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COPD treatment in the home via the Patient Briefcase

– A telemedicine solution for COPD patients that offer safety and comfort

OUH has implemented a telemedicine service for COPD patients that allows them to participate in live video consultations without leaving the comfort of their living room. The telemedicine service ensures that the patient’s condition is checked daily and that any deterioration in the condition can be handled and treated before they become severe enough to require hospital admittance.
The telemedical consultation practice has proved less stressful for both patients and nurses, and has thus been incorporated into the daily operations in the Department of Respiratory Medicine with an assigned telemedicine unit running the service for all relevant patients. The solution meets the chronic patient’s wish to be hospitalised no longer than necessary, and at the same time, it frees up resources in the hospital by reducing overcrowding problems, especially on medical wards. The overall goal of developing the patient briefcase was to bring down the number of re-admissions for COPD patients. 

The patient briefcase is about the size of a large laptop, but only has 3 buttons. It is easy to operate and allows the hospital to collect valuable data about the patient’s lung function and the amount of oxygen in the blood. This helps nurses to provide patients with the information they need to master their chronic condition. In addition, the video consultations forces (and teaches) the patients how to take a more active role in their treatment as they have to take their own measurements while the nurse is watching, guiding and collecting data. 

Patients with COPD are often confused and insecure when they are diagnosed or have experienced an exacerbation of their condition. Previously, these patients would have been hospitalized for a number of days for monitoring and medication training, but now they can be discharged to their own home and receive the same level of care. The “tele-COPD unit” can see up to 15 patients a day using the patient briefcase – on a very busy day, that is – but this means that up to 15 patients are in their own home instead of in a hospital bed.

But it is not only the hospital wards that benefit from the new system. Transportation is often a hindrance for COPD patients short of air supply. Accordingly, daily consultations with a nurse in the comfort of their own homes are of great value to these patients as a alternative to going to continuous control visits. In addition, the patients feel a very close relation to the nurses in the tele-unit as they are met by the same nurse every time they use the briefcase and the consultation is not disturbed by the usual hospital noises and interruptions. This can be secured thanks to careful scheduling and planning by the team and coordination with the patients about the time for the call. Perhaps one day the call will be in the morning, but the next day it can be in the afternoon, if the patient is scheduled to have a visit from the social care services in the morning and so on. The call is planned from day to day by the nurse and patient.
The home consultations also have the positive side-effect that relatives such as spouses and children of the patient can be present when the call takes place and benefit from the knowledge of the nurse and the information given.

 

The nurses in the “Tele COPD unit” are trained to consult patients on screen and do not experience the computer as a barrier in their communication with the patient. “I am often greeted by patients welcoming me to their living room and showing me personal items or introducing me to relatives”, says Bente Grøn, one of four nurses in the telemedicine unit.

Patients are in daily contact with a nurse for up to two weeks following their discharge, and according to Bente Grøn the fear of technology usually disappears within 2 or 3 days. “The patient briefcase makes it easier for COPD patients to return home and continually incorporate new knowledge about their condition into their everyday lives”, states the experienced nurse.

In order to make sure that the patient briefcase is set up correctly, a technician delivers the briefcase to the patient’s home and assists the patient through the first consultation.

See a short video about the service here:

 

 

The patient briefcase solution was developed and piloted for COPD patients from 2007 to 2009 as a part of the EU-project Better Breathing. The briefcase was developed and is now provided by the Danish company TREFOR Telecare (former Medisat).

The COPD briefcase project was part of the European RENEWING HeALTH-project, and has also formed the basis of a clinical PhD project.

The PhD project included an RCT with the following procedure: After being discharged, the patients who participated in the project got a Patient Briefcase installed in their home for 7 days, enabling them to communicate with the COPD nurse from the comfort of their own home. Using the briefcase, the nurse performed daily video calls to the patient during the first week after discharge. Together the nurse and patient measured the oxygen saturation of the blood as well as the lung function using the accompanying measuring instruments.

A total of 266 patients were included in the project. The results of the 133 patients who used the briefcase monitoring were compared to the results from the 133 control patients who did not receive the daily follow-up using the briefcase. The primary focus was to measure the effect of the telemedical intervention in relation to the frequency of re-admittance, as COPD patients are very often re-admitted shortly after discharge.
The PhD-project was concluded in September 2013, where nurse PhD Anne Dichmann Sorknæs presented her final dissertation.
The article from the PhD study can be found here: : http://www.ncbi.nlm.nih.gov/pubmed/24227799

 

 

Contact

Claus Duedal Pedersen
Chief Innovation Officer

Phone:+45 2115 3578
Mail: claus.duedal.pedersen@rsyd.dk

Permanent link to this article: http://old.cimt.dk/ouh-innovative-practices/patient-briefcase/copd/