I would like to take this opportunity to say thank you to Sam for including the call for help in his recent article on page 28 of the AARC Times. In the article, "Winding Down 2010 More Challenges-More Opportunities", Sam has included a call to therapists to volunteer their time to help those who are in dire need across the country. Sam and I have shared several emails over the last year or so about RT's and the role they have in helping those who do not have access to the simplest of the respiratory meds, MDI's. Sam mentions finding a free clinic to volunteer at, to offer your respiratory expertise. As the economic conditions of the country go from horrendous to dismal and as many people have lost their jobs and subsequently their health insurance, this in my estimation creates a greater disaster for the healthcare system in the United States. As we all know, the first place many of those who cannot breathe end up going to is the emergency room. As Medicare cuts loom ever so close, hospitals and physicians have to increase costs in order to recoup the indigent care that comes through the doors. As patients who have co-pays and high deductibles decide not to partake of their usual checkups, this not only decreases the revenues realized in the past by medical offices and hospitals but puts an ominous tone on general prevention across the United States. Prevention that we have all been fighting for over how many years may be decided by none other than the dollar and the lack thereof.
I, as a respiratory therapist started a free medical clinic in rural PA. Basically because I walked in the shoes of those without, without health insurance. My story now is unimportant, but what is important is that I have experienced first hand on a larger basis what it is like for those without health care, especially those who have asthma or COPD. After almost 4 years of driving the ship of the free clinic, we have seen 1000 patients, diagnosed 30 cancers, diagnosed many many cases of hyptertension, diabetes, lupus, etc - the list goes on and on. I have had the opportunity to make a difference in the patient with the asthma exacerbation who refused to go to the ER. Most recently there were two men, one in his 40's and one in his 60's who came into the clinic. Both really belonged in the hospital but for financial reasons both refused to go. The first man's oxygen saturations were sub-optimal. He had accessory muscle use. Fortunately for us, I have accumulated nebulizers and samples of respiratory meds. We gave him a nebulizer, an MDI, Advair, and told him adamantly, if he didn't stop smoking, he would be on oxygen within 3 months or worse yet land in the hospital. We gave him all of this, with lots of education, and did a lot of case management over the week that ensued. We added antibiotics and prednisone and again the warning quit smoking or the outcomes would not be good. Now, after three weeks, he has stopped smoking, he uses his MDI and nebulizer along with his Advair. His oxygen sats now would mean he wouldn't qualify for oxygen. He still has COPD and he understands what that means to him. Amazingly his accessory muscle use is gone. His story is that he works at a local factory, making minimum wage with no ability even if it were offered to have health insurance. The most striking thing is that his beagle James is his best friend. Did we make a difference, our whole team did, no doubt about it. More importantly, we probably saved the healthcare system, thousands of dollars on just one patient, i.e. we have kept him out of the ER. Did we save him money in the long run, yes we did, he now has extra money since he is not buying cigarettes.
I know that everyone out there is shaking their head and saying well if he can smoke, why can't he use that money to buy insurance? As therapists we all know what a hold cigarettes can have on a person. Not always so easy to quit.
The other man, who is in his 60's, came to the clinic in a full COPD exacerbation. The physician and I were not sure that he wouldn't end up going to the ER and subsequently being admitted, possibly even vented. Like the first gentleman, we followed somewhat the same protocol, only with much more guided case management. He unlike the first gentleman had been smoking 3 packs per day and only recently had cut down to 2 packs per day. He too after being rather bluntly that if he didn't quit, he would be on oxygen or worse yet would die. Harsh maybe, but realistic yes. He too is doing much better and again we have saved thousands of dollars for the health care system.
We all know patients that we have worked with in the hospital who when given a discharge prescription has no ability to even get the medication.
What I would really like to ask all of the therapists across the country is to learn what resources are out there for those such patients. For patients who are on Advair, does everyone know about Bridges to Access, sponsored by GSK for Advair products? I talked with some of the pharm reps and they weren't sure how many people really know about the Advair program. How about prescription assistance for Singulair? How about Wal-Mart's and grocery chains, "$4 list"? How about for sleep apnea patients, Awake America? How about Needy Meds for other medications?
I do not wish to be a bearer of bad news but things are only going to get worse. I am asking therapists across the country to think about this, there are many people out there who don't have an MDI to simply keep themselves breathing in the United States - can you with all good conscience not begin to ask the patients you deal with on a regular basis whether they might be that one person? We are the experts in breathing plain and simple and to go to sleep at night knowing that in one of the most progressive countries in the world, we have people who are gasping because they don't have access. I would like to invite all of the state societies to begin a new campaign, "NO PATIENT WITHOUT A BREATH".
I will end by saying if you can't volunteer in a free clinic or if there isn't one near you, please please please start to talk to your patients about what they have and what they don't have. Here is my cell: 570-204-3930, call me to let me know who is interested in starting a national movement.
Thanks again Sam for listening to my pleas!!
Bette Grey, BA, RRT, CPFT
Columbia County Volunteers in Medicine Clinic, Inc.
Serving the needs of the working uninsured!