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AUTUMN 2023 InTouch | 7 PROVISION OF COUGH ASSIST MACHINES IN NEW ZEALAND A summary of MDANZ funded research undertaken by Meredith Perry, Andrew Campbell, Calista Fung, and Alister Neill at the University of Otago. FEATURE Background Neuromuscular disorders (NMD) can present with progressive respiratory muscle weakness and dysfunctional glottis closure, both of which contribute to an impaired cough. An ineffective cough results in secretion retention, leading to frequent respiratory infections, hospitalisations and increased heath risk from acute exacerbations and persistent respiratory failure. Mechanical insufflation-exsufflation (often known by the brand name of a cough assist machines- CAM) devices are recommended when cough is significantly impaired for people with a NMD to assist with secretion mobilization and clearance. A CAM is usually used in combination with other physiotherapy techniques. However, there are no national guidelines (except the recently released Motor Neurone guideline – 2022) to inform clinicians on recommended practice. Anecdotal discussion between health professionals suggested that there are discrepancies between various regions and hospitals in New Zealand regarding: availability of CAM devices; access to device training; provision criteria and; clinical support around ongoing patient use. Regional differences for CAM use in people with NMD pose a risk of inequitable access to respiratory management. This study had three main objectives – 1. To determine the number of CAM devices across New Zealand’s district health boards (DHB’s) for people with NMD 2. To explore currently used guidelines and clinical criteria for provision of CAM by physiotherapists and, 3. To gain an understanding of the experience of being deemed eligible for a CAM, access to service provision and also funding of CAM by both physiotherapists and The “ambulance at the bottom of the cliff” people with NMD. Ethical approval was granted by the University of Otago Human Ethics Committee (Health) (H21/122) and locality approval from all DHB’s The study collected data from three sources. A survey of every DHB which asked for numbers of DHB CAM’s and open questions around service provision. Interviews collected data from respiratory physiotherapists who had provided CAM in the last year and people with NMD who had used CAM in the last year. Data was collected over a period of two years mostly due to Covid restrictions. Research Findings All DHB’s participated in this research. However, as of 1st July 2022 New Zealand shifted to a new national system of healthcare whereby the 20 former DHBs were merged into four much larger regional bodies of Te Whatu Ora. As data was collected from the former DHBs initial data analysis was conducted from these organisations. These data were then grouped into their new Te Whatu Ora bodies. It is also important to note that survey respondents recognized that some of their responses were incomplete and based on estimates; there appeared to be no consistent method either within a DHB or between DHB’s for managing CAM whereabouts and allocation to specific patients. Nine physiotherapists gave interviews. Years of experience with CAM provision ranged from 3 to 18.