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Homecare technology, how far we've come.

Recently, I attended MedTrade, the annual fall ritual of the homecare industry, held in the Atlanta (GA) World Trade Center. I look back on the fact that I have attended this largest of all medical trade shows every year since 1983. That was the year I started in homecare on a fulltime basis as a partner in an independent medical manufacturers sales rep group. Seventeen of the previous years had been spent in respiratory education and three as a RT department director.

In 1983 there were at least a score of concentrator manufacturers. Today, four have the large majority of the market. Over the last decade concentrators have gotten smaller, lighter, quieter, and quite reliable. Shown for the very first time at this year's MedTrade was a highly innovative oxygen concentrator by a new company, Inogen, Inc. This new concentrator, still awaiting FDA 510(k) clearance, is quite remarkable. Only slightly larger than a shoebox and weighing less than 10 pounds, it produces the equivalent flow of up to 5 liters per minute delivered by pulse dose conserver technology. It will operate on AC, 12v DC or for several hours on a removable and rechargeable internal battery, and it is almost silent. This unit has the potential to totally change long-term homecare oxygen therapy. It can be used both as a stationary and portable source of oxygen thus freeing both the patient and the dealer from the concerns and costs of cylinders, refilling liquid portables and being able to go on trips without arranging for oxygen equipment or refills along the way.

In 1983 there was no CPAP for the treatment of obstructive sleep apnea. It wasn't until the end of 1984 that Respironics received FDA clearance to sell its Sleepeasy unit. I was fortunate to be a part of the introduction of CPAP to the fledgling sleep disorders community. Our company, Universal Medical Sales, represented Respironics in six Middle Atlantic States until 1989. Those years saw great strides in the evolution of the CPAP unit. What started as being bigger than a breadbox, too heavy to be easily portable, and as loud as a window air conditioner is now considered heavy if it's over just a few pounds, is practically silent and is getting down to the size of a thick paperback novel. Not to mention the achievements made to masks and nasal interfaces and their headgear, as well as humidifiers. Four or five manufacturers dominate the market with perhaps another dozen competitors vying for their share of this still growing market.


MedTrade has also evolved. No longer is the primary reason to attend to take advantage of the manufacturer's show special sales. It has become the place to see and compare the latest technologies and innovations. Just as importantly, each of the shows three days offers three hours of lectures, seminars and presentations on all the aspects of homecare including a full tract on respiratory. HIPAA, accreditation, new FDA oxygen regulations, sales, management, pending Federal legislation, reimbursement issues, the topics of interest seemed endless.

I feel fortunate to have selected inhalation therapy in 1962 as my career path and to have stayed with it in one form or another for over 40 years. It was in 1963 that I first instructed a patient in his home on how to take an IPPB treatment, probably with Isuprel and Alevaire in the Bird or Bennett unit's nebulizer. For 20 years respiratory homecare was a part-time activity to my full-time position as a respiratory therapy educator. I experienced the introduction of oxygen concentrators that replaced multiple large cylinders thus making long-term oxygen therapy practical in the home. That was soon followed by the introduction by the Linde Company of home liquid oxygen dewers and companion liquid portables. Now oxygen patients were no longer tethered to their home stationary unit and could get around without being hindered by needing to bring along numerous heavy steel "portable" cylinders. Around this same time aluminum cylinders began to slowly replace steel in homecare.

Sometime in the 1970s I worked with my first ventilator dependent patient in the home. Accurate Medical Service, the innovative home medical equipment company I had worked with, didn't hesitate when a local physician asked if they could provide a ventilator for an ALS patient so he could be at home. Since a true home care ventilator did not yet exist, two MA-1s were purchased, and the full-time therapist carried one in his van 24/7 as the backup. The patient, thanks to his devoted caregiver mother, went on to live another seven years with minimal rehospitalizations. Today some half dozen compact portable ventilators are available with a wide-ranging array of functions.

If my memory serves me well, it was in the early 1980s that Chad Therapeutics introduced reservoir oxygen conserving devices. By providing a bolus of high concentration oxygen at the beginning of each inspiration many patients could maintain good oxygen saturation levels at half the oxygen flow rate. During the days of high reimbursement levels for oxygen and when HMEs were paid for the amount of oxygen used, there was little incentive for the use of conservers. The last several years have seen a proliferation of conserving devises being used on stationary and portable gaseous and liquid systems. Several dozen makes and models are available utilizing different theories and technologies requiring therapists to understand their operating functions and limitations and proper applications.

In deed, much has happened during my tenure in this field. We have grown from being oxygen cylinder jockeys, to inhalation therapists, to respiratory therapists, to respiratory care practioners. We are licensed in almost every state. Formal education in an accredited program and a NBRC credential are minimum criteria for employment. The public, our peers and to some extent the government recognize us as a viable and valuable component of the health care delivery team, both institutionally and in homecare. However, we still have a long way to go!

In future issues I look forward to exploring topics of concern to the field particularly respiratory home care. I eagerly anticipate meeting with and talking to many of you at the AARC Congress in Las Vegas in December, the Focus Conference in Baltimore in April and MedTrade in Orlando next October.

by Alan Saposnick RRT
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Title Annotation:HOMECARE
Author:Saposnick, Alan
Publication:FOCUS: Journal for Respiratory Care & Sleep Medicine
Date:Sep 22, 2003
Previous Article:Professional Guide to Sleep Disorders Management.
Next Article:Foundations of Respiratory Care.

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