Winter 2015 Continuing Care/Rehabilitation Section Bulletin

Winter 2015 Continuing Care/Rehabilitation Section Bulletin

Gerilynn Connors, BS, RRT, FAARC
Inova Fairfax Hospital
Falls Church, VA

Arianna Villa, BS, RRT
UCSD Medical Center
San Diego, CA

Pamela Neuenfeldt, MPH, RRT
HealthPartners Institute for Education and Research
Arden Hills, MN

Section Meeting Recap

Arianna Villa, BS, RRT

The Continuing Care/Rehabilitation Section meeting was held on Dec. 11 at AARC Congress 2014 in Las Vegas. Several important topics were covered. Here are a few highlights —

  • A report on current section membership, which stands 418, was made. The importance of increasing membership was discussed, as 1000 members are required for the section to get a seat on the AARC Board of Directors.
  • Our Specialty Practitioner of the Year, Susan Pfanner, CRT, was congratulated on her award. (See article in this issue for more on Susan.)
  • Scott Cerretta, BS, RRT, spoke on behalf of the COPD Foundation to notify the section of new developments in the PEP program. Although PEP enrollment is currently closed, there are still educational materials available for use and the Foundation is hoping to reopen enrollment as soon as possible. In addition to the PEP program, the COPD Foundation has several tools to aid pulmonary rehab programs and those interested in rehab, including a map of PR programs across the country. Visit their website for more information.
  • AARC Director of Regulatory Affairs Ann Marie Hummel spoke about new CMS developments as they pertain to pulmonary rehabilitation. Among the topics discussed was the reimbursement for code G0424, which has been increased to $52.35. The importance of accurate charge reporting was discussed as well, and the Pulmonary Rehabilitation Program Toolkit was referenced as a tool to help members with charge reporting.
  • It was noted that editorship of the Section Bulletin will transition to Pamela Neuenfeldt. Members were asked for feedback on topics they would like to hear more about and encouraged to contribute articles.

Our section goals for 2015 were discussed as well. They are:

  • To increase the number of PR programs nationwide using evidence based guidelines.
  • To improve access to long-term/maintenance PR by working with the AARC, American Association for Cardiovascular and Pulmonary Rehabilitation, and COPD Foundation to research potential access to grants, etc.
  • To update section website information.

Please email Gerilynn Connors or myself for more information on section-related matters.

Specialty Practitioner of the Year 2014: Susan Pfanner, CRT, LRCP

Gerilynn Connors, BS, RRT, MAACVPR, FAARC

Susan Pfanner began her career in respiratory care as a graduate of the Napa Valley RT program in Napa, CA, in 1986. She thanks her brother, a pulmonary physician who gifted her with an AARC membership as an RT student, for allowing her to grow in her newly found profession. Susan is currently the coordinator of the Tobacco Cessation and Pulmonary Rehabilitation Program at the Peace Health Sacred Heart Medical Center in Springfield, OR.

Susan quickly found her niche in pulmonary rehabilitation and has worked effortlessly with the American Lung Association, Better Breathers, as a coordinator since 1988, just two years after completing her RT degree. Susan’s quest to help her chronic lung patients led her to look for increased skill in the area of smoking cessation. She searched out credentialing programs and in 2009 became a Tobacco Treatment Specialist with training from the University of Massachusetts.

Susan’s desire to educate the public and colleagues about chronic lung disease, pulmonary rehabilitation, and smoking cessation has taken her from guest appearances on Oregon’s local Doc Talk radio to presentations at the Addition Professional Association of Lane County, the Oregon Society for Cardiovascular and Pulmonary Rehabilitation, and the St. Mary’s Episcopal Church Parish Health Ministry. In fact, the Parish Health Ministry is a project she has volunteered with since 2002.

Susan is a member of the Lane Community College Respiratory Care Program Advisory Board, the liaison for pulmonary rehab to the Oregon Society for Respiratory Care, and the incoming president of the Oregon Society for Cardiovascular and Pulmonary Rehabilitation. She has a passion for service to her patients, colleagues, and future respiratory therapists.

It was with great honor that we bestowed our 2014 Specialty Practitioner of the Year award on Susan Pfanner at AARC Congress 2014!

New ACCP/CTS Guidelines for the Prevention of COPD Exacerbations

Arianna Villa, BS, RRT

This past October the first-ever evidence-based guidelines to prevent COPD exacerbations were published in CHEST. This joint guideline from the American College of Chest Physicians and the Canadian Thoracic Society refers to COPD exacerbations as “what myocardial infarctions are to coronary artery disease: they are acute, trajectory-changing, and often deadly manifestations of a chronic disease.” The authors add that COPD exacerbations dramatically reduce quality of life, consume financial resources, and hasten a progressive decline in pulmonary function.

Some of their recommendations for the prevention of acute exacerbation of COPD (aeCOPD) include:

  • Administration of the influenza vaccine.
  • Smoking cessation and counseling and treatment using best practices as a part of a comprehensive clinical strategy.
  • Pulmonary rehabilitation within four weeks of an exacerbation.
  • Neither education alone, nor case management alone should be used for prevention of aeCOPD.
  • Education and case management that include direct access to a health care specialist at least monthly has been shown to reduce hospitalizations due to aeCOPD.
  • The provision of a written action plan and case management.
  • Telemonitoring compared to usual care does not prevent exacerbations.

In addition to the above recommendations, the article includes several guidelines on inhaled and systemic drug treatments for the prevention of aeCOPD. There is also a decision tree graphic that illustrates an algorithm for prevention of aeCOPD.

Sleep Duration: A Marker for Overall Health

Laura McFarland, RRT, RPSGT, Cambridge Medical Center, Cambridge, MN

Editor’s Note: This article is being shared with our section from the Summer edition of the Sleep Section Bulletin.

Several longitudinal studies have revealed that abnormal sleep duration (<5 hours or >9 hours) is correlated with adverse effects on our health. It is now commonly accepted in the literature that sleeping less or more than normal is associated with conditions such as hypertension, obesity, diabetes, and cardiovascular disease.

Trends for the past 20-30 years reveal an increase in these medical conditions, while sleep duration has decreased by approximately two hours, going from 8.5 to 6.5 hours since 1960. According to the Centers for Disease Control and Prevention (CDC), an estimated 50-70 million U.S. adults have sleep or wakefulness disorders. The CDC goes further, stating that insufficient sleep is a public health epidemic. But one question remains: is insufficient or excessive sleep duration simply related to other medical conditions known to increase the risk of mortality, or does sleep play an independent role in our health?

Studies controlling for other risk factors and medical conditions (age, sex, marital status, employment grade, smoking status, physical activity, ETOH consumption, self-rated health, BMI, systolic BP, cholesterol, physical illness, GHQ score, prevalent CHD) reveal that sleep duration is independently associated with increased mortality risk. These studies report an increased risk ranging from 62% for short sleepers to 206% for long sleepers, independent of other risk factors.

With these results in mind, is it time to consider sleep duration as a marker of our patients’ overall health? Just as we look at blood pressure and BMI, a simple question about sleep duration could provide valuable information and guidance for primary caregivers. Once identified, those patients sleeping more or less than normal could be screened for OSA and referred for a PSG (in the direct referral environment), or sent to a sleep physician or psychologist for further assessment and care.

Whether it causes increased mortality and morbidity or is merely an indicator of health, sleep duration is something we should track as a vital statistic. Change in sleep duration should be like “the canary in the coal mine.” It is a warning that something is going on and it might be significant to health.

Although we don’t know yet if treating sleep duration problems will prevent disease or improve health outcomes, we should err on the side of caution and refer patients with chronic health conditions and sleep duration problems to a qualified professional to treat the sleep problem. At best, it could improve outcomes; at worst, it will improve quality of life.

Section Connection

Recruit a new member: Know an AARC member who could benefit from section membership? Direct them to section sign up. It’s the easiest way to add section membership to their overall membership package.

Section discussion list: Go to the section website and click on “Discussion List” to start networking with your peers via the AARC’s social networking site, AARConnect.

Attention all budding authors: Got an interesting story? Have an abstract you would like to share? Want to tell a funny story about your program? (Names changed to protect the innocent and HIPAA laws, of course.) Email your contributions to Gerilynn Connors or Pamela Neuenfeldt by the deadlines stated below.

Bulletin deadlines: Winter Issue: December 1; Spring Issue: March 1; Summer Issue: June 1; Fall Issue: September 1.