The “COPD Briefcase” The effects of telemedical nursing consultations for patients with COPD.

1. The “COPD Briefcase”
The effects of telemedical nursing consultations
for patients with COPD
Background- The challenges
The aim of the PhD. Study
The intervention
The results
The Patient Briefcase
Åbo, Finland August the 25. th. 2011
Sorknæs, AD; Jest,P; Bech,M; Hounsgaard,L; Olesen,F; Østergaard, B.

2. Background- The challenges
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

3. The Aim of this PhD. Telemedicine study
The aim of this PhD. 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. Studies with the COPD-briefcase
At OUH-Odense University Hospital & Svendborg Hospital
2007-2009: A Controlled intervention study with virtual
nurse video consultations consisting of observation,
education and patient measurements. Part of the EU study
”Better Breathing. Published January 2011.
2010-2011: A qualitative postphenomenological
fieldwork. 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. Intervention controlled study
• 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 year
• Living in the county of Funen

6. Organisation of the set-up
The COPD- Telenurse Telephone
Briefcase is Consultation follow-up
installed with mea-
surements
daily/ 7 days
Telehealth group
Outpatient State-
Discharge review ment 4
4 weeks weeks
Control group

7. The virtual nursing consultation
Observation
Measurements
Education
General talk

8. Results: Readmission
Telemedicine Control patient:
patient: (n: 50) (n: 50)
Total number of 8 (16 %) 15 (30%)
Readmission (14% reduction)
Total number of 6 (11%) 11 (22%)
Readmission (10% reduction)
(exacerbation)
Total days of 37 (4,6) 116 (7,7)
Readmission
Readmission 15 (2,5) 48 (4,4)
days with exac. (3 <1 day) (2<1day)

9. 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

10. Advantages for the patient
Can stay at home - No transportation to the
hospital
Uninterrupted consultation
Possible to create proximity and to be cared
for - make them feel safe
Close relationship to the nurses
The patients can (almost) decide the time for
the consultation

11. 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 after discharge
Create proximity
Timesaving compared to assisted homecare

12. Socio-cultural etichal and legal aspects
Changed patient role
Not all patient can be offered telemedicine
Legal aspects - laws
Change the role for the staff – can they
handle the new role

13. Technology aspects
Secure internet line is required
Media training and education is required
Telemedicine equipment must be easily
accessible

14. Technology aspects
Need of (a little) technical knowledge
Equipment and the connection must be
reliably

15. Organisational aspects
Require:
The manager of the organization must back
up the implementation of telemedicine
Economy
Staff safety - Legal aspects
Specialist knowledge (clinical and
technical)

16. Thank you
Any questions?
anne@sorknaes.dk