COPD patients to take charge

in new VHBC-project

Author: Bianke Buursma, Isala

Jan-Willem van den Berg, Pulmonary specialist at Isala

Photographer: Hester Snaak, Isala

This month, Isala’s Department of Pulmonology will begin a value-driven care pathway for COPD patients. As far as the Department can tell, there has never been a value-based health care project (VHBC) for COPD patients. Pulmonary specialist Jan Willem Van den Berg comments, ‘I find it exciting. How will it turn out? I hope, and expect that, in a year from now, we’ll have more satisfied patients whose quality of life has improved.’

COPD is a chronic condition whose characteristic symptoms include shortness of breath, coughing and mucus production. The symptoms fluctuate, and the disease generally has a slow progression. On Isala’s Pulmonary Healthcare department, 50% of the patients have COPD. That amounts to approximately 1,500 patients. According to Van den Berg, ‘For this patient group, we want to get away from the old doctor-patient relationship. By which I mean that the patients will do not only what the doctor tells them to, but they will also take the reins. That happens to be far better for patients with a chronic condition. Rather than the doctor, it is the team that becomes increasingly important for the patient. For instance, the pulmonary nurse and the physiotherapist.’

Pulmonary specialist Jan Willem Van den Berg points out,

“We want to get away from the old doctor-patient relationship”

Earlier intervention

The department took the first step in giving patients more control a few years ago, by initiating telemonitoring for COPD patients. Fifty patients received an iPad they could use to contact the pulmonary nurse via video call. Telemonitoring, however, facilitates even more. The iPad contains digital questionnaires that patients can complete at home and can use to indicate how they are doing. Or if their symptoms may have worsened. Van den Berg notes, ‘In this way, you make adjustments much sooner, thereby reducing visits to the outpatient clinic and hospital admissions. Before we worked with this remote care application, COPD patients visited the outpatient clinic at regular intervals for a check-up. Frequently, the patient would be doing well at that time, only to develop symptoms again just two weekends later. Thanks to the digital questionnaires and the video call option, we can provide on-demand care, which has the added advantage of often being able to prevent a lung attack.  This is important because every time a patient suffers a lung attack, the COPD regresses a bit. Whereas, you can often prevent a lung attack if you are on time. In addition, the iPad questionnaires offer up a wealth of information about how a patient’s feeling, what she’s experiencing and what may be bothering her: i.e., the PROMS and PREMS. Finally, we’re also going to use telemonitoring for coaching and E-learning. Our objective is to have 1,000 COPD patients participate in the telemonitoring. Therefore, we’ll continue to see a small portion of this patient group at the outpatient clinic.’

Diagnostic burden

In the renewed care pathway for COPD patients, the department will look more closely at which diagnostics has already been performed. Has a lung function test already been administered in primary care? ‘Then we don’t have to do that again,’ says Van den Berg. ‘This also applies to taking a lung X-ray if a recent one is still available. Avoiding repetition allows us to reduce the diagnostic burden on the patients and to save on costs. We also critically examine whether the hospital care actually adds anything. If not, patients are better off with their GP and nurse practitioner, so we refer them back.’

Pulmonary specialist Jan Willem Van den Berg states,

“We take a critical look at whether the hospital care actually adds anything. If not, we refer the patient back” 

Group information sessions

‘Because we’re going to give patients more control over their illness to achieve health gains, it’s important that we better inform them about their condition,’ explains Van den Berg. ‘This takes time, so we’ll accomplish this via group information sessions. As well as information about COPD, we’ll inform patients about the importance of exercise, quitting smoking and the correct use of medication. Of course, contact with others who have the same condition is also valuable. If, as a patient, you adhere well to the exercise and lifestyle regimens, COPD can remain stable for a long time. It is important to prevent the aforementioned lung attacks as much as possible. That’s possible thanks to telemonitoring, and we’ve developed a lung attack action plan. This gives patients a handle on how to act if things get worse and whether they might be heading for another lung flare up. The action plan consists of three phases, each with its own colour. Green is for stable, orange is for imminent deterioration and red means urgent. Should you end up in the red phase, you can, for example, pick up a treatment or you may have it already at home. Because, one way or another, you always seem to have those attacks on the weekend or at other inconvenient times.’

Remote position

When considering his own role, Van den Berg sees himself as occupying a more and more remote position.  ‘Certainly, in our new VBHC care pathway for COPD patients. I think patients can arrange a great deal for themselves. This is apparent from a trial currently underway for patients who use telemonitoring. Thanks to the efforts of the pulmonary nurse and other care professionals, I can fade more into the background. Of course, I do see new patients all the time. But after that, as far as I’m concerned, the patient should take control.’