Lead the Way in COPD Case Management. AARC Times. University of California Davis; 2012.

4. American Association for Respiratory Care. AARC COPD Educator Course. www.aarc.org/education/copd_course/.

5. Global Initiative for chronic obstructive lung disease. www.goldcopd.org.

6. American Lung Association. ALA COPD Educator Course. www.lung.org/.

7. Barnes, et al.. Transitioning the Respiratory Therapy Workforce for 2015 and Beyond. Respiratory Care Journal. 2011; 56(5).

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