Academic journal article Australian Health Review

Best-Practice Care for People with Advanced Chronic Obstructive Pulmonary Disease: The Potential Role of a Chronic Obstructive Pulmonary Disease Care Co-Ordinator

Academic journal article Australian Health Review

Best-Practice Care for People with Advanced Chronic Obstructive Pulmonary Disease: The Potential Role of a Chronic Obstructive Pulmonary Disease Care Co-Ordinator

Article excerpt

Background

Individuals with multiple needs are perhaps least poised to navigate the complex and fragmented health care system, yet are often left to serve as the only link among their various professional care providers.1

Chronic obstructive pulmonary disease (COPD) is recognised as being a major global public health problem, with a substantial morbidity and economic burden.2 It is one of the few chronic diseases that is an increasing cause of mortality and morbidity internationally,3 but there is a growing body of local and inter- national evidence demonstrating that the care provided for people with advanced COPD does not meet their needs.4-6 Gardiner et al.7 identified the specific needs of people with advanced COPD, highlighting their significant symptom burden, specific needs around education and access to specialist and palliative services as well as the significant issues affecting their families.7 The basis of best-practice care for chronic diseases such as COPD is systematic management8,9 incorporating coor- dinated, multidisciplinary care10 and the integration of care between the acute and primary care sectors where multiple providers may be involved.11 However, there are few current models of care that reflect the key elements of best-practice COPD care as summarised by Disler et al.12 and which integrate systematic chronic disease management with a pallia- tive approach.7

Although there is consensus that care co-ordination is a key element of best-practice chronic disease management (CDM) models,13-15 there is little agreement on the most effective processes for actually co-ordinating care. There is a clear dis- tinction between care coordination and service coordination: service co-ordination is undertaken at a system level, whereas care co-ordination is undertaken at an individual level (Box 1). The key components of care co-ordination have been identified in several reviews;16,17 however, the US Agency for Healthcare Research and Quality has identified that there is little clarity around who should be responsible for co-ordinating care, what approaches to care co-ordination are likely to work (e.g. should approaches be generic or disease based) and what strat- egies would improve care co-ordination (Table 1).10

One care co-ordination strategy for which there is increas- ing international evidence is the care co-ordinator role, with the UK18,19 and US13,20 increasingly using care co-ordinators to ensure best-practice care for people with chronic and complex conditions. There is no consensus on the definition of a care co-ordinator,21 although there is increasing evidence about the most effective tasks that a care co-ordinator can undertake.22 Moreover, there are a variety of titles given to the care co-ordinator role including 'case manager', 'care manager', 'care co-ordinator' and 'system navigator',incor- porating a variety of definitions of these roles, many of which overlap and none of which are consistent.22-24

Although heart failure and diabetes have been identified as benefiting from a systematic CDM approach (which includes care co-ordination),25 there is international and local evidence that the care provided for people with advanced COPD is neither systematic nor coordinated.4,6,26 Best-practice care for people with advanced COPD should include a multidisciplinary, palli- ative approach in parallel with active disease management.5,6 COPD exacerbations are currently managed largely in the acute hospital setting, with care provided by respiratory specialists or general physicians, then referral back to the general practitioner (GP). There has been little coordinated community support for people with COPD living at home. Despite the evidence around care needs, there seems to be little ability to translate this evidence into practice. A care co-ordination framework offers a practical option for integrating both a CDM and palliative approach - identified as a key element of COPD care by the American Thoracic Society27 and in the COPD-X Guidelines. …

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