Health Care Professionals

How to Apply

Getting it right the first time.

Application to PROP should only take place after the individual being considered for eligibility has been medically optimized. Medically optimized implies that the health care team has determined that the individual is stable, that no further acute medical care is necessary or appropriate and that preparations for discharge are being made.

Candidates on Bipap should have their application to PROP submitted within 5-7 days of discharge (including recent ABG results). Candidates who are invasively ventilated require significantly more preparation specific to their home supports, i.e.: 3-5 caregivers being trained, and to ensure that they meet PROP criteria; complex candidates should have their application to PROP be submitted early in the discharge planning process.

A PROP application form should be completed by the attending Respirologist and should be submitted with proof of medical optimization i.e.: consult and history notes that identify that individual is stable and ready for discharge. Failure to provide the necessary documentation and/or ensuring that care by a Respirologist in community has been arranged, may create a delay in assessing an individual’s eligibility to PROP and discharge from hospital.

Prescriptions

PROP Medical Criteria

Individuals who meet the following medical criteria may be eligible for PROP services:

  • Candidates should be stable and optimally managed for any reversible component of their associated pulmonary disease
  • Candidates are required to be under the care of a Respirologist on discharge
  • Individuals with neuromuscular disorders or chest wall restrictions that have documented hypercapnia (PCO2 at rest on room air >45mmHg)
  • Individuals who have neuromuscular disorders or chest wall restrictions that have normal PaCO2’s (in the range of 40-45 mmHg) may be considered eligible if any of the following other criteria are present:
    • Cor Pulmonale
    • Nocturnal hypoventilation (as documented by elevation in nocturnal CO2 (TCCO2) levels and associated morning symptoms)
    • Severe supine dyspnea i.e., Diaphragmatic paralysis
    • Symptoms of alveolar hypoventilation
  • Individuals with normal neuromuscular function but who have documented central alveolar hypoventilation secondary to abnormal ventilatory control may qualify i.e., Primary Alveolar Hypoventilation or Obesity Hypoventilation Syndrome
  • Individuals who use a tracheostomy with re-usable (whenever possible) inner cannula. Uncuffed tracheostomy tubes are preferred; potential members requiring a cuffed tracheostomy tube will be assessed for program eligibility on an individual basis. Speaking valves used with uncuffed tracheostomy tubes will be considered when they are situated in-line with documented evidence of being well tolerated and within accepted risk parameters
  • Individuals who are not PEEP dependent
  • Individuals whose secretions can be safely managed without the use of in-line suction

PROP Non-Medical Criteria

  • Must be 19 years of age or older
  • Must be a BC citizen and registered with the BC Medical Services Plan
  • Candidates must be capable of self-directing their therapy so that they have control over their choices and decisions when it comes to their own respiratory care and therapy or have a current and appropriate Representation Agreement in place
  • Candidates who reside in assisted living/transitional care facilities are eligible if they can direct their own respiratory care and therapy (via themselves or through a Representation Agreement) and no other service provider (other than their physician/Respirologist) is involved in directing PROP clinicians in care
  • Candidates are strongly encouraged to have a current Representation Agreement in place prior to application being made

At Home Program Applicants

  • All candidates coming from the At Home Program are required to have made formal application to PROP through a prescription for services
  • It is recognized that candidates coming from the At Home Program are sometimes not able to fully participate themselves in decisions about their respiratory care and therapy and that a parent or other designated representative will be involved; in this situation, a current Representation Agreement must be in place
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