COPD Insider

Answers to some of your trickiest care questions

 

As we learn more and more about COPD, many questions remain. Discover what our panel of insiders had to say about some of your most pressing questions.

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COPD affects nearly 30 million people in the United States.1

As the prevalence continues to rise, so does the overall cost of care. To curb these rising costs, strides have been made to improve COPD care delivery. From new guidelines and protocols to innovative devices and medications, the COPD community is dedicated to easing the burden of this disease.

Despite the progress that has been made, many questions remain. We took some of those pressing questions to our panel of COPD experts. Read on to hear their insights and to learn what you can start doing TODAY to improve care delivery.

Contributors

Christine Cunningham

Christine Cunningham, RRT

Director of Clinical Services

CHI Health at Home

Brian Carlin

Brian Carlin, MD, FCCP, FAARC

Critical Care Staff Physician

Altoona Regional Health System

Becky Anderson

Becky Anderson, RRT

Manager, Respiratory Care Services

Sanford Medical Center

Jennifer Anderson

Jennifer Anderson

Director of Respiratory Care and Pulmonary Function Labs

AU Medical Center

Les Duncan

Les Duncan

Director of Operations

Highmark Community and Health Services

Jill Ohar

Jill Ohar, MD, FCCP

Professor of Internal Medicine, Pulmonary, Critical Care, Allergy, and Immunological Diseases,Wake Forest University School of Medicine; Director of Clinical Operations,

Wake Forest University Baptist Medical Center.

Question #1

My patients seem to understand their treatment plan and the health implications of nonadherence, but they still don’t follow the guidance they’ve been given.

 

How can I better support my patients in staying engaged in their treatment long term?

Question 1 icon

Christine Cunningham advises that you should keep care centered around your patients’ needs through motivational interviewing.

 

It’s critical to understand what motivates your patients to engage with them in a positive way. Motivating factors will be different for everyone but consider starting by asking your patients about what they desire out of treatment and out of life.

The do’s and don'ts of motivational interviewing

 

Do

  • Ask the patient what makes them happy/what activities they enjoy
  • Identify goals the patient wants to achieve
  • Encourage the patient to focus on the positive elements of their lives

 

Don't

  • Scold or reprimand the patient for nonadherence
  • Discuss specific treatments (the discussion should be focused on the patient)
  • Assume the patient isn’t trying
Christine Cunningham video
We create a goal centered around the patient’s problem. And in doing so, it engages them in participating to create a goal.”

Christine Cunningham

Director of Clinical Services, CHI Health at Home

Question #2

I put my patients on a specific treatment plan based on their individual case. But because other care team members aren’t informed about what we discussed, they often give conflicting direction. This leads to confusion and dramatically raises the risk of readmission.

 

How can I ensure that patient care is aligned throughout the entire continuum?

Question 2 icon

Ms. Cunningham suggests creating a patient checklist that can be used at each appointment.

 

You go to great lengths to understand your patients’ needs, but it’s equally important to document these needs to ensure other care team members understand them as well.

 

Work with your patient to create a checklist of the things they need. This can include goals, education, prescriptions, rehab, or follow-up appointments. Encourage your patient to bring this list to every appointment and share it with every care team member.

Use these thought starters to refine your patient checklist

Patient goals

  • Therapy-related
  • Life-related

 

Education

  • COPD general
  • Importance of adherence
  • Therapy options
  • Medication usage
  • Other

 

Health-related

  • Is the patient able to exercise?
  • Is the patient a smoker?
  • Does the patient have an underlying mental illness?
  • Does the patient have any key comorbidities?
  • What is this patient’s readmission history?
  • Other

Prescriptions

  • Names of medications
  • Types of devices
  • Other

 

Rehab

  • Is the patient enrolled in pulmonary rehab?
  • Other

 

Follow-up appointments

  • When is the patient due for a follow-up visit?
  • Other

 

Other

  • Does the patient have an action plan in the event of an exacerbation?
  • Other
By documenting the elements of your patients’ care experiences and plans, you can ensure pieces don’t fall through the cracks as each patient moves throughout the system. Keeping the lines of communication open between care team members helps you enable better collaboration, alignment and patient health.
Jennifer Anderson video
You have the ED physician, the hospitalist physician, the ICU physician, the primary care provider, and oftentimes it is a handoff from one to the other without much communication.”

Brian Carlin

Critical Care Staff Physician, Altoona Regional Health System

Question #3

Some of my patients continually readmit to the ED despite already being on an established care plan.

 

How can I ensure continuity of care so they can stay healthy at home?

Question 3 icon

Dr. Jill Ohar recommends establishing a care coordinator to help patients get the care they need in the most appropriate setting.

 

A care coordinator acts as a point of contact for the patient once they leave the hospital. It can be a nurse, a respiratory therapist (RT) or someone newly appointed. This person can lead the charge for a readmission reduction program, and they can also help to de-escalate situations that would normally result in an ED visit. From ensuring proper discharge protocol to mitigating patient concerns, the care coordinator quickly becomes an invaluable part of your care team when it comes to reducing readmissions.

Ensure your care coordinator is providing the greatest value by adhering to these responsibilities

 

  • Ensuring patients understand their discharge plan
  • Helping patients book and confirm follow-up appointments
  • Acting as a point of contact if the patient has any problems
  • Reinforcing self-management efforts in the home
  • Helping patients navigate the complex healthcare system
Becky Anderson video
You need to make sure you have the people in charge of building the program and maintaining it.”

Becky Anderson

Manager, Respiratory Care Services, Sanford Medical Center

Question #4

Many of my patients leave with a treatment plan that includes some sort of follow up or pulmonary rehab. But in many cases, these patients don’t have a way to get to their appointments.

 

What can I do to ensure that my patients have access to the care they need?

Question 4 icon

Les Duncan suggests identifying simple, effective ways to connect patients with needed transportation.

 

COPD primarily affects an older population. In many cases, due to comorbidities, these patients can no longer drive and rely on a caregiver or family member to get them to appointments. When this is not enough, and patients begin missing follow-ups, it’s time to look outside the box for better transportation options.

Key ways to connect patients with transportation

 

Personal connections

If your patients can’t drive themselves, encourage them to reach out to friends, family or others. Often, these people won’t volunteer to help because they are unaware of the need. But with a fuller understanding, their generosity can help drive better outcomes all around.

 

Local partnerships, such as with churches or community initiatives

Do a little outreach to local organizations. This can help to spark some interest in how they can support the community with simple transportation. You may be amazed at what you’ll find.

 

Companies like Uber, Lyft and taxi services

Help your patients download applications that can connect them with inexpensive transportation. These applications are so simple and convenient that no patient should have to miss an opportunity to receive care. In many cases, Medicaid will even cover the cost of patient transportation to non-emergency medical appointments, as do many Medicare Advantage plans.

Are there other opportunities in your local area? Work with your care team, engage with the community, and get creative. Possibilities are all around you.
Christine Cunningham video
But we have to be innovative as you said before, you have to be looking at other things. There’s people out there that want to help and they’re taking somebody to the doctor anyway, usually it’s a family member, they wouldn’t mind picking somebody else up too.”

Christine Cunningham

Director of Clinical Services, CHI Health at Home

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Further reading

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As COPD continues to plague millions of people, we continue searching for solutions. Each new initiative or program is another step forward in care delivery. As you and your team embark on new, innovative initiatives, rely on COPD insider for the proven strategies that can bring success closer.

References

1. Iyer AS, Bhat SP, Garner JJ, et al. Depression is associated with readmission for acute exacerbation of chronic obstructive pulmonary disease. Ann Am Thorac Soc. 2016;13(2):197-203.

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