Remember when your doctor knew a lot about your family? He or she might have asked about the dog, how your job was going, and if there was any more trouble going with that Chevy. In other words, your doctor knew medical histories and what life was like at home—diet, stress level, social interactions, work, median income, commute, family dynamics, and community involvement.
Medical diagnosis, intervention and therapy have improved dramatically over the decades. However, one integral part of the past may be needed now to help us optimize treatment for today’s COPD patients.
Well, there used to be this thing called a physician-patient relationship. Now if you see the same physician twice in a system it's pretty remarkable—that long-term relationship with your small-town doctor is gone. If you have a multi-year relationship with the same physician, you have that opportunity to accomplish so much more.”
Chris Landon, MD, FAAP, FCCP, CMD
Director of Pediatrics, Ventura County Medical Center Associate Medical Director of Pediatric Diagnostic Center, and CEO of Landon Pediatric Foundation
Chikita Mann, MSN, RN, CCM Disability RN
Case Manager Supervisor
Genex Services, LLC for the State of Georgia
Jerry Krishnan, MD, PhD
Associate Vice Chancellor for Population Health Sciences
University of Illinois Hospital and Health Sciences System
Keith T. Kanel, MD, MHCM, FACP
Clinical Associate Professor of Medicine University of Pittsburgh
Krystal Craddock, BSRC, RRT-NPS, AEC
COPD Case Manager
Department of Respiratory Care at UC Davis Medical Center
Chris Landon, MD, FFAP, FCCP, CMD
Director of Pediatrics, Ventura County Medical
Director of Pediatric Diagnostics Center and CEO, Landon Pediatric Foundation
Why the patient-physician relationship is important
GOLD* guidance recommends COPD patients be assessed on:
Impact of symptoms
Assessment of FEV1
History of exacerbations
Presence of comorbidities
It’s about getting to know the individual beyond an FEV1."
Jerry Krishnan, MD, PhD
Associate Vice Chancellor for Population Health Sciences, University of Illinois Hospital and Health Sciences System
Beyond GOLD guidelines, evidence suggests that a patient-centered approach—with meaningful physician-patient communication—improves the quality and efficiency of care, patient satisfaction, and clinical outcomes.
Despite an emphasis on patient-centered care, research suggests there’s a lack of understanding between patients and physicians.1,2 A poor understanding of patients can result in treatment decisions that don’t match a patient’s ability or reality.1
In a 2013 cross-sectional, descriptive, multicenter study in COPD patients (n=450), concordance between patients and their pulmonologists was analyzed. In the study, the concordance analyzed by the Kappa index between patients and physicians based on the perception of symptom severity was poor.1
of physicians agreed with patients1
Insider insight: COPD patients vary significantly in meaningful ways
Different therapies: inhaler, ventilator, oxygen
Different regimens: monotherapy, dual therapy, triple therapy
Gender: male and female
Age: 40-year-olds and 90-year-olds
Different background: income, family size, home, mental state, health literacy, comorbidities, cultural/community
As Chikita Mann explains, “The 40-year-old COPD patient is not the same as a 65-year-old COPD patient. The 40-year-old may be trying to catch a trip to Las Vegas. Yes, he’s got the diagnosis, but he's ready to party. The 65-year-old COPD patient is saying, ‘I'm getting ready to retire and I want to spend more time with my grandchildren.’ You cannot treat those two patients the same. And I think that what has happened with COPD, we put it in a box. This neat little box, this is how we treat everyone and it's not working.”
If we don’t take an individual approach to understanding our COPD patients on a deeper level—and treating them based on their abilities and personal lifestyle goals—are we setting them up for failure?
If we really want to start to tackle COPD readmissions and exacerbations, we’ve got to see the patient for who they are, where they are, and why it is important for them to remain healthy. And when we do that, we'll be making a big impact, when it comes to outcomes in COPD.”
Chikita Mann, MSN, RN, CCM
Disability RN Case Manager Supervisor Genex Services, LLC for the State of Georgia
Success Snapshot: Getting personal enhances COPD outcomes5,6
The Reversible Obstructive Airway Disease (ROAD) program, established at UC Davis in 2012, brings hospitalists, nurses, pharmacists, discharge planners and respiratory therapists together in a united mission to improve patient outcomes and reduce costs of care.
ROAD educates, engages and empowers patients to successfully transition them from hospital to home.
individualized treatment planning
access to a registered respiratory care practitioner
My name's Krystal Craddock, I am a COPD Case Manager at UC Davis Medical Center. I'm a registered respiratory therapist, a certified asthma educator and a certified case manager. For the role of a COPD case manager it really takes a certain type of person, and for the role of a respiratory therapy COPD case manager. Not everybody you know wants to do it. Not every therapist wants to work in the NICU or the PICU or with the emergency traumas that come in our department. So we want to make sure that this therapist really has the drive to want to think about not just working in the critical care setting, but thinking about the continuum of care… from when the patient comes in the emergency department until they go home, and then there on after. So we need someone who is really driven to want to help the patient manage their disease at home, and to help improve quality of life—not just saving a life at that moment. You're really thinking about what's going to happen to the patient after they leave the hospital.
Krystal Craddock, BSRC, RRT-NPS, AE-C, CCM
COPD Case Manager UCalDavis
reduction in COPD readmissions
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1. Miravitlles M, Ferrer J, Baro E, et al. Differences between physician and patient in the perception of symptoms and their severity in COPD. Respir Med. 2013 Dec;107(12):1977-85. doi:10.1016/j.med.2013.06.019. Epub 2013 Jul 24. 2. Ulmeanu R, Mihaltan F, Arghir O, et al. Treatment Goals in COPD: The Concordance Between Patients and Physicians (Interim Results of ACORD Study). Chest. 150(4):873A. https://doi.org/10.1016/j.chest.2016.08.973. 3. Heath S. 3 Key Traits of a Positive Patient-Provider Relationship. Patient Engagement Hit. https://patientengagementhit.com/news/3-key-traits-of-a-positive-patient-provider-relationship. Accessed January 23, 2019. 4. Luxford K, Sutton S. How does patient experience fit into the overall healthcare picture? Patient Exp J. 2014;1(1):20-27. 5. UC Davis Health. New "ROAD" program provides path to breathing easier. https://health.ucdavis.edu/publish/news/newsroom/6739. Accessed January 23, 2019. 6. UC Davis Health. ROAD Center Program. Utilizing Education and Post-Discharge Support to Enhance Outcomes for Chronic Obstructive Pulmonary Disease Patients. https://health.ucdavis.edu/internalmedicine/pulmonary/road-center.html. Accessed January 23, 2019.
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