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Diagnosis COPD: Now what?

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COPD is the third leading cause of death in the United States.

 

More than 11 million people have been diagnosed with COPD, but millions more may have the disease without even knowing it. COPD can cause serious long-term disability and early death. At this time there is no cure, and the number of people dying from COPD is growing.1

Patients who end up with a COPD diagnosis might have suspected that something was wrong with their lungs. But they might have been reluctant to engage with their physicians—angry, ambivalent, embarrassed—and fearful, especially if they are smokers. Unlike other diseases, COPD calls for a multifaceted and transformative approach to patient care.  
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In 2014, COPD-related healthcare costs exceeded $36 billion.2

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In 2015, 78% of hospitals were penalized for readmission.2

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Dr. Lee-Chong Teofilo, Chief Medical Liaison at Philips, shares his perspective on what clinicians can do to help their patients manage this difficult disease.

What can physicians do to treat these patients holistically and give them hope?

 

Clinicians need to approach and manage COPD patients with sensitivity and understanding because of the psychological difficulties that this diagnosis might cause. Patients might blame themselves for getting sick because they were—or are still are—smokers.

 

They may have difficulty discussing their diagnosis with family and friends and feel isolated. They may be afraid that they won’t be able to do their job. They may view their therapeutic regime as burdensome and get discouraged. They might be overwhelmed because this disease impacts their entire life—their personal relationships, work, exercise, sleep and other everyday activities.

 

The facts of the diagnosis itself—the condition is chronic, there is no cure—can certainly cause depression.  

Here are four ways of approaching your COPD patient holistically—and provide them with an enhanced level of care.

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1. Listen to your patients’ stories.

 

The key to making patients better lies within them. Ask them how they feel, what they want to achieve, what it means to them to get better, and how they see themselves in the future. Get to know their needs and world view.

 

For example, if their family and friends are smokers, their challenge to quit will be made even more difficult.

 

By finding out about what make them tick, you can recommend the right combination of therapy, education, support groups, nursing assistance, and rehab. And because you’ve engaged them in a productive dialogue rather than a prescriptive approach, you’re encouraging them to participate more fully in their care.

 

Therapies like ventilators and devices that assist with upper body exercise are vital, yet so is nutritional care to combat malnutrition, smoking cessation support, and the important social connections in the broader community, such as their place of worship.

 

The biggest challenge might be to replicate the services they receive at the hospital when they go back home to their jobs and their communities. Directing patients to local resources that can meet their defined set of needs is key to their success.

 

Remember, one size does not fit all.

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2. Set long-term goals—but don’t forget the short term.

 

Just as one size does not fit all in terms of how to approach your patient and their therapy, the same is true of setting goals for their therapy and rehabilitation. Perhaps focusing only on the long-term is too daunting for some patients.

 

COPD affects many aspects of patients’ lives, not just their lungs. Getting better means working on difficult physical as well as psychological and social challenges. Breaking down these big challenges into bite-sized actions—exercising more, eating better, sticking to your therapy plan—can increase your patients’ odds of success.

 

Encourage them to take one step at a time. Focus on what can be achieved today, and assure them that all their accomplishments of today and tomorrow can have a powerful cumulative value that can lead to a more hopeful future.  

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3. Use Innovative Ways to Communicate

 

COPD patients have a lot to keep track of. You can help keep them on track by maintaining on ongoing dialogue with them, even if they aren’t in your office. By employing telemedicine, you can check in on your patients at home, at their convenience.

 

It’s an efficient and effective way keep the patient’s entire multidisciplinary team involved, too. Respiratory therapists, pharmacists, and nutritionists can join in the session, or reach out to the patient individually.

 

A vital part of a patient’s treatment plan is to continue to receive continuous care and monitoring. By bringing the hospital to the home, you can integrate all of the services that the patient depends upon to feel better, eat right, and meet their short- and long-term goals.   Everyone that the patient would see in the hospital is right there—at the other end of a screen.

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4. Reimagine how you treat COPD patients, and rethink your practice. 

 

I believe that we have an obligation to reimagine how we treat COPD. We need to evolve from episodic management to continuous care and monitoring that’s highly informed, personalized, and connected. Yes, this takes more time. I call it time-based care, rather than what we practice know, which I might called results-based care.

 

Innovation in technology has brought significant advances to COPD care. There are very accurate diagnostic tests that help us begin treatment quickly. There are excellent devices for oxygen delivery, rehab, and so on.

 

Let’s employ these advances and deliver continuous, connected, and long-term care for the COPD patient. Let’s transform the patients themselves so that they can take an active role in shaping the rest of their lives, for as long as they are able. Let’s forge strong partnerships with the patient’s family and extended community, from the workplace to the place of worship.

 

COPD is treatable and there are a wide range for resources available for patients and clinicians alike.

1American Lung Association. https://www.lung.org/lung-health-and-diseases/lung-disease-lookup/copd/learn-about-copd/how-serious-is-copd.html

2Kaiser Health News analysis of data from the Centers for Medicare & Medicaid Services. Available at http://khn.org/news/medicare-readmissions-penalties-2015 and http://kff.org/medicare/issue-brief/aiming-for-fewer-hospital-u-turns-the-medicare-hospital-readmission-reduction-program/

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