There’s a burgeoning crisis taking hold in the COPD management space; there are simply not enough pulmonologists, respiratory therapists, or pulmonary rehabilitation facilities to treat the growing number of COPD patients. This has left our field with an urgent window of opportunity to implement digital innovation into traditional treatment paradigms. Ironically enough, it was a respiratory disease that led to a global pandemic more than two years ago, which accelerated an unprecedented revolution in the widespread deployment of virtual care models. This paradigm shift has transformed care delivery for many chronic conditions, such as diabetes and heart failure but has all but missed the respiratory disease space. As a pulmonologist, I see on a daily basis the ways in which the care environment for COPD is ripe for digital innovation. But there’s no time to waste.
As it stands today, we’re faced with an extreme shortage of respiratory therapists, and by 2025 experts predict that there will be a deficit of 1,400 pulmonologists in the United States. Moreover, COPD cases continue to rise, and the condition is the third leading cause of death by chronic disease in the United States, costing the health care system an estimated $49 billion annually. This confluence of factors has left pulmonologists and respiratory therapists stretched thin and burned out while limiting patients’ access to care.
In addition, while evidence shows that pulmonary rehabilitation can reduce hospitalizations, increase exercise capacity, and improve quality of life, people with COPD are often limited in their mobility and unable to travel at a regular frequency to access the pulmonary rehabilitation facilities in their vicinity – if there are any. Estimates indicate that there are 18,000 COPD patients for every pulmonary rehabilitation facility, an imbalance that results in only a 3 to 10 percent utilization rate for this effective, evidence-based form of COPD management. Although some rehabilitation centers and patient organizations develop their own video series to guide people through exercises, the overall scarcity of these resources has left COPD patients with a difficult choice: patch together what scant options they can find or magically discover a way to be more mobile.
Another area where traditional care models fall short is with medication adherence: research has found that only 40 to 60 percent of patients with COPD adhere to their treatment regimen. Other studies have shown that those with COPD who are less adherent face higher risks of exacerbation episodes, resulting in higher health care costs than those who were adherent to their medication regimen. Too often, patients’ conditions can deteriorate in between visits because of these gaps in care, whether it’s because they do not have regular visits to help them understand how to take their medications correctly or because clinicians don’t have the ability to track objective changes in the patients’ health, such as symptom burden or declines in oxygen or spirometry levels.
Finally, patients aren’t the only part of the equation that have to contend with a fragmented care landscape. As an outpatient pulmonologist, most of my patients’ interactions with respiratory therapists are limited to brief instructional meetings when they deliver respiratory equipment such as oxygen concentrators or nebulizers. The only other interactions are limited to hospital stays. At present, there is little opportunity to maintain ongoing outpatient relationships between patients and respiratory therapists. In addition, COPD patients could benefit from working with health coaches to work with them on medication compliance, tobacco cessation, and self-monitoring. If pulmonologists were better integrated with other members of patients’ care teams, we could transform our ability to coordinate care and improve outcomes.
Virtual care innovations offer the potential to combine remote patient monitoring, on-demand coaching, and regular touch points for patients to engage with their health into one central nexus. Some models also extend provider capabilities, enabling them to deliver care beyond clinic walls and reach patients who may have difficulty accessing in-person care. For patients with COPD, they can make pulmonary rehabilitation more accessible, but they also streamline clinical workflows for providers and consistently monitor for acute exacerbations to improve health outcomes and ease the disease’s burden on our health care system. Equally important, these models can act as connective tissue between members of a patient’s care team, giving each provider insight into the patient’s overall care journey and enabling them to act as a cohesive whole. If a solution can connect a pulmonologist to a health coach, coordinating medication adherence in the process, and both could follow a patient’s progress with a respiratory therapist, this virtual model of care would transform disparate touchpoints into a constellation of care with the patient at the center.
The recent adoption of digital health solutions that we’ve seen across the health care industry, and the growing body of research that points to their efficacy, demonstrate that there’s fertile ground for innovation and implementation in the COPD management space. The time to adopt these solutions is now, and by doing so, we can transform the paradigm of care, extend the reach of providers, and empower patients to improve their health.
Brian Gelbman is a pulmonary and critical care physician.
