Problem Solvers

POCs: Education for Improved Outcomes

Why oxygen providers should establish POC education programs, and how they should implement them.

The portable oxygen concentrator has been revolutionary for both long-term oxygen therapy equipment providers and their patients. For providers, POCs create a much more affordable and manageable cost scenario than delivering oxygen cylinders. For patients, POCs given them increased mobility and freedom, which not only confers a much improved quality of life, but improved therapeutic outcomes.

That said, POCs are not portable cylinders. They are much more complex devices that end users must fully understand so that they can maximize the benefit they derive from their POCs. Bearing that in mind, providers should implement POC education programs that can ensure a solid level of therapy and device comprehension among their LTOT patients.

Benefits of Education

The benefits of a POC education program should be clear to any provider: Once a provider ensures the patient is matched to the most appropriate device, a thorough understanding of that unit will optimize outcomes.

“The clinical literature has demonstrated that patients that are appropriately oxygenated with various activities, particularly ambulation and exercise have the best clinical outcomes, which includes the best life expectancy,” says Joe Lewarski, vice president of global respiratory and sleep for Drive-DeVilbiss Healthcare. “Stable patients will be less likely to experience unplanned healthcare interventions, including readmission.”

“Providing the patient with a strong foundation of POC knowledge and information at the initial delivery pays big dividends,” says Dave Marquard II, owner and CEO of Applied Home Healthcare Equipment. “A, patient education eliminates anxiety about being on oxygen. B, patients learn that if handled properly, oxygen in the home is very safe. C, patients well educated on their POC are likely to recommend the DME that educated them to others. D, patients well educated on their POC are likely to comment favorably to physicians and other referral sources on service capabilities of the DME. E, a well-educated POC patient is less likely to require numerous service calls from the DME.”

Also, an education program will reinforce the basic therapeutic value of a POC, which can get lost on patients, particularly new ones, who might be struggling to grasp large volumes of information about their condition.

“A lot of patients don’t really understand the benefits of a POC,” says George Coppola, director of marketing for respiratory at CAIRE Inc., a Chart Industries company. “Patients using a POC device need to understand what the device provides them, and that’s ample oxygen whether at rest or more important when exercising or during exertion.”

Another reason why providers should educate patients on their devices is that POCs are not uniform. Providers must match their patients to the POC that is right for them, and those POCs might use different oxygen delivery methods. Moreover, the settings on one device are not the settings on another.

Coppola points out that while POCs have various numerical settings, the amount of oxygen at those setting vary wildly from unit to unit.

“It’s really important to understand that, if a prescription of two liters per minute is needed to maintain saturation levels above 94 percent, then the device that the patient is using in that pulse mode should be set to keep that patient saturated during exercise,” he says. “The device setting on one might be a two, but on another might be a five. So a high-quality pulse oximeter needs to be used in conjunction with the POC to ensure the right settings are made.”

“As had been discussed myriad times in both the clinical literature and trade press, all POCs are not equal; they produce different amounts of oxygen and deliver it differently,” Lewarski explains. “Oxygen production ranges from about 350 ml to 3,000 ml per minute. Oxygen delivery methods include pulse-dose only, as well as continuous flow and pulse-dose. Pulse-dose delivery varies significantly as well, with fixed-bolus and fixed minute volume approaches using various bolus sizing models that ideally need to be titrated to the patient during the different activities the device will be used (resting, walking, exercising, etc.).”

Elements of an Effective POC Education Program

Education should start with benefits, according to Coppola. A key part of the training should be simple understanding of the benefits of using a POC and encouragement to get patients to use them specifically while engaging in some kind of exercises.

“Included in the education needs to be the use of the device while exercising and traveling to reduce risk of hypoxia and increase exercise tolerance,” he explains. “So encourage the patient to live as normal a life as possible with COPD, get out of their homes, stay active. We want the patients to understand that they can go to the park; they can walk their grandkids; they can go to the ballgame; they can do anything that they would normally do under any other circumstances.”

In addition to benefits the program should also include a nuts-and-bolts understanding of the device so that the patient can use it competently and confidently. Marquard listed several:

Medical. Marquard says all POC patients should understand why they are on oxygen generally and why they are on portable oxygen specifically.

Safety. While Marquard notes that POCs are safe and effective when “common sense” rules are followed, he says an effective training program should include safety training to ensure users understand issues such as the dangers of smoking while on a POC. “Safety issues related to the operation of Productsthe POC should be the No. 1 item stressed to the patient,” he says.

Operational. As Marquard puts it, “Operating a POC is not rocket science. But every user of a POC should feel comfortable in his or her knowledge of how to properly operate a POC, its limitations, its advantages over being teth-ered to a stationary oxygen tank, and how to deal with an alarm or get help should one go off.”

Trouble shooting. POCs are the future of home oxygen and are reliable. Almost 40 percent of patient returns of POCs end up classified as “no trouble found,” he says. In these cases, there was nothing wrong with the POC. The patient was confused or not properly trained. Marquard says Applied Home Healthcare dedicates training to its DMEs to help them in turn educate the patient on how to understand and take advantage of their POCs. This includes helping patients do minor trouble shooting, such as removing pet fur from filters, making sure the power supply is plugged in, and similar technical checks.

Maintenance. POCs need to be maintained to ensue they operate at optimum performance levels for patients. Bearing that in mind, patients should be instructed on what are the correct maintenance practices and service sched-ules and how to follow them.

Lewarski stresses that any patient POC training must be hands-on. The provider needs to see that they patients are demonstrating their knowledge of their devise through actual use. Also, patients should be monitored and appropriately titrated to their device during the training, he advises.

An Ongoing Effort

Also, once the patient is educated on his or her device, the instruction doesn’t stop. It’s important to keep up with that patient and continue the education.

“Each patient is different, so a follow-up and re-education care plan should be individualized based on the educator’s evaluation of the patient and caregivers,” Lewarski notes. “Some patients may do well with one session and others may need additional follow-up, which may be face to face, by phone or email.”

And that follow-up effort gives providers and opportunity to update patients on new developments. As POCs improve, patients need to be kept aware of new advances, Marquard says. As technology of miniaturization help POCs become lighter and more portable, patients can gain even more benefits through expanded usage.

“Allowing patients to keep up with and benefit from new advances in technology requires some sort of patient follow up education,” he explains. “It’s just good DME business practice to have such a program in place. The chance to re-instruct a patient when needed should be looked at as a customer sales opportunity by the DME, not as a burden.”

Coppola adds that the process is an ongoing effort that should come from the providers as well as peers. The more group support that patients can get, the more peer-to-peer insights they will gain in managing their conditions and their devices.

“Education in terms of managing or improving condition, such as COPD, does take time,” Coppola adds, stressing that providers must offer, “follow-up, specifically being provided in a modular fashion, to assist the patients’ learn styles and abilities. So getting enrolled in pulmonary rehab programs and being around other patients to share their experiences on what works and what doesn’t work is very helpful to them.”

He adds that even if patients have limited mobility or don’t have local access to such groups, there are a number of online resources and groups that providers can leverage as part of their ongoing education efforts.

Enlisting Help

The provider isn’t alone in helping educate patients on their POCs, either. Referring physicians and other healthcare providers can help ensure that patients are getting the best use and benefit from their devices if they understand what the patient is learning.

“As many providers know, referral sources may also benefit from education about POCs, along with an understanding of the home education provided to POC users,” Lewarski explains. “For all of the reasons previously stated, referral sources also benefit from their HME partner providing patient-specific clinical and therapy-specific education. Referral sources, patients and providers are all key stakeholders in the care of oxygen dependent individuals.”

“It pays to keep the referral partners in the loop,” Marquard says. “Some of the smartest OxyGo providers I have seen make it a point to always let the providing medical staff referral source know exactly how the patient was educated. They report on what the instruction covered, any questions the patient had, the comprehension level of the patient observed. This can be done electronically or by personal visit to the referring source. It should be looked at as another opportunity to enable the providing referral source to do a better job of reinforcing what their patients need most. By doing this the partnership between referral source, provider and patient is strengthened to the max.”

Ultimately, this can be a unified front. Everyone involved in the patient’s respiratory care can help reinforce the lessons from the provider’s POC education program.

“Patient outcomes should be first on everyone’s mind; making sure that patients are well taken care of and well educated,” Coppola says. “So providers linking up with local pulmonary centers and local physicians is very important. There is no such thing as too much information. The more information the better.”

This article originally appeared in the August 2016 issue of HME Business.

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