Q. What are the biggest challenges and/or insights of which providers should be aware?
A. COPD is a progressive disease that can ultimately reduce the quality of life for the patient, so they are undoubtedly anxious about receiving treatment, especially if we need to start them on high intensity NIV therapy. When implementing telemedicine and home NIV initiation, there are a number of considerations that providers need to keep in mind:
- Platforms and technology – while technology has advanced in this space, we’re still having to log in to multiple platforms to monitor devices and patient data. When working with numerous HMEs, clinicians need to keep this in mind as they manage patients who may be on different ventilator systems. They also need to consider the technology that patients have in place, such as a reliable Internet connection in order to ensure they have the best experience.
- Privacy and Security – data encryption is vital when working in a remote capacity. Since much of the patient data is sent over the Internet, it’s important to have the right technology and partners in place to guarantee patient data is kept private and is transferred in a secure manner.
- Technical and digital adeptness/comfort – it’s important that the patient has some basic understanding of technology or is at least comfortable using the technology and devices.
- Patient selection – every patient receiving home NIV initiation needs to be evaluated individually to make sure that they will receive the best outcomes and can adhere to therapy. The patient’s environment, level of tech skills and mobility must be considered, as well as whether they will be receiving support from a caregiver.
There are also political and geographical challenges to consider. In some regions, the application of care is entirely dependent on organizational structure and reimbursement. Many countries do not reimburse for elective or home care, while some countries don’t have enough hospital beds to support elective patients and have no other choice but to find creative solutions to discharge patients and treat them at home. It tells us that homecare will never be a primary practice. Patients will always need more guidance and organizational structures will always vary. But as the world begins to become more aware of alternative chronic respiratory treatment options, perhaps broader organizational reimbursement will follow.
Q. What results have you seen in your research from initiating home ventilation using remote monitoring/telemedicine?
A. In talking with our patients, we continue to learn that most do not want hospital care, and prefer to begin with NIV initiation at home, where they feel most comfortable. For those that are more debilitated or disabled from the disease, the need for home NIV increases greatly. With more flexibility on how to organize care in the home, caretakers can provide a level of comfort and support, lessening any anxiety patients may be feeling about receiving treatment. Via our non-inferiority study of COPD patients, we found that it was as equally effective to start at home, where many of the outcomes remained the same, with costs dropping by at least one third. Before these studies began, it was assumed that home ventilation for COPD patients was impossible due to their need for higher pressures and more frequent pressure adjustments. But through our research, we found that it was not only possible, but in many cases just as effective and less expensive.
Our ultimate goal is to improve the overall quality of life for the patients, so providers will need to assess each patient’s individual circumstances and any comorbidities involved to be clear about the disease, and work to tailor their therapy to their unique situations.
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