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The 3 biggest factors to consider when tailoring care to your patient population  

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Caring for your COPD patients isn’t just a science – it’s also an art. In the past, many healthcare providers took a turnkey, textbook approach to COPD care, but today, we know the importance of recognizing the varying backgrounds and needs of different patient populations and taking a proactive approach with those nuances in mind.1  Otherwise, you run the risk of an ineffective or inefficient COPD care plan that can lead to costly readmissions, leaving you right back where you started. 
Overall, the United States healthcare system is reactive. Basically, you’re behind the 8 ball. We have to get to a point where we are proactive and anticipatory.”

Chikita Mann, MSN, RN, CCM 

Disability RN Case Manager Supervisor 

Genex Services, LLC for the State of Georgia

There are a number of demographic factors that can influence a COPD care plan. Below, we offer insider insight on three of the most important factors to consider, along with a few tips that may ultimately help reduce COPD readmissions.

Contributors

Chikita Mann

Chikita Mann, MSN, RN, CCM Disability RN

Case Manager Supervisor

Genex Services, LLC for the State of Georgia

Krystal Craddock

Krystal Craddock, BSRC, RRT-NPS, AEC

COPD Case Manager

Department of Respiratory Care at UC Davis Medical Center

Chris Landon

Chris Landon, MD, FFAP, FCCP, CMD

Director of Pediatrics, Ventura County Medical

Director of Pediatric Diagnostics Center and CEO, Landon Pediatric Foundation

Jerry Krishnan

Jerry Krishnan, MD, PhD

Associate Vice Chancellor for Population Health Sciences

University of Illinois Hospital and Health Sciences System

Factor #1

Socioeconomic Status

COPD patients come from vastly different socioeconomic situations that can impact their health or hinder their ability to pay for healthcare services.
We need to find out what they can afford. Patients can come in and say they're on all these inhalers, but when you call the pharmacy, they haven't filled in a few months. Why not? They can't afford it.”

Krystal Craddock, BSRC, RRT-NPS, AE-C, CCM

COPD Case Manager

UCal Davis

It is key to recognize that your patients may not have the ability to afford the proper medications and treatments, and to work with them to find a solution.
Insider guide:
simple ways to help your low-income patients comply with your COPD care plan
Money icon
Try to select more affordable treatment options for patients with financial struggles.
Check icon
Double check that the medication or inhaler you prescribe is compatible with the patient’s insurance.
Goals icon
Set manageable goals for your patients, keeping their socioeconomic status in mind.

It’s better to have your patients adhering to a more affordable treatment plan, even if it may not be the most ideal or most effective treatment, than it is to have a patient potentially shun treatment entirely due to high costs.

 

In other cases, the problem could be as simple as a lack of transportation to or from appointments. Spending a few dollars on patient transportation to ensure patients are able to make it to treatment is a small investment that can help prevent costly COPD readmissions down the line.

Insider case study:
Project Pronto
The problem:
Dr. Jerry Krishnan of the University of Illinois Hospital and Health Sciences System recognized that transportation was a roadblock to care for many patients.
The solution:
Dr. Krishnan sought advice from his colleagues in the healthcare design field. He learned that ride-sharing companies like Uber and Lyft were increasingly being utilized in healthcare, so he helped launch a four-month evaluation project called Project Pronto where patients could hitch a free ride on the hospital’s dime.
The results:

The project was so successful that it was permanently implemented by hospital leadership shortly after the trial period ended.

 

“Every patient in the hospital who needs a ride gets a ride home for free,” Krishnan said. “This is an example that as we think about addressing the health of populations, we need to think broader than healthcare delivery itself.”

Socioeconomic status can be a touchy subject, but as long as you treat patients with respect and kindness, you should be able to get a dialogue started that can benefit both you and your patients.

Factor #2

Cultural Background

Language and cultural differences can be another barrier standing between healthcare providers and their patient populations. If you can’t effectively communicate with your patients or your patients are struggling to comprehend your instructions, how can you be sure they’ll follow through on them? 
You have to be bilingual. You have to have cultural awareness. Not cultural blindness, but actually be able to speak to them in their language, in order to accomplish improving their own healthcare.”

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

 

Clinicians need to be able to communicate clearly with patients from different backgrounds and cultures. Having team members who are capable of conversing in different languages is a huge help, but the solution can be as simple as utilizing materials that can be understood by a wide variety of patients.

Depending on the community, you might need different languages. We've been piloting videos actually showing people how to use medications.”

Jerry Krishnan, MD, PhD

Associate Vice Chancellor for Population Health Sciences,

University of Illinois Hospital and Health Sciences System

Insider case study:
Tailoring medical messages to your audience
The problem:
In Ventura County, California, healthcare providers frequently deal with the Mixteco people, an indigenous group of immigrants originally from Mexico. They come to California to work, often taking jobs picking strawberries, but they speak a unique language that is difficult to translate.
The solution:

In order to more effectively reach this segment of the population, a radio station was established exclusively tailored for these immigrants.

 

“So we just put up a radio station, 94.1 FM, so that when they're in the fields, they can hear on their radio, in their language, music and health messages,” explained Dr. Chris Landon. “They don't have smartphones, but they do have radios. So, whatever we can do with technology to get there.”

In addition to language barriers, other cultural factors, like diet, can play a role in causing discord with a patient.

 

“You’re going in and you're saying, ‘You can't eat this and you can't eat that,’” says Chikita Mann, a case manager supervisor. “And they're like, ‘No, you're taking my life away from me.’”

 

Instead of coming in and setting hard-and-fast rules, Mann suggests working hand-in-hand with a patient to discover their personal or cultural preferences, and being open and flexible in order to adhere as closely as possible to those preferences.

 

“Because of cultural competence, you're starting to realize that this patient has a certain type of diet,” Mann said. “Let's find a suitable substitution for them that keeps them involved and allows them to still have some control. Let's face it, COPD is a disease where to a certain degree, the patient may feel like they’ve lost control of their life. Let's find a way to give them back control of their life. Once we start to do that, I promise you, we're gonna see results that are out of this world.”

Factor #3

Health Literacy

Not all patients fully understand their condition, let alone the COPD treatment plan you recommend to them. Advice or treatment instructions that fall on deaf – or underinformed – ears won’t be effective, but assessing a patient’s health literacy isn’t always easy.
I can’t tell you how many times we’ve had a patient come into the hospital for a COPD exacerbation and I asked them, ‘Well, what do you know about COPD? What is COPD?’ And they say, ‘I don’t have COPD. I have emphysema.’ And so, they don’t know.”

Krystal Craddock, BSRC, RRT-NPS, AE-C, CCM

COPD Case Manager

UCal Davis

When dealing with patients, ask questions to get an idea of their health literacy. For example, a COPD patient should be familiar with the word “exacerbation” and know what it means. However, a study found that just 1.6% of COPD patients understood the term, while just under 2% of patients surveyed could explain its meaning correctly.2

 

If you get the sense that your patients aren’t well-educated on COPD care or might not be fully comprehending the various aspects of treatment, do your best to explain things to them in simple terms and have them repeat your instructions back to you to make sure they truly understand what to do.

Insider guide:
The challenges of low health literacy
A minimum of 
15%
of all patients may have diminished literacy3
Only
50%
of patients with impaired health literacy are correctly identified by doctors4
Less than
50%
of patients recall what they are told during their consultations5
Chikita Mann screenshot from video
Play video
There are times when we are assuming that the patient understood everything we said. And in actuality, they nodded, but we're not confirming that they understood how to implement the strategies that were given to them. So, I think one of the things that we're gonna have to step our game up in, honestly, is truly assessing their health literacy. Did they truly understand? Have them regurgitate back to us, "Yes, I understood how to take this medication. I understood that BID is twice a day." Because let’s face it, we still have medical professionals who don’t know what BID means. So, if we still have our peers who don’t know what BID is, what about the patient? So, health literacy is one of the primary items of patient engagement that we're gonna have to start paying attention to.

Chikita Mann, MSN, RN, CCM

Disability RN Case Manager Supervisor

Genex Services, LLC, for the State of Georgia

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Further reading

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COPD insider

References

1. https://www.ajmc.com/contributor/sanjay-sethi/2018/11/effective-management-of-copd-in-primary-care-challenges-and-opportunities

2. Kessler R, Stahl E, Vogelmeier C, et al. Patient understanding, detection, and experience of COPD exacerbations: an observational, interview-based study. Chest. 2006;130(1):133–142.

3. Gordon M, Hampson R, Capell H, et al. Illteracy in rheumatoid arthritis patients as determined by the Rapid Estimate of Adult Literacy in Medicine (REALM) score. Rheumatology. 2002;41(7):750–754.

4. Rogers ES, Wallace LS, Weiss BD. Misperceptions of medical understanding in low-literacy patients: implications for cancer prevention. Cancer Control. 2006;13(3):225–229.

5. Falvo D, Tippy P. Communicating information to patients. Patient satisfaction and adherence as associated with resident skill. J Fam Pract. 1988;26:643–647.

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