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Spring 2008

Respiratory Therapist in Alabama Asthma Clinic Helps Serve Unmet Needs of His Community

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The Official Publication of AAN - MA

Respiratory Therapist in Alabama Asthma Clinic Helps Serve Unmet Needs of His Community

Statistics on the number of uninsured people in America are troubling. At last count, more than 46 million men, women, and children were without coverage, making it more difficult for them to receive the health services they need to manage acute and chronic conditions.

In Mobile, AL, these individuals have a place to turn for help. And AARC member Timothy Op’t Holt, EdD, RRT, AE-C, FAARC, professor of cardiorespiratory care at the University of South Alabama (USA), is one of the reasons why. For the past four years, he has been volunteering at the Victory Health Partners Clinic, a faith-based facility that provides care for uninsured patients, including those with asthma, COPD, and other respiratory problems.

The facility grew out of the experiences of its medical director, Robert Lightfoot, MD. “Dr. Lightfoot and his wife had been on several medical mission trips outside the United States, and they realized how much people locally could use better, more affordable medical care,” says Dr. Op’t Holt. While services are not free, patients are charged on a sliding scale based on income, which opens the door to treatment for many who would otherwise have to seek assistance in local emergency departments.

Dr. Op’t Holt first became involved in the clinic when Dr. Lightfoot put out a call for professionals who could assist with asthma and COPD care in January of 2003. “I spoke with my colleagues in the USA cardiorespiratory department to determine if they were interested in helping the clinic, and they were. We visited an asthma clinic in Little Rock, AR, and were helped greatly by Sherry L. Barnhart, RRT-NPS, FAARC, who assisted us with our educational program and teaching devices. We began seeing patients in July of 2003.”

RT faculty from USA staff the clinic every Wednesday, seeing patients who are referred to them by either Dr. Lightfoot or one of the other physicians or nurse practitioners on staff. Visits consist of a screening and evaluation for asthma or COPD, a review of currently used medications, pre- and post-bronchodilator spirometry when indicated, asthma or COPD education, provision of a care plan or asthma action plan, and drug and device education. “We spend about 1 1/2 hours with our asthma patients during their initial visit, mostly for education about triggers and environmental control,” says Dr. Op’t Holt. “We talk about keeping a tidy house and controlling sinusitis and rhinitis, dust mites, and mold — all common in the South.”

Asthma care is guided by the National Asthma Education and Prevention Program guidelines, and the clinic is in the process of upgrading to the new Expert Panel Report 3. COPD care is governed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. The therapists also help patients who can’t afford their medications by directing them to medication assistance programs, and they provide smoking-cessation counseling and referrals to local hospitals for smoking-cessation programs.

Helping these patients manage chronic conditions like asthma and COPD is a challenge, mainly due to the poor living situations of so many. “The main problems are psychosocial and socioeconomic,” says Dr. Op’t Holt. “We have patients who live in questionable conditions, in the presence of allergens and irritants often beyond their control. There are renters whose landlords are not very interested in helping our patients with environmental control. We have many patients in older house trailers or who live with others who are unwilling to quit smoking. We have COPD patients who are depressed about their debility.”

Follow-up care is an issue as well, because many of the patients are transient. “If they hear about a job elsewhere, or a relative who will take them in, they move on. So, we often do the best we can in one visit, never knowing if the patient will return for a follow-up appointment.” Sometimes, though, patients move up in life, finding jobs with insurance coverage, and no longer need the clinic, and that’s always a success story, he says.

The primary goal, however, is to keep patients from needing more costly care that they can ill afford. “Since all our patients are uninsured, we have a major focus on keeping them out of the emergency department or hospital,” says Dr. Op’t Holt. For example, he recently treated a woman who came in saying she was out of breath and wheezing. Normally, she would have been a candidate for hospitalization; but with oxygen, aerosol treatments, oral steroids, and antibiotics delivered in the clinic and an oxygen concentrator at home, she was able to avoid a trip to the emergency department. “I saw her a few weeks later and she seemed to be in her usual state of health, just in for a doctor visit,” says Dr. Op’t Holt.

Op’t Holt says delivering respiratory care in this community clinic has provided him with many benefits, both professional and personal. Not only has it been gratifying to serve those in need, he’s been able to get his students involved as a part of a sub-acute care course, and he believes the clinic is a prime example of the value respiratory therapists can bring to health care as a whole. “We are providing a level of patient care that is the ideal for the role of the therapist of the future,” he says. “We are truly acting as physician extenders, as we are relied upon by the medical staff for our expertise and involvement.” Dr. Op’t Holt credits Dr. Lightfoot for this, and he also thanks all his colleagues, including Bill Pruitt, MBA, RRT; Bill Wojciechowski, MS, RRT; Fred Hill, MA, RRT; and David Chang, EdD, RRT, for “playing an instrumental role in keeping the program vibrant and progressive.”
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