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


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Présentation d'un outil de télésurveillance médicale à domicile de patients atteints de broncho-pneumopathie chronique obstructive (COPD Briefcase)
Anne DICHMANN-SORKNAES, Universitaire d’Odense au Danemark - COPD Briefcase

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

  1. 1. The “COPD Briefcase” The effects of telemedical nursing consultations for patients with COPD Background- The challenges The aim of the Ph.D. Study The intervention The results Paris, France October the 21th. 2011 The Patient Briefcase1Sorknæs, AD; 1Hounsgaard,L; 2Olesen,F; 3Jest,P; 4Bech,M; 1Østergaard, B.1 Institute of Clinical Research Nursing, Faculty of Health Sciences,University of Southern Denmark2 Department of Information and Media Studies, University of Aarhus, Denmark3 OUH-Odense Universitetshospital & Svendborg Hospital, of Southern Denmark4 Institute of Public Health, Health Economics, University of Southern Denmark
  2. 2. Background- The challenges An increasing number of elderly patients withchronic diseases - as COPD In Denmark, COPD is the most common reasonfor admission to the medical departments COPD exacerbations constitute a heavy patientand societal burden Telemedicine nurse consultations might reducethe burden of COPD, but the evidence is still week
  3. 3. 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.
  4. 4. Studies with the COPD-briefcaseAt OUH-Odense University Hospital & Svendborg Hospital  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
  5. 5. Intervention controlled study• Patients admitted because of an E-COPD• 50 intervention patients and 50 geographicdefined controlled patients• Severe to very severe COPD• Age: 74 years• Pack year: 40 years• Living in the county of Funen
  6. 6. Organisation of the set-up The COPD- Telenurse 1 Telephone Briefcase is Consultation follow-up installed with mea- call within wihin 24 surements one week hours daily/ 7 days Telehealth group Outpatient State-Discharge review ment 4 4 weeks weeks Control group
  7. 7. The virtual nursing consultation Observation Measurements Education General talk
  8. 8. Set-up
  9. 9. Set-up
  10. 10. Set-upAnd now to the results
  11. 11. Results: Readmission Telemedicine Control Difference patients: patients: (Reduction) (n: 50) (n: 50)Total number of 8 (16 %) 15 (30%) 14% reductionReadmissionTotal number of 6 (12%) 11 (22%) (10% reduction)Readmission(exacerbation)Total days of 37 (4,6) 116 (7,7) 79 (68%)ReadmissionReadmission days with 15 (2,5) 48 (4,4) 33(69%)exac. (3 <1 day) (2<1day)
  12. 12. Patient satisfaction Yes No ? % Because of the TVC the patients felt more safe or 76 7 17 safe with discharge Used the equipment without help from anyone* 83 15 2 Could easily or with little difficulty make the 98 2 TVC measurements work The measurements made the patients feel more 93 7 safe or no difference Found the number of consultations suitable** 88 5 7 Will recommend that the TVC should be the 95 0 5 usual care*5 % some times with help; **5 % wants more consultations; ***20 % preferred both telemedicine and telephone calls
  13. 13. Proximity and care“-When she talks to me I know I am infocus. And only me.And thats probably what makes me feelmore safe. It must be that.Sometimes I even forget the illness I haveand I just think we are two normal peoplehaving a normal conversation”.
  14. 14. Advantages for the patient Possible to create proximity and to care forthe 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 forthe consultation
  15. 15. Nurse experiencePossible to: Nurse and care for patients at long distance Guide and educate the patients, the relativesand the homecare system after discharge Control how the patients administrate thetreatment and their illness after discharge Create proximityTimesaving compared to assisted homecare
  16. 16. 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)
  17. 17. 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”.
  18. 18. Technology aspects Safe and secure internet line is requiredMedia training and education is required Telemedicine equipment must be easilyaccessible Patient:“-It just works! I just press the button and we are connected”.
  19. 19. Technology aspects Need of (a little) technical knowledgeEquipment and the connection must bereliably Nurse: ”The worst thing is when it doesnt work. It is very frustrating for both me and the patient because we rely on the equipmentand it affects everything when it doesnt work.It affects me so much that I cannot do my job. My focus is forced away from the patient”.
  20. 20. Merci beaucoup Questions?• Thanks to: Supported by:• Supervisors: – Birte Østergaard Jensen lecturer Ph.D. Odense University Hospital – Peder Jest director, doctor University of Sourthern – Finn Olesen lecturer, Ph.D. Denmark – Lise Hounsgaard lecturer, Ph.D. – Michael Bech professor, Ph.D. European Union• MedCom Helsefonden• Telemedical nurses, The Danish Nurses• Doctors Organization• Managers• MTV and Science department OUH• MedCom• EU-commission and European colleagues and partners• GITS/Medisat