Expertentreffen COPD: Integriertes Patientenmanagement bei COPD^[*]

Zusammenfassung

Die Lebensqualität und Prognose der COPD-Patienten lässt trotz erheblich verbesserter medikamentöser Therapieoptionen weiterhin zu wünschen übrig. Ziel des Workshops war es, COPD-spezifische Hindernisse auf dem Weg zur verbesserten Betreuung der Patienten zu beschreiben. Dazu zählen der Sozial- und Bildungsstatus der COPD-Patienten sowie die gesellschaftliche Stigmatisierung der Erkrankung als selbstverschuldete „Raucherkrankheit“. Die strenge sektorale Trennung trägt zu Defiziten in der Betreuung bei. Im zweiten Teil des Workshops wurden Möglichkeiten der Verbesserung dargestellt. Die Nutzung IT-basierter Hilfsmittel, verbesserte Kommunikation zwischen Patienten und Therapeuten und zwischen den Sektoren des Gesundheitswesens, verbesserte Integration von Rehabilitation sowie durch Strategien des Selbstmanagements, sind solche Möglichkeiten. Als Schlussfolgerung konnte festgehalten werden, dass ein integriertes Patientenmanagement mit Einbeziehung multiprofessioneller Teams die Betreuungsqualität nachhaltig verbessern könnte.

Abstract

Despite considerable progress concerning pharmaceutical therapeutic options, many COPD patients show a markedly reduced quality of life and increased mortality risk. This workshop aimed to identify COPD-specific factors impeding an improved mode of care for patients with COPD. Such factors are: the generally lower social and educational status of the majority of COPD patients; the stigma of COPD as a self-inflicted disease (“smoker’s lung”); the strict sectoral separation within the German health care system. In the second part the workshop tried to identify ways to improve the care of COPD patients. Use of health information technology, improved communication between care givers and patients as well as between the health care sectors, integrating rehabilitation and establishing self-management education are factors within an integrated patient-centered approach. In summary, an integrated management of the individual patient with COPD including multi-professional teams should contribute to optimizing the quality of COPD care.

^* Sponsor: Boehringer Ingelheim Pharma GmbH & Co KG

• Literatur

• 1 von Leupoldt A , Sommer T, Kegat S. et al. The unpleasantness of perceived dyspnea is processed in the anterior insula and amygdala. Am J Respir Crit Care Med 2008; 177: 1026-1032
• 2 Vanfleteren LEGW, Ullman A, Fabbri LM. Time for a longer and better life for patients with COPD. Eur Respir J 2018; 51 DOI: 10.1183/13993003.02569-2017.
• 3 Nici L, ZuWallack R. An official American Thoracic Society workshop report: The Integrated Care of The COPD Patient. Proc Am Thorac Soc 2012; 9: 9-18
• 4 Garner A, Hodson M, Ketsetzis G. et al. An analysis of the economic and patient outcome impact of an integrated COPD service in east London. Int J Chron Obstruct Pulmon Dis 2017; 12: 1653-1662
• 5 World Health Organization. Economics of the Social Determinants of Health and Health Inequalities (The). World Health Organization; 2013
• 6 Pleasants RA, Riley IL, Mannino DM. Defining and targeting health disparities in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2016; 11: 2475-2496
• 7 Kosacz NM. Chronic Obstructive Pulmonary Disease Among Adults – United States, 2011. Morb Mort Wkl Rep 2012; 61: 938-943
• 8 Eisner MD, Blanc PD, Omachi TA. et al. Socioeconomic status, race and COPD health outcomes. J Epidemiol Community Health 2011; 65: 26-34
• 9 Ellison-Loschmann L, Sunyer J, Plana E. et al. Socioeconomic status, asthma and chronic bronchitis in a large communitybased study. Eur Respir J 2007; 29: 897-905
• 10 Schraufnagel DE, Blasi F, Kraft M. et al. An official American Thoracic Society/European Respiratory Society policy statement: Disparities in respiratory health. Am J Respir Crit Care Med 2013; 188: 865-871
• 11 Institute of Medicine. Health Literacy: A Prescription to End Confusion. Washington, DC:
• 12 Omachi TA, Sarkar U, Yelin EH. et al. Lower health literacy is associated with poorer health status and outcomes in chronic obstructive pulmonary disease. J Gen Intern Med 2013; 28: 74-81
• 13 Hagstad S, Backman H, Bjerg A. et al. Prevalence and risk factors of COPD among neversmokers in two areas of Sweden – Occupational exposure to gas, dust or fumes is an important risk factor. Respir Med 2015; 109: 1439-1445
• 14 Schikowski T, Sugiri D, Reimann V. et al. Contribution of smoking and air pollution exposure in urban areas to social differences in respiratory health. BMC Public Health 2008; 8: 179
• 15 Pötschke-Langer M. Tabakatlas Deutschland 2015. Lengerich, Westfalen: Pabst Science Publishers; 2015
• 16 Trachtenberg AJ, Dik N, Chateau D. et al. Inequities in ambulatory care and the relationship between socioeconomic status and respiratory hospitalizations: A populationbased study of a canadian city. Ann Fam Med 2014; 12: 402-407
• 17 Blanc PD, Eisner MD, Yelin EH. et al. Socioeconomic gradients in tiotropium use among adults with COPD. Int J Chron Obstruct Pulmon Dis 2008; 3: 483-490
• 18 Axelsson Fisk S, Merlo J. Absolute rather than relative income is a better socioeconomic predictor of chronic obstructive pulmonary disease in Swedish adults. Int J Equity Health 2017; 16: 70
• 19 Burney P, Jithoo A, Kato B. et al. Chronic obstructive pulmonary disease mortality and prevalence: The associations with smoking and poverty – a BOLD analysis. Thorax 2014; 69: 465-473
• 20 Steenland K, Hu S, Walker J. All-cause and cause-specific mortality by socioeconomic status among employed persons in 27 US states, 1984-1997. Am J Public Health 2004; 94: 1037-1042
• 21 Gershon AS, Hwee J, Victor JC. et al. Trends in socioeconomic status-related differences in mortality among people with chronic obstructive pulmonary disease. Ann Am Thorac Soc 2014; 11: 1195-1202
• 22 Huisman M, Kunst AE, Bopp M. et al. Educational inequalities in cause-specific mortality in middle-aged and older men and women in eight western European populations. Lancet 2005; 365: 493-500
• 23 Jahagirdar D, Kroll T, Ritchie K. et al. Patient-reported outcome measures for chronic obstructive pulmonary disease: The exclusion of people with low literacy skills and learning disabilities. Patient 2013; 6: 11-21
• 24 Kühl K, Kenn K, Rief W. et al. Ist das peinlich!?: Die Rolle von Scham bei COPD. AT 2012; 38: 333-341
• 25 Solano JP, Gomes B, Higginson IJ. A comparison of symptom prevalence in far advanced cancer, AIDS, heart disease, chronic obstructive pulmonary disease and renal disease. J Pain Symptom Manage 2006; 31: 58-69
• 26 Cully JA, Graham DP, Stanley MA. et al. Quality of life in patients with chronic obstructive pulmonary disease and comorbid anxiety or depression. Psychosomatics 2006; 47: 312-319
• 27 Kunik ME, Roundy K, Veazey C. et al. Surprisingly high prevalence of anxiety and depression in chronic breathing disorders. Chest 2005; 127: 1205-1211
• 28 Bosley CM, Corden ZM, Rees PJ. et al. Psychological factors associated with use of home nebulized therapy for COPD. Eur Respir J 1996; 9: 2346-2350
• 29 Stapleton RD, Nielsen EL, Engelberg RA. et al. Association of depression and life-sustaining treatment preferences in patients with COPD. Chest 2005; 127: 328-334
• 30 Fan VS, Giardino ND, Blough DK. et al. Costs of pulmonary rehabilitation and predictors of adherence in the National Emphysema Treatment Trial. COPD 2008; 5: 105-116
• 31 Gardiner C, Gott M, Small N. et al. Living with advanced chronic obstructive pulmonary disease: Patients concerns regarding death and dying. Palliat Med 2009; 23: 691-697
• 32 Leung JM, Udris EM, Uman J. et al. The effect of end-of-life discussions on perceived quality of care and health status among patients with COPD. Chest 2012; 142: 128-133
• 33 Giacomini M, DeJean D, Simeonov D. et al. Experiences of living and dying with COPD: A systematic review and synthesis of the qualitative empirical literature. Ont Health Technol Assess Ser 2012; 12: 1-47
• 34 Weiner B, Perry RP, Magnusson J. An attributional analysis of reactions to stigmas. J Pers Soc Psychol 1988; 55: 738-748
• 35 Meerwein F. Die Arzt-Patientenbeziehung des Krebskranken. In: Meerwein F. Hrsg. Einführung in die Psycho-Onkologie. 2.. Aufl. Bern: Huber; 1981: 84-156
• 36 Pinto RA, Holanda MA, Medeiros MMC. et al. Assessment of the burden of caregiving for patients with chronic obstructive pulmonary disease. Respir Med 2007; 101: 2402-2408
• 37 Simpson AC, Young J, Donahue M. et al. A day at a time: Caregiving on the edge in advanced COPD. Int J Chron Obstruct Pulmon Dis 2010; 5: 141-151
• 38 Caress A-L, Luker KA, Chalmers KI. et al. A review of the information and support needs of family carers of patients with chronic obstructive pulmonary disease. J Clin Nurs 2009; 18: 479-491
• 39 Jones PW, Harding G, Berry P. et al. Development and first validation of the COPD Assessment Test. Eur Respir J 2009; 34: 648-654
• 40 Miravitlles M, Garcia-Sidro P, Fernandez-Nistal A. et al. Course of COPD assessment test (CAT) and clinical COPD questionnaire (CCQ) scores during recovery from exacerbations of chronic obstructive pulmonary disease. Health Qual Life Outcomes 2013; 11: 147
• 41 Garcia-Sidro P, Naval E, Martinez Rivera C. et al. The CAT (COPD Assessment Test) questionnaire as a predictor of the evolution of severe COPD exacerbations. Respir Med 2015; 109: 1546-1552
• 42 Kang HK, Kim K, Lee H. et al. COPD assessment test score and serum C-reactive protein levels in stable COPD patients. Int J Chron Obstruct Pulmon Dis 2016; 11: 3137-3143
• 43 Karloh M, Fleig Mayer A, Maurici R. et al. The COPD Assessment Test: What Do We Know So Far?: A Systematic Review and Meta-Analysis About Clinical Outcomes Prediction and Classification of Patients Into GOLD Stages. Chest 2016; 149: 413-425
• 44 Gupta N, Pinto LM, Morogan A. et al. The COPD assessment test: A systematic review. Eur Respir J 2014; 44: 873-884
• 45 World Health Organization. Adherence to long-term therapies: evidence for action. Geneva, Switzerland:
• 46 National Institute for Health and Care Excellence. Medicines adherence: in volving patients in decisions about prescribed medicines and supporting adherence. 2017
• 47 Effing TW, Vercoulen JH, Bourbeau J. et al. Definition of a COPD self-management intervention: International Expert Group consensus. Eur Respir J 2016; 48: 46-54
• 48 Global Initiative for Chronic Obstructive Lung Disease, Inc. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease: (Updated 2018). Im Internet: goldcopd.org/
• 49 Zwerink M, Brusse-Keizer M, van der Valk PD. et al. Self management for patients with chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2014; CD002990
• 50 Living well with COPD. Montreal: 2006
• 51 Bourbeau J, Julien M, Maltais F. et al. Reduction of hospital utilization in patients with chronic obstructive pulmonary disease: A disease-specific self-management intervention. Arch Intern Med 2003; 163: 585-591
• 52 Bourbeau J, van der Palen J. Promoting effective self-management programmes to improve COPD. Eur Respir J 2009; 33: 461-463
• 53 European Lung Foundation (ELF) and European Respiratory Society. Living well with COPD.
• 54 Verein Lunge Zürich. Besser leben mit COPD: Ihre Schulung für mehr Kompetenz im Umgang mit der Krankheit: Ein praktischer Leitfaden für Betroffene und Angehörige. 2. Aufl. Zürich: Im Internet: gesundheit-heute.ch/wp-content/uploads/2016/12/copdchronic-obstructive-pulmonary-disease_2.pdf
• 55 Howcroft M, Walters EH, Wood-Baker R. et al. Action plans with brief patient education for exacerbations in chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2016; 12: CD005074
• 56 Lenferink A, Brusse-Keizer M, van der Valk PD. et al. Self-management interventions including action plans for exacerbations versus usual care in patients with chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2017; 8: CD011682
• 57 Jonkman NH, Westland H, Trappenburg JCA. et al. Characteristics of effective selfmanagement interventions in patients with COPD: Individual patient data meta-analysis. Eur Respir J 2016; 48: 55-68
• 58 Criner GJ, Bourbeau J, Diekemper RL. et al. Prevention of acute exacerbations of COPD: American College of Chest Physicians and Canadian Thoracic Society Guideline. Chest 2015; 147: 894-942
• 59 Kessler R, Casan-Clara P, Koehler D. et al. COMET: A multicomponent homebased disease-management programme versus routine care in severe COPD. Eur Respir J 2018; 51 DOI: 10.1183/13993003.01612-2017.
• 60 Russell S, Ogunbayo OJ, Newham JJ. et al. Qualitative systematic review of barriers and facilitators to self-management of chronic obstructive pulmonary disease: Views of patients and healthcare professionals. NPJ Prim Care Respir Med 2018; 28: 2
• 61 Spruit MA, Singh SJ, Garvey C. et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med 2013; 188: 64
• 62 Vogelmeier C. et al. S2k - Leitlinie zur Diagnostik und Therapie von Patienten mit chronisch obstruktiver Bronchitis und Lungenemphysem (COPD). Pneumologie 2018; 72: 253-308
• 63 Gloeckl R, Marinov B, Pitta F. Practical recommendations for exercise training in patients with COPD. Eur Respir Rev 2013; 22: 178-186
• 64 Murray JA, Waterman LA, Ward J. et al. Perceptual and physiologic responses during treadmill and cycle exercise in patients with COPD. Chest 2009; 135: 384-390
• 65 American College of Sports Medicine. ACSMʼs guidelines for exercise testing and prescription. Wolters Kluwer; 2017
• 66 Harrison SL, Robertson N, Graham CD. et al. Can we identify patients with different illness schema following an acute exacerbation of COPD: A cluster analysis. Respir Med 2014; 108: 319-328
• 67 Hataji O, Nishii Y, Ito K. et al. Smart watch-based coaching with tiotropium and olodaterol ameliorates physical activity in patients with chronic obstructive pulmonary disease. Exp Ther Med 2017; 14: 4061-4064
• 68 Lee AL, Dolmage TE, Rhim M. et al. The Impact of Listening to Music During a High-Intensity Exercise Endurance Test in People With COPD. Chest 2017; 153: 1134-1141
• 69 Glaab T, Vogelmeier C, Hellmann A. et al. Guideline-based survey of outpatient COPD management by pulmonary specialists in Germany. Int J Chron Obstruct Pulmon Dis 2012; 7: 101-108
• 70 Puhan MA, Gimeno-Santos E, Scharplatz M. et al. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2011; CD005305
• 71 Spielmanns M. Pneumologische Rehabilitation – ambulant oder stationär?. Der Pneumologe 2015; 12: 219-226
• 72 Holland AE, Mahal A, Hill CJ. et al. Home-based rehabilitation for COPD using minimal resources: A randomised, controlled equivalence trial. Thorax 2017; 72: 57-65
• 73 Guell M-R, Cejudo P, Ortega F. et al. Benefits of Long-Term Pulmonary Rehabilitation Maintenance Program in Patients with Severe Chronic Obstructive Pulmonary Disease. Three-Year Follow-up. Am J Respir Crit Care Med 2017; 195: 622-629
• 74 Tudor-Locke C, Hatano Y, Pangrazi RP. et al. Revisiting “how many steps are enough?”. Med Sci Sports Exerc 2008; 40: S537-S543
• 75 Demeyer H, Burtin C, Hornikx M. et al. The Minimal Important Difference in Physical Activity in Patients with COPD. PLoS One 2016; 11: e0154587
• 76 Coughlin S, Liang WE, Parthasarathy S. Retrospective Assessment of Home Ventilation to Reduce Rehospitalization in Chronic Obstructive Pulmonary Disease. J Clin Sleep Med 2015; 11: 663-670
• 77 Free C, Phillips G, Watson L. et al. The effectiveness of mobile-health technologies to improve health care service delivery processes: A systematic review and meta-analysis. PLoS Med 2013; 10: e1001363
• 78 Abaza H, Marschollek M. mHealth Application Areas and Technology Combinations*. A Comparison of Literature from High and Low/Middle Income Countries. Methods Inf Med 2017; 56: e105-e122
• 79 Bamidis PD, Paraskevopoulos E, Konstantinidis E. et al. Multimodal e-Health Services for Smoking Cessation and Public Health: The SmokeFreeBrain Project Approach. Stud Health Technol Inform 2017; 245: 5-9
• 80 IKK classic. Umfrage Medizin- und Gesundheits-Apps. Im Internet: www.ikk-classic.de/export/de/.galleries/Dokumente-Presse/Ergebnisse-Umfrage-Medizin-und-Gesundheits-Apps.pdf
• 81 Initiative Präventionspartner. GAPP-Studie. 2014
• 82 Wieder richtig Durchatmen – Wie eine App Ihnen bei COPD hilft: Atemnot und Husten bekommen Sie dank MyTherapy besser unter Kontrolle. Im Internet: www.mytherapyapp.com/de/copd-apps-atemwegserkrankungen-so-helfen-sie-inhalieren
• 83 Muller T, Muller A, Hubel C. et al. Optimizing inhalation technique using web-based videos in obstructive lung diseases. Respir Med 2017; 129: 140-144
• 84 Knipel V, Criée CP, Windisch W. Korrekte Inhalationstherapie: Einweisung mittels Internet-verfügbarer Filmsequenzen. Eine Initiative der Deutschen Atemwegsliga e.V. Pneumologie 2013; 67: 157-161
• 85 Österreichische Gesellschaft für Pneumologie. COPD Help: Die App für COPD-Patienten. Im Internet: www.copdapp.at/
• 86 Borel J-C, Pelletier J, Taleux N. et al. Parameters recorded by software of non-invasive ventilators predict COPD exacerbation: A proof-of-concept study. Thorax 2015; 70: 284-285
• 87 Ambrosino N, Vitacca M, Dreher M. et al. Tele-monitoring of ventilator-dependent patients: A European Respiratory Society Statement. Eur Respir J 2016; 48: 648-663
• 88 Masefield S, Vitacca M, Dreher M. et al. Attitudes and preferences of home mechanical ventilation users from four European countries: An ERS/ELF survey. ERJ Open Res 2017; 3 DOI: 10.1183/23120541.00015-2017.
• 89 Chatwin M, Hawkins G, Panicchia L. et al. Randomised crossover trial of telemonitoring in chronic respiratory patients (TeleCRAFT trial). Thorax 2016; 71: 305-311
• 90 World Health Organization, Regional Office for Europe. Use of well-being measures in primary health care – the DepCare project health for all. 1998
• 91 Fletcher CM, Elmes PC, Fairbairn AS. et al. The significance of respiratory symptoms and the diagnosis of chronic bronchitis in a working population. Br Med J 1959; 2: 257-266
• 92 Rose L, Istanboulian L, Carriere L. et al. Program of Integrated Care for Patients with Chronic Obstructive Pulmonary Disease and Multiple Comorbidities (PIC COPD+): A randomised controlled trial. Eur Respir J 2018; 51 DOI: 10.1183/13993003.01567-2017.