John Chang

COPD care delivery pathways in five European Union countries: mapping and health care professionals’ perceptions

Background COPD is among the leading causes of chronic morbidity and mortality in the European Union with an estimated annual economic burden of €25.1 billion. Various care pathways for COPD exist across Europe leading to different responses to similar problems. Determining these differences and the similarities may improve health and the functioning of health services. Objective The aim of this study was to compare COPD patients’ care pathway in five European Union countries including England, Ireland, the Netherlands, Greece, and Germany and to explore health care professionals’ (HCPs) perceptions about the current pathways. Methods HCPs were interviewed in two stages using a qualitative, semistructured email interview and a face-to-face semistructured interview. Results Lack of communication among different health care providers managing COPD and comorbidities was a common feature of the studied care pathways. General practitioners/family doctors are responsible for liaising between different teams/services, except in Greece where this is done through pulmonologists. Ireland and the UK are the only countries with services for patients at home to shorten unnecessary hospital stay. HCPs emphasized lack of communication, limited resources, and poor patient engagement as issues in the current pathways. Furthermore, no specified role exists for pharmacists and informal carers. Conclusion Service and professional integration between care settings using a unified system targeting COPD and comorbidities is a priority. Better communication between health care providers, establishing a clear role for informal carers, and enhancing patients’ engagement could optimize current care pathways resulting in a better integrated system.

AEGLE: A big bio-data analytics framework for integrated health-care services

AEGLE project1 targets to build an innovative ICT solution addressing the whole data value chain for health based on: cloud computing enabling dynamic resource allocation, HPC infrastructures for computational acceleration and advanced visualization techniques. In this paper, we provide an analysis of the addressed Big Data health scenarios and we describe the key enabling technologies, as well as data privacy and regulatory issues to be integrated into AEGLEs ecosystem, enabling advanced health-care analytic services, while also promoting related research activities.

User profiling for coordinated and integrated care

Integrated care has been increasingly advocated as an approach to promote better coordination of services and quality of care at different levels. In this study, views were elicited from different users of the healthcare system (patients, informal carers and healthcare professionals) in four European countries. The views pertained to current states of care and the role that remote patient monitoring and telehealth in general can play to facilitate effective implementation of integrated care. Overall, services were perceived to be fragmented at different levels ranging from personal to system fragmentation. Approaches such as telehealth, remote patient monitoring and having specialised urgent clinics in primary care were positively perceived by users as possible solutions for tackling fragmented care and for promoting better integration of services1.

Experience of Using the WELCOME Remote Monitoring System on Patients with COPD and Comorbidities

The WELCOME system is an innovative telemonitoring system designed to provide constant monitoring of COPD patients also suffering from other major comorbidities. It consists of a sensors vest capable of recording various vital parameters in real time and transmitting them to the cloud via a tablet PC and wireless connection. In addition, peripheral devices record extra physiological data which is coupled with responses to validated health questionnaires that the patient responds to via the tablet. A dedicated medical decision support system (DSS) and a medical professional user interface support the system in providing automated detection of abnormal conditions. The obtained signals included Heart and Respiratory Rate, Body Posture, SpO2, multi-lead ECG, Auscultation and Electric Impedance Tomography. The system is tested with pilot studies in two European countries, Greece and UK. The preliminary results from the Greek pilot study are presented in this paper, highlighting the main findings from the first operational use of the WELCOME infrastructure.

A cross-sectional survey investigating women’s information sources, behaviour, expectations, knowledge and level of satisfaction on advice received about diet and supplements before and during pregnancy

BackgroundThe reported long-term effects of poor maternal nutrition and uptake of recommended supplements before and during pregnancy was the impetus behind this study. Our objectives were to investigate and understand women’s expectations, knowledge, behaviour and information sources used regarding the use of nutrition and vitamin supplements before and during pregnancy.MethodsA cross-sectional survey using a self-administered questionnaire was undertaken. A purposive sampling technique was used. Women attending the antenatal clinic at Croydon University Hospital during 2015 were invited to take part in the study. The data was analysed using descriptive statistics, paired sample T-tests and Chi-squared tests, with the level of significance set at 5% (p < 0.05).ResultsA total of 133 pregnant women completed the survey. Analysis of the results showed that women are currently using electronic resources (33%, n = 42) rather than healthcare professionals (19%, n = 25) as an information source before pregnancy. Women who sourced information through the internet were significantly more likely to take folic acid (p = 0.006) and vitamin D (p = 0.004) before pregnancy. Women preferred to receive information from the antenatal clinic (62%, n = 83), internet (46%, n = 61) and from mobile applications (27%, n = 36). Although women believed they had sufficient knowledge (60%, n = 80) and had received adequate advice (53%, n = 70) concerning the correct supplements to take, this was not demonstrated in their behaviour, with only a small number of women (37%, n = 49) taking a folic acid supplement before pregnancy. Women mistakenly perceived the timing of supplement advice as correct, with only a small number of women (18%, n = 23) considering the advice on supplements as too late.ConclusionsDespite the small sample size, this study demonstrated that women did not receive timely and/or accurate advice to enable them to take the recommended supplements at the optimal time. Women had the misconception that they understood the correct use of pregnancy supplements. This misunderstanding may be prevented by providing women intending to become pregnant with a structured, approved electronic source of information that improves their supplements uptake.

Shared decision making and experiences of patients with long-term conditions: has anything changed?

BackgroundMedication problems among patients with long-term conditions (LTCs) are well documented. Measures to support LTC management include: medicine optimisation services by community pharmacists such as the Medicine Use Review (MUR) service in England, implementation of shared decision making (SDM), and the availability of rapid access clinics in primary care. This study aimed to investigate the experience of patients with LTCs about SDM including medication counselling and their awareness of community pharmacy medication review services.MethodsA mixed research method with a purposive sampling strategy to recruit patients was used. The quantitative phase involved two surveys, each requiring a sample size of 319. The first was related to SDM experience and the second to medication counselling at discharge. Patients were recruited from medical wards at St. George’s and Croydon University Hospitals.The qualitative phase involved semi-structured interviews with 18 respiratory patients attending a community rapid access clinic. Interviews were audio-recorded and transcribed verbatim. Thematic analysis using inductive/deductive approaches was employed. Survey results were analysed using descriptive statistics.ResultsThe response rate for surveys 1 and 2 survey was 79% (n = 357/450) and 68.5% (240/350) respectively. Survey 1 showed that although 70% of patients had changes made to their medications, only 40% were consulted about them and two-thirds (62.2%) wanted to be involved in SDM. In survey 2, 37.5% of patients thought that medication counselling could be improved. Most patients (88.8%) were interested in receiving the MUR service; however 83% were not aware of it. The majority (57.9%) were interested in receiving their discharge medications from community pharmacies. The interviews generated three themes; lack of patient-centered care and SDM, minimal medication counselling provided and lack of awareness about the MUR service.ConclusionAlthough patients wanted to take part in SDM, yet SDM and medication counselling are not optimally provided. Patients were interested in the MUR service; however there was lack of awareness and referral for this service. The results propose community pharmacy as a new care pathway for medication supply and counselling post discharge. This promotes a change of health policy whereby community-based services are used to enhance the performance of acute hospitals.

M23 The use of Wearables for COPD patients: A Qualitative study

There have been significant advances in Technology enabled care (TEC) including wearable technology. However, to our knowledge, there is a paucity of literature related to patient perceptions of smart wearable sensors. The WELCOME platform (FP-7 funded project) is an innovative integrated system using wearable sensors and smart computing for COPD patients with co-morbidities.1 The aim of this platform is the early diagnosis of exacerbations and disease deterioration allowing for early intervention. The wearable sensors in this project have been integrated into a vest (Figure 1) and several prototypes with mock sensors were developed. A structured interview was designed to explore COPD patient perceptions pertaining to vest comfort, ease of wear and handling, willingness to use and concerns. Interviews were designed to take place at the clinic (England and Netherlands) where patients are provided with a suitably sized vest to try on followed by the structured interviews.Abstract M23 Figure 1 To date, 15 interviews have been completed at Croydon Healthcare services Trust, and the Dutch interviews are underway. Results The interview transcripts were thematically analysed using mostly framework analysis. Analysis was conducted using NVIVO 10. The following themes emerged from the data.1) Acceptance of vest 2) willingness to wear the vest during daytime 3) Discomfort with sensor size and shape prohibiting night wear 4) Demonstrated capability of donning the vest and handling of the sensors 5) Safety concerns emphasising importance of patient education before use 6) Gender related concerns regarding vest design. Conclusion The vests were well received by patients however the above results illustrate the importance of involving the end users in the design and development of any smart intervention. These results will be used for the final design and development of the vest. Reference 1 Chouvarda I, Philip NY, Natsiavas P, et al. WELCOME-innovative integrated care platform using wearable sensing and smart cloud computing for COPD patients for comorbidities. Conf Proc IEEE Eng Med Biol Soc. 2014;2014:3180–3. doi: 10.1109/EMBC.2014.6944298