Today I was extremely fortunate to be able to do a screening spirometry on a patient who showed up at the free clinic. This lady, 59 years old, of course has no insurance. She has been our patient for a while and has had off and on complaints of shortness of breath. Today she had a follow-up and I was able to do the spirometry for free. Of course, she would not have gotten it until it was too late, as in she would have already been in need of oxygen or she would have found herself in the ER. O2 sats with ambulation will be next. Yep, she was a smoker, but she quit 20 years ago. She won't probably ever know what a good decision that was. It turns out that she was moderately obstructed and it turns out that she admitted to SOB with ambulation and activity. Of course, most of the pulmonary treatment and followup probably won't be done in a specialist's office, but rather in the free clinic. Pulmonary consults in our area begin at least at $300 and then when you add a full complement of PFT's including diffusion, etc. We are now up around $3,000 - $4,000. We can suggest all we want and promise that possibly Medicaid would pick up the tab, but at 59, she will refuse and refuse to go for a pulmonary consult and the more complex PFT's. And if she ends up on Sprivia she probably won't be able to afford it but hopefully we'll be able to get her signed into the prescription assistant program, she may feel better. Of course, we sent her for a CXR. Now we wait for the results.
Another woman, similar story, came to the clinic - she was a cosmetologist and she smoked and she was exposed to second hand smoke, was diagnosed with spirometry and by CXR all through the free clinic. We were able to fill out the paperwork for her to get Medicaid. But in addition to the pulmonary issues she also has cardiac issues which is probably what helped her get the assistance. But she came back to the clinic to review her CXR and brought the good news that she has MA. She said she didn't want to end up having to take meds, but I reminded her that sometimes the meds she might be taking in the future is more about maintenance. I am hoping the seed that was planted will stick with her down the road. And she was so grateful, so grateful - you could see it in her face.
Another woman, who I was able to get signed up for Advair through the Bridges to Access program and to who I gave a holding chamber/spacer to so she could use her albuterol the correct way, stopped by to pick up samples of albuterol MDI's. I asked her how things were going and if she were using her holding chamber/spacer and she told me it was the "best thing" and that her inhaler was much more effective, wow now that is a huge revelation. She even said her husband wanted one but he is insured and she told him to ask his doctor. Such a win win. She is so happy to have her Advair and she is happy because her inhaler actually works the way it should. Now that is impact on a patient's life.
I really haven't heard from anyone since the last blog, the one where I posted that we as therapists should really begin to take a hard cold look at making sure people have simple inhalers to breathe. I guess everyone is too busy at the annual meeting to jump on board. I will keep blogging because I have learned with founding a free clinic, one small step on the journey of many steps may just need much prodding from my colleagues.
Hope everyone is having a great time in Vegas - go PA sputum bowl team!!
Bette Grey, BA, RRT, CPFT