HF patient education: Are we making headways? · 2016-02-23 · History of heart failure patient...
Transcript of 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
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
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
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
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
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
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
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
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
Pilot project of Swiss Heart Foundation:
Free offer of patient education in Basel and Berne
01.04.2009 – 21.01.2010
22 patients
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
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
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
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
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
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
Obstacles
Patient education by trained non-medical healthcare personnel
Insufficient awareness of physicians
Mistrust among healthcare professionals
No reimbursement
Interprofessional collaboration 2016…….
Obstacles
Patient education by trained non-medical healthcare personnel
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
Patient education by trained non-medical healthcare personnel
• 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
13th Winter-MeetingWorking Group on Heart FailureGuarda ValJanuary 20-22, 2011
HF patient education: Are we making headways?
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.