Expanding the reach of respiratory therapy: A need for evaluation.

On November 27, 2014, Medavie Blue Cross and the Canadian Lung Association announced a breakthrough in increasing access to essential respiratory services for patients with chronic obstructive pulmonary disease (COPD) and asthma. Patients will now be able to self-refer to certified respiratory educators (CREs), including respiratory therapists.

Dr Jason Nickerson

Chronic respiratory diseases comprise a significant health burden in Canada and around the world. Internationally, these diseases account for 4.7% of global disability-adjusted life years, and COPD comprises two-thirds of all chronic respiratory diseases, ranking it as the ninth most burdensome disease in the world (1). Recent estimates from Ontario identified a COPD population prevalence of 11.8% among adults ≥35 years of age (2). This prevalence increased by 64.8% from the mid-1990s to the mid-2000s, suggesting a significant growth in the number of individuals with COPD (3). Asthma prevalence similarly increased by 70.5%, with an overall population prevalence of 13.3% by the mid-2000s (4). Collectively, these diseases account for significant morbidity and mortality among Canadians, and represent major health expenditures for unplanned hospital admissions and drug spending.

Existing evidence suggests that an integrated disease management approach to the treatment of COPD is effective for improving disease-specific quality of life and for reducing health services utilization (5). In asthma, some evidence exists to support similar models of care; however, more investigation and studies of higher quality are needed to draw more robust conclusions (6,7).

The expansion of coverage for CREs presents an opportunity to improve the care of patients with chronic respiratory diseases across Canada, and to expand the reach of respiratory therapy services in the community. Presently, few respiratory therapists practice outside of acute care settings, despite a growing need for primary care services (8). As provinces continue to seek to improve care for older adults in particular, there is a strong need to identify programs and interventions that enable seniors to stay healthy and at home longer; the introduction of community-based respiratory therapy services is likely a core component of this.

From a research and professional practice standpoint, there is a strong need to evaluate the impact of these programs and this coverage to demonstrate clinical and cost effectiveness, as well as the impact of these interventions on the health system in general. Obtaining these data through robust study designs is essential for understanding the impact of these programs on important clinical and economic outcomes, and for justifying the further expansion of these programs to other payers. Several studies support the role of respiratory therapists in providing hospital-based care and education for chronic respiratory diseases; however, it is essential to extend these analyses to the community and to these new roles to ensure that the care provided is safe and effective, and to demonstrate the impact of these services to decision makers.

In short, this initiative represents a large step forward for respiratory therapists practicing as CREs and certified asthma educators, and will likely solidify the role of respiratory therapists as leaders in respiratory health. However, this advancement should not be taken lightly, nor should it be taken for granted. We need to rigorously evaluate the impact of new policy changes to ensure that we continue to demonstrate the feasibility of expanding respiratory therapy services, as well as the impact of doing so. This is essential for ensuring the sustainability of the profession and for continuing to improve the health of Canadians.