Advanced nursing practice in COPD exacerbations: the solution for a gap in Switzerland?

Abstract

AimThis study aimed to address the need for adaptation of the current model of chronic obstructive pulmonary disease (COPD) care in Switzerland, particularly in regard to acute exacerbations, and how far an integrated approach involving advanced nursing practice can meet those needs.MethodsA state analysis guided by the PEPPA framework was initiated by the Pulmonology Clinic of University Hospital Zürich. Literature describing the current provision of COPD care regarding exacerbations in Switzerland and international qualitative studies describing the patient perspective were systematically searched and summarised. The health providers' perspective was investigated in three focus-group interviews.ResultsA lack of systematic and state-of-the-art support for patient self-management in Switzerland was described in literature and confirmed by the health providers interviewed. While care was assessed as being comprehensive and of good quality in each individual sector, such as inpatient, outpatient, rehabilitation and home settings, it was identified as being highly fragmented across sectors. The interview participants described day-to-day examples in which a lack of support in COPD self-management and fragmentation of care negatively affected the patients' disease management.ConclusionThe necessity of coordinating the transition between healthcare sectors and self-management support and that these organisational boundaries should be addressed by a multi-professional team were identified. Initial evaluation indicates that advanced practice nurses potentially have the skill set to coordinate the team and address patients' self-management needs in complex patient situations. However, the legal foundation and a reimbursement system to ensure long-term implementation is not yet available.

Qualitative Validation of COPD Evidenced Care Pathways in Japan, Canada, England, and Germany: Common Barriers to Optimal COPD Care

“… 36 , 37 In Switzerland it been suggested that advanced practice nurses may also be able to play a key role within a multi-professional team in future models of care to coordinate patient care across sectors. 38 Increased use of telehealth technologies for pulmonary rehabilitation or remote consultations, likely to have been accelerated by the COVID-19 pandemic, are also providing additional options for care models. 39 , 40 There is a need for a multidisciplinary approach across all stages of the pathway, there is no point in diagnosing patients earlier if they then cannot be appropriately treated or access effective non-pharmacological interventions.…”

Effekte einer begleiteten Nachsorge in der Post-Reha-Phase bei COPD-Patienten: eine kontrollierte Studie

“…Verschiedene Ansätze versuchen diese Schnittstellenprobleme zu überwinden, etwa Modelle der integrierten Versorgung, in denen Fach-und Hausärzte als Case-Manager fungieren, die eine bedarfsgerechte Versorgung zwischen den Sektoren planen, steuern und überprüfen. Ein weiterer vielversprechender Ansatz scheint der Einsatz von qualifiziertem Pflegepersonal zu sein, das zwischen den Sektoren vermittelt (Advanced Nursing Practice [21]). Der Erfolg solcher Ansätze ist bereits auch in der akutmedizinischen Versorgung belegt [22].…”

“…Die Überführung der körperlichen Aktivität in den Alltag scheint der IG besser zu ge-lingen als der KG. Allerdings erreichen die Patienten nicht die Erfolge von Studienteilnehmern mit anderen Indikationen [21,35].…”

Supporting Behavior Change After AECOPD – Development of a Hospital-Initiated Intervention Using the Behavior Change Wheel

“…The focus group interview results and our synthesis of the qualitative studies describing the patients' perceptions of exacerbation management are reported elsewhere. 21 Eight qualitative studies describing patient experiences have been identified: five for smoking cessation challenges, [39][40][41][42][43] three for physical activity. [44][45][46] The results of the literature review and the assessment of the health professionals' perspective are described in Supplemental Table 1.…”