CURRENT ISSUES

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COPD new target for DM programmes Early results of US disease management (DM) programmes show that patient-centred approaches have significant potential for improving the quality of life and reducing the costs associated with chronic obstructive pulmonary disease (COPD). COPD has not traditionally been a target for DM programmes; however, the expected introduction of costly end-stage treatments, such as lung transplants and lung reduction surgery, mean that DM is an increasingly attractive option for patients with this condition. There are a number of emerging models for the DM of COPD. For example, Californian consulting group the Pulmonary Care Continuum has developed a methodology that will hopefully be available to all US individuals with chronic lung disease. The Pulmonary Care Continuum has taken elements from short-term COPD programmes and created a programme of standard care based on self-management.

Self-management a key focus 'The new role of the respiratory therapist is to train chronic lung patients to care for themselves and to interact with the doctor' , according to respiratory physician and founder of the consulting group Dr Brian Tiep. He says that this is achieved in an inexpensive way by matching the goals of physicians and managed-care organisations (MCOs). Introduction of parts of the self-management programme has already reduced patient hospitalisations by up to 50%, and reduced durations of hospital stay by about 1 day. Self-management is also the main focus of the multidisciplinary COPD programme developed at National Jewish Medical and Research Center, and offered to MCOs. The programme aims to teach patients how to manage their condition, cope with emergencies and prevent complications.

Hospital's DM activities National Jewish employs case-management experts in COPD to educate MCO case managers in the specifics of patient requirements, contracts with home health agencies in the MCO's area, provides MCOs with data on the appropriateness of enrolling patients in the DM programme, and offers an outpatient programme that teaches patients and their families how to deal with the disease. The hospital has also introduced a new programme whereby a device is used to measure airway function and report results via telephone to the medical team. 'National Jewish has made major inroads in home management of COPD and for this reason it's an ideal area for us to offer disease management', commented Dr David Tinkelman from the Health Initiatives division of the hospital. Widespread and expensive, COPD is prime DM target. Medical Outcomes and Guidelines Alert 6: 5, 10 Sep 1998 800708390

PhannacoEconomics & Outcomes News 10 Oct 1998 No. 183

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