COPD Workgroup 01/08/20
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MVC discusses personalized medicine in the COPD patient.
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COPD Workgroup 01/08/20
- 1. COPDWorkgroup Personalized Care for the COPD Patient January 14th, 2019
- 2. Agenda Introductions Data and Literature Review Discussion Wrap Up
- 4. What is precision medicine? The right treatment, for the right patient, at the right time. A form of medicine that uses information about a person’s genes, proteins, and environment to prevent, diagnose, and treat disease. Tailoring of medical treatment to the specific characteristics of each patient
- 5. Data and Personalized Medicine An increase in biological data and relevant medical information will be seen with personalized medicine We have the ability to analyze these data sets and to extract all of the useful information
- 6. COPD and Personalized Medicine Refers to a label-free, precision medicine approach Management is based on individual treatable traits and these treatable traits are summarized into three groups: pulmonary treatable traits, extra pulmonary treatable traits, and treatable behavioral lifestyle risk factors.
- 8. Pulmonary Rehabilitation: Personalized Management Pulmonary rehabilitation: an intervention based on a “thorough” patient assessment followed by therapies designed to improve physical and psychological conditions Healthcare practitioners push for a patient-tailored approach to improve outcomes. Push our patients/physicians to adhere to this long-term
- 9. The Process of Getting to a Patient- Tailored Approach
- 10. Data and Literature Conclusion Personalized medicine can fundamentally change the ways therapies are being developed and explore how genetic, environmental and lifestyle factors interact in our bodies to foster health or develop disease.
- 11. Discussion Overview Share current practices Analyze trends Brainstorm future practices and barriers
- 12. Discussion Is your facility using a patient-tailored approach for COPD management? If so, what does this approach entail? What is the biggest psychological/behavioral obstacle your facility faces related to COPD? How does your facility manage these obstacles? What self management tools are being used in your facility? Do patients have access to their own medical record?
- 13. NextSteps Next COPDWorkgroup:Tuesday, March 3rd from 2-3:30 pm Deliverable &Topic:TBD
- 14. Resources Agusti, A. (2014).The path to personalised medicine in COPD. Thorax, 69(9), 857–864. https://doi.org/10.1136/thoraxjnl-2014- 205507 Franssen, F. M.,Alter, P., Bar, N., Benedikter, B. J., Iurato, S., Maier, D., Maxheim, M., Roessler, F. K., Spruit, M. A.,Vogelmeier, C. F.,Wouters, E. F., & Schmeck, B. (2019). <p>Personalized medicine for patients with COPD: where are we?</p>. International Journal of Chronic Obstructive Pulmonary Disease, Volume 14, 1465–1484. https://doi.org/10.2147/copd.s175706 Leung, J. M., Obeidat, M., Sadatsafavi, M., & Sin, D. D. (2019). Introduction to precision medicine in COPD. European Respiratory Journal, 53(4), 1802460. https://doi.org/10.1183/13993003.02460-2018 Wouters, E. (2020). HighWire Lens: Personalised pulmonary rehabilitation in COPD. Ersjournals.Com. https://err.ersjournals.com/lens/errev/27/147/170125#toc Ziegelstein, R. (2017). Personomics:The Missing Link in the Evolution from Precision Medicine to Personalized Medicine. Journal of Personalized Medicine, 7(4), 11. https://doi.org/10.3390/jpm7040011
Editor's Notes
- Hello, Welcome to the first MVC COPD Workgroup of the New Year My name is Meghan Nyrkkanen and I am the engagement associate for the Michigan Value Collaborative. And I am here with Deby Evans………. Today we are going to be discussing Personalized care for the COPD Patient. We choose this topic based on current research and relevancy to our audience. We do want to tailor these workgroups to our members though, so please let us know if there are specific things we can discuss that would be helpful for your facility. I am going to be recording todays session so I am able to send It out to all of you, as well as a synopsis for you to reference back to. I did also want to mention that the MVC Open forum is now live with questions. You are able to post and collaborate with other members. We will also be posting questions posed in the workgroup there for other members to get involved.
- All of the information on the slides was obtained from a study done in 2018 on the ongoing developments in personalized and or precision medicine in COPD. The authors begin with discussing what precision medicine is. Is there one definition? All of these definitions have one common thing in mind: the patient. We want to focus our care around the patient. Within precision medicine there is this idea of something called “personomics”. Personomics takes into account an individual’s personality, preferences, values, goals, health beliefs, social support network, financial resources, and unique life circumstances that affect how and when a given health condition will manifest in that person and how that condition will respond to treatment.
- With the rise of digital technology, personalized medicine is also going to become more popular. Digital technology allows us to do things we once were not able to do. With this increase of data that we can extract from individuals, comes an increase in the types of treatments we are able to offer. We are able to see many layers of data from an individual, from demographic and social data, to genome-DNA sequencing. This data allows us to look at treatment differently
- So how can we incorporate personalized medicine in COPD Pulmonary treatable traits: Within this subcategory we see things like Airflow variability, neutrophilic inflammation, and the inability to exercise. Extra pulmonary treatable traits: Within this subcategory we see things like Depression, anxiety, obesity, and dysfunctional breathing. Treatable behavioral lifestyle risk factors: Finally within this subcategory, we see things like smoking and incorrect use of an inhaler.
- So moving forward, addressing that “treatable” trait must be based on profound understanding of underlying, individual factor. For example, Exercise is important for COPD treatment. A variety of social and personal barriers can limit or encourage participation in physical activity in patients with COPD. You can see on the screen that we have personal barriers on the right, and personal enablers on the left. These barriers can be the difference between survival and treatment plan adherence versus a decline in health. In order to try and steer our patient toward the enabler side, we can try and look at the barriers and reverse that thought process or situation.
- As you can see, we have the definition of pulmonary rehabilitation on the screen. Now you will see here we have “thorough” in quotation marks. Everyone has a different idea of what thorough means, and no two assessments are the same. Healthcare professionals want this assessment to include the thought of a holistic approach. Holistic meaning “whole” patient. Healthcare practitioners want to see the offer of a patient-tailored, individualized, comprehensive interventions targeting complex looking to improve physiological and social outcomes. This long-term adherence to health-enhancing behaviors can be the cornerstone of every rehab program. So what does a patient-tailored approach look like?
- This is the process of a tailored program including the three core processes (which are, baseline assessment, tailored treatment, and outcome assessment.) You will see on the left that much more is taken into account than symptoms alone. By applying these sociotechnical principals, patient-tailored interventions can be implements. When this approach is followed, It has been reported that outcomes by such a personalized program are nonlinear and really can downsize the burden of disease for the individual patient.
- This type of approach could change the way we care for our patients with COPD. It could allow for more successful treatment of psychological and behavioral treatments specifically.
- P4(medicine that is predictive, preventative, personalized, and participatory) Has anybody introduced the concept of P4 medicine?