Primary care and family practice nurse practitioner Dixie Harms, DNP, ARNP, FNP-C, BC-ADM, FAANP, works in a busy Iowa primary care practice and sees a large number of patients weekly. Over the years, she has become more familiar with the risks and effects of COPD and is working diligently to make a difference in the lives of her patients.
Her first step was to seek an effective, validated tool to help identify at-risk patients. When she discovered the COPD Population ScreenerTM (COPD-PS) endorsed by the COPD Alliance, she adopted it into her practice. “I consider using the screener whenever I have a patient who either smokes or works in an occupation that may increase risk factors for lung disease,” Dr. Harms said. “I keep the screener in my office and distribute it to patients, asking them to take a moment to answer the questions. It is a simple assessment tool for early detection of COPD. I was definitely not addressing all the important questions prior to using this screening tool,” she said.
The second step of Dr. Harms’ process involves the use of in-office spirometry. The screener has helped identify patients appropriate for spirometry testing, currently the only test available for diagnosing COPD. Technology has brought about many changes in spirometry testing, transforming it from a test performed only in a hospital setting to an easy-to-use tool for the primary care clinician. With a little training, in-office spirometry can become an important asset to the clinician, and its use for at-risk patients is also reimbursable. She notes that “doing spirometry in the office definitely helps because you can show patients their printouts and see where their numbers are, so they can see the reality of it all.”
Early detection allows Dr. Harms more time to educate patients about their disease and the benefits of smoking cessation. However, as simple as this tool is, she has encountered patient resistance. “Convincing patients that early detection of COPD is necessary is usually difficult and not the primary reason for their visit to the clinic.” She added, “I like to see my patients with COPD at least every 6 months. Reinforcement of smoking cessation occurs at each visit, and I try to offer my patients options such as patches, inhalers, medications, and quitting cold turkey.”
Sometimes, despite the best efforts of clinicians, a COPD diagnosis can be missed in patients such as an 84-year-old former farmer who never smoked. “This patient came to the clinic complaining of not having the wind he used to have,” Dr. Harms said. Despite multiple comorbid conditions, he had never been assessed for COPD. His responses to the questions on the COPD-PS demonstrated that he needed to be evaluated. Years of exposure to dust, pollens, chemicals, and manure had done their damage, and spirometry confirmed COPD. He was finally able to get the proper disease management support he needed and, although he is not always compliant with his medications, according to Dr. Harms, his progress is being monitored.
Much like the hard-working people she serves, Dr. Dixie Harms is using all available tools to make her practice “COPD Prepared.” Learn more about how you can become COPD Prepared.