HF patient education: Are we making headways? · 2016-02-23 · History of heart failure patient...

HF patient education:

Are we making headways?

René Lerch, Geneva

18th Winter-MeetingWorking Group on Heart FailureGrindelwald, January 21-23, 2016

Conflict of interest

I was involved in

− the application for reimbursement of HF patient education by nurses;

− the creation of a cardiovascular training module for medical assistants MPAs.

No financial conflicts

Outline

1. Patient education in HF – still on the agenda?

2. The Swiss efforts – Tops and flops

13th Winter-MeetingWorking Group on Heart FailureGuarda ValJanuary 20-22, 2011

HF patient education: Are we making headways?

3. Obstacles and opportunities

ESC Guidelines

for the diagnosis and treatment of acute and chronic heart failure

Eur Heart J 2012;33:1787-847

Heart failure disease management:

Reasons for dampened enthusiasm

McAlister, F.A., et al; J Am Coll Cardiol, 2004;44:10-9; 29 studies, 5039 pts.

Roccaforte, R., et al ; Eur J Heart Fail 2005; 7:1133-44; 33 studies, 5308 pts.

Göhler, A., et al; J Card Fail 2006 ;12:554-67; 36 studies, 8341 pts.

Critical analysis: Clark et al; J Am Coll Cardiol 2009; 54:397-401

Albanoi et al; Arch Cardiovasc Dis 2014; 107: 328-339

Savard et al; Trials 2011; 12:194-204

Jaarsma et al; JAMA 2008;168:316-324 COACH- Study; 1023 pts.

Powell et al; JAMA. 2010;304(12):1331-1338 HART-Study; 902 pts.

Evidence is based on meta-analyses with considerable

heterogeneity

Several recent large randomized controlled trials

with disappointing results

Essential components of heart failure

management programs:

Education

Monitoring(Heart failure clinics, home visits by nurses, structured

telephone support, telemonitoring)

Whellan et al, in:

Heart Failure: A Companion to Braunwald's Heart Disease p. 709 - 711

Patient education is key element

of heart failure management programs

Outline






History of heart failure patient education in Switzerland

2002 First postgraduate course for nurses in heart failure (HF)

patient education (BZ Bern; P. Mohacsi)

2004 Educational kit for HF patients (Swiss Heart Foundation)

2005 Task Force HF Disease Management (P. Buser)

2006 Publication of recommendations by Task Force

2009 Application for reimbursement of patient education by

nurses by basic health insurance (R. Lerch, P. Buser)

2009 Pilot project for offer of free patient education by

nurses in Basel and Berne (Swiss Heart Foundation)

2010 Application for reimbusement rejected by FDHA

2012 Elaboration of training module for medical assistants (MPA)

in education of cardiac patients (P. Mohacsi, R.Lerch)

2013 Introduction of module for MPAs at "Bildungszentrum

Pflege" Bern (P. Mohacsi, R. Lerch)

2016 APP for patient education in heart failure (P. Meyer;

Swiss Heart Foundation)

~2003 First programs for HF partient education

2002 Postgraduate course

"Patient education in HF"

2010

postgraduate study curriculum "Cardiology"

Duration: 21 Days

Certification: Certificate BZ Bern / WG Heart failure

Integration of postgraduate course in

3 Module: Heart failureCommunication and counselingPrevention and rehabilitation

10 days

6 days

5 days

Entire postgraduate study curriculum

until today ~ 135 attendees

60 days

Certificate: • Diplom NDS HF Kardiologie SBK (HöFa 1 anerkannt)

• Diplom Berufsbildnerin/Berufsbildner in Lehrbetrieben,

eidgenössisch anerkannt

21 days

HF: Heart failure

Schweizerische

Ärztezeitung 2006;87:

1943-1952

Paragraphs on patient education

• Time and duration

• Initiation in hospital (3 sessions)

• After discharge number and time of sessions fixed

by treating physician

• Topics

3 levels:

• Training requirement

Nurse with special postgraduate training in HF patient

education approved by WG Heart hailure of SSC.

o Understanding of disease

o Self-monitoring

o Nutrition, risk factors

o Physical activity

o Drug treatment

o Emergency scenarios

o Self-documentation

o Psychosocial problems

Application 2009 for reimbursement of HF patient education:

Tariff options

SwissDRG

Tarmed

KLV

Hospital:

Outpatients:(BUT: with few exceptions

only medical services)

(not tariff in the strict sense,

but list of medical and

nonmedical services that

have to be reimbursed by

basic insurance)

agreement between insurance and care

provider

For selected patient populations

KLV, Krankenpflege Leistungsverordnung

Application 2009 for reimbursement of HF patient education:

Proposed wording in KLV

KLV, Krankenpflege Leistungsverordnung

• medical prescription

• nurse with training recognized

by

WG Heart failure of SSC

• initially maximum 8 sessions

• further session possible upon

medical justification

• at least 1 HF hospitalization

Estimation of volume

o 18'000 pts/year

Average costs per patient(3 educational session

+ 5 phone-followups)

o 482 CHF

Ablehnung des Antrags

Pilot project of Swiss Heart Foundation:

Free offer of patient education in Basel and Berne

01.04.2009 – 21.01.2010

22 patients

OdA Berufsbildung Medizinische Praxisassistentin:

Postgraduate studies "Medizinischen Praxiskoordinatorin"

Pflichtmodule

– Chronic Care Management (Basismodul I)

– Chronic Care Management (Basismodul II)

– Qualitätsmanagement in der Arztpraxis

– Beratung von Langzeitpatienten – Diabetes

Zwei der folgenden Wahlpflichtmodule

– Beratung von Langzeitpatienten – Rheuma

– Beratung von Langzeitpatienten – Atemwegserkrankungen

– Beratung von Langzeitpatienten – Koronare Herzkrankheit/Herzinsuffizienz

– Hirnleistungsschwäche

– Wundbehandlung

– Dosisintensives Röntgen

Study curriculum:

Certification:

Duration:

• 30 – 40 days (variable duration of Modules)

• Medizinische Praxiskoordinatorin klinischer Richtung mit

eidgenössischem Fachausweis

Beratung von Langzeitpatienten/-Patientinnen mit

koronarer Herzkrankheit / Herzinsuffizienz

Module für Medical praxis assistants (MPA):

Analogie Beratung von

Chronischen Herzpatienten

Basismodul I

Basismodul II

Herzmodul

5 Tage

5 Tage

8 Tage

18 Tage

Module Koronare Herzkrankheit / Herzinsuffizienz for MPAs

Bildungszentrum Pflege Bern

8 days / 60 hoursDuration:

First course in French in preparation

(Espace Competence, Cully)

Courses 2013/14/15

39 attendees

Outline






Obstacles

Patient education by trained non-medical healthcare personnel

Insufficient awareness of physicians

Mistrust among healthcare professionals

No reimbursement

Interprofessional collaboration 2016…….

Obstacles


Insufficient awareness of physicians

Mistrust among healthcare professionals

No reimbursement

Hospital

KLV

Ambulatory

Tariff

SwissDRG

Potential submitter SGK (SGK +?) •Hausärzte Schweiz •SGAIM

Nurse MPA

Chances of success(RL; 22.01.2016)

++ + +++

Tariff options for reimbursement of patient education

Sector

Flat rate Fee for service

Tarmed

Ambulatory

Fee for service

Flat rateKLV

Opportunities


• Federal health strategy 2020 (2013)

The importance of patient education and interprofessional

collaboration for the management of chronic disease is

increasingly recognized!

• Plattform Interprofessionalität (2014)

• Schweizer Strategie HGHD (2016)

• Charta der SAMW zur interprofessionellen Zusammenarbeit (2014)

• Bericht "Neue Versorgungsmodelle für die medizinische Grundversorgung" (2012)

Conclusion



The preconditions to offer therapeutic education to HF

patients in Switzerland are favorable!(training of nonmedical healthcare providers, instructional material, new concepts of care)

The main obstacle is lack of reimbursement.

Constructive dialogue and cooperation between

stakeholders is indispensable.

HF patient education: Are we making headways? · 2016-02-23 · History of heart failure patient...

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