5 Questions: Tim Buckley

Tim Buckley, MSc, RR, FAARC (Tim.buckley@uhsi.org) is Director of Respiratory Care, Sleep Disorder Center and Neurodiagnostics for United Hospital System in Kenosha, Wisconsin. Amazingly (his word!), Tim graduated from his RT program more than 40 years ago. Since that time he has worked in a variety of settings, including: pediatric critical care, home care, acute care, management and most recently in value-based care initiatives. He has worked both in industry for a Fortune 35 company as well as various hospital systems.

Along with an associate’s degree in respiratory care, Tim has a BA degree in management and a master’s in respiratory care. He is a frequent author and speaker on topics related to respiratory care. He was recognized by the American Association for Respiratory Care in 2002 as a Fellow for significant sustained contributions to the profession of respiratory care. In 2004 he was honored to be awarded the Invacare Award for Respiratory Care for Excellence in Home Respiratory Care.

What is the biggest challenge you face in improving the lives of people with COPD?

The biggest challenge that we all continue to face is the lack of diagnosis and early recognition of COPD. When you review the chart of a patient with symptoms, there is often no clear diagnosis of COPD; acute exacerbations are also often managed by just treating the symptoms. Early recognition and diagnosis are particularly important in the current healthcare environment. The value-based initiatives that drive programs and payments are evidenced based and outcomes oriented. We can achieve extraordinary outcomes, but only if we know what we are trying to achieve.

To achieve this accurate and timely diagnosis, RTs should be working closely with physicians in the frontline identification of COPD. Most people with early COPD (and many with moderate) are not seen by a pulmonologist, so RTs need to work closely with Internal Medicine and Family Practice docs to ensure that individuals with COPD are treated for COPD. Smoking cessation, pulmonary rehab and medication adherence are all important steps in slowing the progression of symptoms and avoiding exacerbations.

What do you think is the single most promising practice in COPD diagnosis or care right now?

Clearly the single most effective practice in COPD management is effective pulmonary rehabilitation. Effective pulmonary rehabilitation combines all of the evidenced-based best practices for COPD management and exacerbation avoidance. Anyone working around pulmonary rehab knows that there are many obstacles to patient participation in pulmonary rehab – it is our job as professionals to recognize those obstacles and do everything we can to support patient participation.

If you are involved in pulmonary rehab, take a look at the patients who do not come to sessions and you will identify many of these obstacles. To support good program outcomes, you may have to work around issues such as transportation, parking or patient/caregiver behavioral issues. It is always worth it if you increase participation. We improve the patient outcomes one patient at a time.

Value-based healthcare recognizes that chronic diseases are where resources need to be concentrated, especially if those resources can reduce overall spending and improve the quality of care. Pulmonary rehab clearly produces these outcomes at a relatively low cost.

If you had a magic wand, how would you improve COPD care?

My magic wand would take us back to early identification and recognition of COPD. While we all remain hopeful for a cure, the reality is that with smoking, air quality issues and genetics we will continue to see COPD for many years. The good news is that we have very effective disease management techniques once we effectively engage the patient and their caregiver. Nothing can be done until we know someone has COPD – treating the symptoms alone is not enough.

What is one aspect of COPD diagnosis or care you think is too often overlooked?

It seems like I may be harping on it, but early recognition and diagnosis is clearly overlooked by many. As an RT, I constantly talk to patients who report a history of symptoms – on top of a significant smoking history – who have never been evaluated for COPD. It is also not infrequent for me to see individuals who are being treated for symptoms that have never had spirometry.

For many physician practices, there are barriers to obtaining accurate and timely spirometry for their patients. I have recently worked with an accountable care organization (ACO) that developed a patient-centered medical home (PCMH) to care for high-risk patients. We were able to put an RT into that practice to help in providing appropriate screening and spirometry at the practice setting. The RT also provided patient education, smoking cessation, medication management and pulmonary rehabilitation referrals.

A few hours per week of RT time at the point of referral is paying big dividends to this population of high-risk patients. They are not waiting for the patients to become symptomatic or show up at the ED. They are working with the primary care doc (family practice) to screen for high-risk patients. Early stage COPD is being identified and managed, so time will tell if they will bend the curve on COPD.

What do you think will be your most important contribution to improving the lives of people with COPD?

As I mentioned earlier, we have effective treatments and approaches for the management of COPD. Between pulmonary rehabilitation, improvement in symptom management, exacerbation avoidance and home oxygen support, we can improve the lifestyle and safety of those with COPD. I hope that my contribution will be to continue to bring the RT to the forefront of COPD management. We are uniquely qualified by education, training and experience to be experts in management of COPD. Yet, most RTs are employed in providing acute care of the COPD patient.

The Care of the Sick Era is ending and we are beginning to look at the delivery of Well Care, yet I find only a few RTs are aware of what this means for them. Education programs continue to focus on providing acute care. IF “well care” is successful, there will be fewer individuals admitted to hospitals with COPD and they will be there for shorter periods of time. RTs need to shift their focus and continue to provide value at the point where it will do the most good. If I can provide anything in the remaining years of my career, I hope it is a road map for RTs to be engaged in the management of the number one disease that impact respiratory health: COPD.

This page was reviewed on March 3, 2020 by the COPD Foundation Content Review and Evaluation Committee