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

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 Briefcase
1Sorknæs, AD; 1Hounsgaard,L; 2Olesen,F; 3Jest,P; 4Bech,M; 1Østergaard, B.
1 Institute of Clinical Research Nursing, Faculty of Health Sciences,
University of Southern Denmark
2 Department of Information and Media Studies, University of Aarhus, Denmark
3 OUH-Odense Universitetshospital & Svendborg Hospital, of Southern Denmark
4 Institute of Public Health, Health Economics, University of Southern Denmark

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 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. Studies with the COPD-briefcase
At 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. 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 years
• Living in the county of Funen

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. The virtual nursing consultation
Observation
Measurements
Education
General talk

8. Set-up

9. Set-up

10. Set-up
And now to the results

11. Results: Readmission
Telemedicine Control Difference
patients: patients: (Reduction)
(n: 50) (n: 50)
Total number of 8 (16 %) 15 (30%) 14% reduction
Readmission
Total number of 6 (12%) 11 (22%) (10% reduction)
Readmission
(exacerbation)
Total days of 37 (4,6) 116 (7,7) 79 (68%)
Readmission
Readmission days with 15 (2,5) 48 (4,4) 33(69%)
exac. (3 <1 day) (2<1day)

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. Proximity and care
“-When she talks to me I know I am in
focus. And only me.
And that's probably what makes me feel
more safe. It must be that.
Sometimes I even forget the illness I have
and I just think we are two normal people
having a normal conversation”.

14. Advantages for the patient
 Possible to create proximity and to care for
the 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 for
the consultation

15. 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 and their illness after discharge
 Create proximity
Timesaving compared to assisted homecare

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. 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. Technology aspects
 Safe and secure internet line is required
Media training and education is required
 Telemedicine equipment must be easily
accessible
Patient:
“-It just works! I just press the button and
we are connected”.

19. Technology aspects
 Need of (a little) technical knowledge
Equipment and the connection must be
reliably
Nurse:
”The worst thing is when it doesn't work. It is
very frustrating for both me and the patient
because we rely on the equipment
and it affects everything when it doesn't work.
It affects me so much that I cannot do my job.
My focus is forced away from the patient”.

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