Emerging Research Assesses The Ability Of DPMs To Supervise HBOT

Research should be the basis of patient care for any health-care provider and sometimes that means a paradigm shift in a specific pathology or treatment.  Several years ago, I wrote a blog on monitoring hyperbaric oxygen treatments (HBOT) and the role of podiatric physicians.¹ At that time, the wound care center in which I treated patients made the decision that podiatric physicians could not monitor HBOT. I based my conclusions on anecdotal experience, not evidence-based research, because none existed on that specific topic at that time. 

Certainly, some of my colleagues disagreed with my conclusions as their anecdotal experience was different from mine, since they monitored HBOT in their wound care centers. I understood their frustration with that specific blog.¹ New evidence-based research submitted to the American Podiatric Medical Association Annual Meeting/Summer Series Abstract Competition by Rogers, Crisologo and Lavery proves podiatric physicians with appropriate HBOT education, training and experience are equally qualified to supervise HBOT as our allopathic and osteopathic colleagues.²

As the authors state, “Occasionally, payers, institutions, or competitive organizations have expressed concern that because podiatrists are limited license providers, they may not be able to recognize or manage complications of HBOT, especially if there was a seizure or tension pneumothorax.”² The study authors set out to compare HBOT complications rates among different types of providers.

Drawing upon data from 204,252 units of HBOT, the study authors excluded events due to equipment issues, conflicting appointments, weather, fire alarms, community emergency, provider coverage, and bowel or bladder urgency.² They categorized complications as serious (chest pain, shortness of breath, seizure, hypertensive emergency, unresponsiveness, hypoglycemic event) or minor (confinement anxiety, barotrauma, pain, nausea, dizziness, headache, visual changes).

Monitoring 56,723 units of the 204,252 units of HBOT, podiatric physicians had a complication rate of 0.12 percent whereas all other supervising providers averaged a 0.28 percent complication rate.² When separating out the serious events, researchers noted the complication rate for DPMs was 0.019 percent in comparison to 0.043 percent for other providers.²

In addition to finding that HBOT is a safe modality with a low complication rate, the authors found that “Doctors of podiatric medicine had a lower rate of overall complications, and when (these complications are) separated by severity, had significantly lower rates of both serious and minor complications. With appropriate training, it appears to be safe for DPMs to supervise HBOT.”²

This is the kind of evidence that propels the profession forward while ensuring patient outcomes. The Center for Medicare and Medicaid Services (CMS) National Coverage Determination for HBOT lists 15 qualifying conditions for treatment with eight of those within the scope of podiatric physicians.³ I commend Rogers and colleagues for examining the topic to provide clarity to the question of podiatric supervision of HBOT. I happily admit I was wrong in my opinion on this topic. 

“Research is formalized curiosity. It is poking and prying with a purpose.” 

― Zora Neale Hurston

Dr. DeHeer is the Residency Director of the St. Vincent Hospital Podiatry Program in Indianapolis. He is a Fellow of the American College of Foot and Ankle Surgeons, a Fellow of the American Society of Podiatric Surgeons, and a Fellow of the American College of Foot and Ankle Pediatrics. Dr DeHeer is also a Fellow of the Royal College of Physicians and Surgeons of Glasgow, and a Diplomate of the American Board of Podiatric Surgery.

References

1. DeHeer P. Should podiatric physicians monitor HBOT? Podiatry Today. Available at: https://www.podiatrytoday.com/blogged/should-podiatric-physicians-monitor-hbot . Published May 16, 2012. Accessed August 19, 2020.
2. Rogers LC, Crisologo A, Lavery LA. Podiatrists supervising patients undergoing hyperbaric oxygen treatments (HBOT) had a lower complication rate than all other providers: a retrospective review of 204,252 consecutive units of HBOT.. https://indexsmart.mirasmart.com/APMA2020/PDFfiles/APMA2020_Pres-000153.pdf
3. Centers for Medicare and Medicaid Services. National coverage determination (NCD) for hyperbaric oxygen therapy. Available at:  https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?ncdid=12&ver=3 . Published June 19, 2006. Accessed August 19, 2020.
4. Rogers LC, DellaCorte MP, Stavosky JW, Millington JT, Capotorto JV. Credentialing guidelines for doctors of podiatric medicine supervising hyperbaric oxygen therapy: a position paper. J Am Podiatr Med Assoc. 2015;105(4):367-370.