2011-10-21 ASIP Santé Conférence Télémédecine "Présentation de COPD Briefcase"

Paris, France October the 21th. 2011

1Sorknæs, AD; 1Hounsgaard,L; 2Olesen,F; 3Jest,P; 4Bech,M; 1Østergaard, B.

1 Institute of Clinical Research Nursing, Faculty of Health Sciences, University of Southern Denmark 2 Department of Information and Media Studies, University of Aarhus, Denmark 3 OUH-Odense Universitetshospital & Svendborg Hospital, of Southern Denmark 4 Institute of Public Health, Health Economics, University of Southern Denmark

The “COPD Briefcase”

The effects of telemedical nursing consultations

for patients with COPD

The Patient Briefcase

Background- The challenges

The aim of the Ph.D. Study

The intervention

The results

An increasing number of elderly patients with

chronic diseases - as COPD

In Denmark, COPD is the most common reason

for admission to the medical departments

COPD exacerbations constitute a heavy patient

and societal burden

Telemedicine nurse consultations might reduce

the burden of COPD, but the evidence is still week

Background- The challenges

The Aim of this PhD. Telemedicine study

The aim of this Ph.D. study is to investigate

the effects of

telemedicine nursing consultations

compared with conventional treatment

for patients with

Chronic Obstructive Pulmonary disease

with focus on readmission, mortality

and the users’ experience

with virtual nursing video consultations.

2007-2009: A Controlled intervention study with 100

participants. Part of the EU study ”Better Breathing.

Published January 2011.

2010-2011: A qualitative technology philosophy

fieldwork study. Part of the EU study “Renewing Health”

2010-2012 A randomized controlled trial (266 patients).

Part of the partly-financed EU study “Renewing Health”

And now to the intervention

Studies with the COPD-briefcase

At OUH-Odense University Hospital & Svendborg Hospital

• Patients admitted because of an E-COPD

• 50 intervention patients and 50 geographic

defined controlled patients

• Severe to very severe COPD

• Age: 74 years

• Pack year: 40 years

• Living in the county of Funen

Intervention controlled study

Organisation of the set-up

1 Telephone

follow-up

call within

one week

State-

ment 4

weeks

Telenurse

Consultation

with mea-

surements

daily/ 7 days

The COPD-

Briefcase is

installed

wihin 24

hours

Telehealth group

Control group

Outpatient

review

4 weeks

Discharge

The virtual nursing consultation

Observation

Measurements

Education

General talk

Set-up

Set-up

Set-up

And now to the results

Results: Readmission Telemedicine

patients:

(n: 50)

Control

patients:

(n: 50)

Difference

(Reduction)

Total number of

Readmission

8 (16 %)

15 (30%) 14% reduction

Total number of

Readmission

(exacerbation)

6 (12%)

11 (22%) (10% reduction)

Total days of

Readmission

37 (4,6) 116 (7,7) 79 (68%)

Readmission days with

exac.

15 (2,5)

(3 <1 day)

48 (4,4)

(2<1day)

33(69%)

Patient satisfaction Yes No ?

%

Because of the TVC the patients felt more safe or

safe with discharge

76 7 17

Used the equipment without help from anyone* 83 15 2

Could easily or with little difficulty make the

TVC measurements work

98 2

The measurements made the patients feel more

safe or no difference

93 7

Found the number of consultations suitable** 88 5 7

Will recommend that the TVC should be the

usual care

95 0 5

*5 % some times with help; **5 % wants more consultations; ***20 % preferred both telemedicine and telephone calls

Proximity and care

“-When she talks to me I know I am in

focus. And only me.

And that's probably what makes me feel

more safe. It must be that.

Sometimes I even forget the illness I have

and I just think we are two normal people

having a normal conversation”.

Advantages for the patient

Possible to create proximity and to care for

the patients (- make them feel safe)

Empower the patients

Close relationship to the nurses

Can stay at home

Uninterrupted consultation

The patients can (almost) decide the time for

the consultation

Nurse experience

Possible to:

Nurse and care for patients at long distance

Guide and educate the patients, the relatives

and the homecare system after discharge

Control how the patients administrate the

treatment and their illness after discharge

Create proximity

Timesaving compared to assisted homecare

Socio- cultural- etichal- legal - organisational

Changed the patient role

Not all patient can be offered telemedicine

Legal aspects - laws

Economy

Change the role for the staff – Specialist

knowledge (clinical and technical)

Another kind of nursing

“Sure, at first I was annoyed that I could

not use the normal observation methods,

but then I thought

'I have to do something different' so I

learned”.

Technology aspects

Safe and secure internet line is required

Media training and education is required

Telemedicine equipment must be easily

accessible

Patient:

“-It just works! I just press the button and

we are connected”.

Technology aspects

Need of (a little) technical knowledge

Equipment and the connection must be

reliably

Nurse:

”The worst thing is when it doesn't work. It is

very frustrating for both me and the patient

because we rely on the equipment

and it affects everything when it doesn't work.

It affects me so much that I cannot do my job.

My focus is forced away from the patient”.

Merci beaucoup

Questions?

• Thanks to: • Supervisors:

– Birte Østergaard Jensen lecturer Ph.D.

– Peder Jest director, doctor

– Finn Olesen lecturer, Ph.D.

– Lise Hounsgaard lecturer, Ph.D.

– Michael Bech professor, Ph.D.

• MedCom

• Telemedical nurses,

• Doctors

• Managers

• MTV and Science department OUH

• MedCom

• EU-commission and European colleagues and partners

• GITS/Medisat

Supported by:

Odense University Hospital

University of Sourthern

Denmark

European Union

Helsefonden

The Danish Nurses'

Organization