By ANNE CHRISTIANSEN-BULLERS
KU Medical Center
The COVID-19 pandemic shed light on many shortcomings in rural health, and one of them was the lack of certified pulmonary rehabilitation specialists in rural areas. These are medical professionals in various fields who have received extra respiratory training to guide patients through therapies intended to enhance their breathing and strengthen their pulmonary system once it’s been damaged.
Faculty at the University of Kansas Medical Center are leveraging a $1.54 million federal grant to get more trained pulmonary rehabilitation specialists into rural Kansas. The three-year grant from the U.S. Health Resources and Services Administration (HRSA) runs through 2025.
Dave Burnett, Ph.D., associate dean for community engagement and workforce initiatives in KU School of Health Professions, said “the light bulb just went off” when the grant application suggested pulmonary rehabilitation as a potential focus area. “The reality of the situation is that there are not enough folks with specialized (pulmonary rehab) training in Kansas, and that’s the gap that we needed to improve,” he said.
Even though the HRSA established the grant with COVID in mind, Burnett said more pulmonary rehabilitation specialists in Kansas would be an advantage for other respiratory problems, too. He quoted a federal statistic indicating that only 4% of all COPD patients eligible for pulmonary rehabilitation under Medicaid or Medicare actually received that rehabilitation.
“In addition to a lack of clinicians with specialized training in pulmonary rehabilitation, there is a scarcity of actual (pulmonary rehabilitation) programs, especially in rural communities,” said Burnett, who is also an associate professor in the Department of Respiratory Care and Diagnostic Science in KU School of Health Professions.
A collaboration between Health Professions and Nursing
The grant-funded initiative is called the Interprofessional COVID Academic Network, or I-CAN. Burnett contacted Cynthia Teel, Ph.D., FAAN, professor and associate dean of academic affairs in KU School of Nursing, to make the initiative interprofessional.
“We want to bring together the skills that respiratory therapists have and the skills that registered nurses have, and bring these skill sets together for the benefit of the patient,” Teel explained. “We’ve started with respiratory therapy and nursing as the two professions in this stage of the grant, but it in no way has to be limited to only those two professions.”
The initiative currently has three major parts. First, faculty reviewed the curriculum of a pulmonary rehabilitation certificate already offered by the American Association of Respiratory Care (AARC) to assure its appropriateness for treating long COVID.
Second, primary investigators reached out to faculty at KU School of Nursing-Salina as well as instructors of nursing and respiratory care programs at Kansas community colleges that serve rural populations. These educators then incorporated elements of the pulmonary rehabilitation curriculum into existing classes, and students were able to use grant funds to cover the costs of certification.
Two examples from community colleges
Delyna “Dee” Bohnenblust, director of the nursing program at Labette Community College in Parsons, Kansas, said the initiative gave nursing faculty and students a “wonderful opportunity” to improve their skills. Parsons is located in southeast Kansas, 150 miles from Kansas City. “We are very rural, and we don’t have the same resources available that you’re going to have in the larger metropolitan areas,” Bohnenblust said.
All eight members of the Labette Community College nursing faculty became certified in pulmonary rehabilitation, and following extra training incorporated into their last class before graduation, all 29 nursing graduates of the Class of 2023 became certified as well.
“Respiratory nursing has always been part of the general nursing curriculum, but it does not lend itself to the depth that this certification allowed,” Bohnenblust said. “We looked at this truly as an opportunity as we’re coming out of the COVID pandemic for students to feel more prepared as they graduate our program and move into entry-level nursing positions.”
Seward County Community College, Liberal, has had 10 respiratory therapy students and two respiratory therapy faculty members certified in pulmonary rehabilitation via the new initiative.
Janae Zachary, director of respiratory therapy, said the certification builds student confidence. “Only a small part of the respiratory therapy curriculum is currently dedicated to reviewing cardiopulmonary rehab,” she said. “The access provided by I-CAN to the AARC Pulmonary Rehabilitation certification program certainly covers it more completely and supports their competency in this area.”
Seward County Community College’s nursing program is now considering adding pulmonary rehabilitation via the new initiative as well, Zachary said.
Expanding the initiative to current professionals
The third element of the network, currently under development, is to contact hospitals and clinics so nurses, respiratory therapists and other medical clinicians currently in practice have an opportunity to be certified as pulmonary rehabilitation specialists.
“We’re committed to increasing skills in the rural health care workforce, and we also have recognized the importance of trying to provide meaningful resources for people who have had COVID-19 and who are dealing with the aftermath of long COVID,” Teel said.
“Now, especially, as the resources available during the acute portion of the pandemic are being discontinued and we move into a more post-pandemic phase, this project has given us the opportunity to ask, ‘What are the needs of the people in our communities, and what can we do to improve things for the people with those needs?’”