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Leveraging Telemedicine for Procedures: Pulmonary Function Tests

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In this series we discuss how health systems can leverage telemedicine to increase procedural utilization locally. Focusing on individual procedures, these are evidence-based mimi-reviews of how and why telemedicine offers advantages to patients, healthcare providers, and communities. This week’s blog post explores the importance of pulmonary function tests and the role of telemedicine in making them more accessible. 

Pulmonary function tests are a vital component of advanced pulmonary care. They are essential to the diagnosis and management of disease such as asthma, chronic obstructive pulmonary disease (COPD), and restrictive disease processes. The test gives an objective measure of how the lungs are working by testing and recording lung volumes, flow rates, gas exchange.  Tracking these measurements over time can play a key role in determining what treatments a patient may qualify for and help prognosticate a patients disease course. 

A technician performs the pulmonary function test locally. It requires the patient to use maximal effort to breath in air and blow into spirometry equipment. Testing may also include an exercise component. The data generated is then interpreted by a pulmonologist for the above described purposes. 

Pulmonary function tests provide important clinical information for an array of conditions and populations. They are crucial because symptoms of pulmonary disease do not correlate well with disease severity or progression.1 Testing occurs in both pediatrics and adults. These tests help diagnosis and determine management for asthma, COPD, and restrictive lung disease. They are also indicated for chronic dyspnea, airway obstruction, and pulmonary vascular diseases. In certain circumstances they support perioperative evaluations and disability assessments. Even for its most common indications, pulmonary function testing appears to be significantly underutilized.2

Rural populations may face barriers to accessing pulmonary function tests while simultaneously facing greater disease burdens. Recent research on COPD found the prevalence of COPD  in rural populations to be double that of urban populations. Higher rates of the disease were found across all age groups in rural populations.3 Exacerbating this is the trend that pulmonary function tests are under utilized in the elderly, underprivileged and those with barriers or limited access to testing.4  Studies have found that small and isolated rural communities have greater distances to travel for pulmonary function testing than urban or large rural communities.5 

Certain diseases require more frequent pulmonary function tests to maintain patient safety and trigger vital treatment intervention. Motor neuron disease is one such disease process. As a motor neuron disease becomes more advanced, patients suffer from increasing chest wall weakness such that patients lose the strength to make enough effort for sufficient inspiration. Guidelines recommend pulmonary function tests every three months to determine the need for non-invasive ventilation. Research has validated the use of remote pulmonary function tests in this context as accurate and acceptable to determine the need for establishing non-invasive ventilation at home for patients with motor neuron disease.6 

Telemedicine can help bridge patient populations and specialist driven procedures, thereby directly addressing known healthcare disparities. Telemedicine facilitated pulmonary function testing one such example of this.  Leveraging telemedicine for procedures is an efficient means of healthcare delivery in which reductions in the geographic barriers to care engagement can increase care engagement, patient savings, and health outcomes. Knowing this, Beam Healthcare is excited to engage healthcare systems and communities to design and employ telemedicine systems that both increase access to care provision and procedural while reducing geographic and financial barriers to care.

 

1Crapo, R. O. (1994). Pulmonary-function testing. New England Journal of Medicine, 331(1), 25-30.

2Gershon, A. S., Hwee, J., Croxford, R., Aaron, S. D., & To, T. (2014). Patient and physician factors associated with pulmonary function testing for COPD: a population study. Chest, 145(2), 272-281.

3Raju, S., Brigham, E. P., Paulin, L. M., Putcha, N., Balasubramanian, A., Hansel, N. N., & McCormack, M. C. (2020). The burden of rural chronic obstructive pulmonary disease: analyses from the national health and nutrition examination survey. American journal of respiratory and critical care medicine, 201(4), 488-491.

4Skalski, J. H., Gibson, R. A., Narotzky, S. A., Yadav, H., & Scanlon, P. D. (2016). Health Disparities and Pulmonary Function Testing. In Health Disparities in Respiratory Medicine (pp. 79-104). Humana Press, Cham.

5Chan, L., Hart, L. G., & Goodman, D. C. (2006). Geographic access to health care for rural Medicare beneficiaries. The Journal of Rural Health, 22(2), 140-146.

6Geronimo, A., & Simmons, Z. (2019). Evaluation of remote pulmonary function testing in motor neuron disease. Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration, 20(5-6), 348-355.