Stichting Begeleide Selfzorg
Primary Care "and-a-half": managed thrombosis selfcare
An interview with David Kat, innovation expert and secretary of the sBZ
A well informed thrombosis patient knows when to call for help. Plus, a person that understands their disease will be more faithful in taking their medications. The sBZ - Stichting Begeleide Ze
lfzorg (Managed Selfcare Institute), wants to show that many medication complications can be avoided, by providing better education to the patient, and through optimization of communication between physician, pharmacist and the thrombosis specialist.
Better information to patient concerning disease
In the Netherlands, every year 34,000 people are hospitalized due to improper use of medication. In about 10% of these cases it concerns the use of anti-coagulation medication. A recent study (HARM) into safe self-medication concluded that the number of hospitalizations could be reduced by 50%. "A significant number of cases can be avoided by providing the patient with better information concerning their disease", says David Kat, innovation expert and secretary of the sBZ.
David Kat used to be a patient at the Amsterdam Medical Center (AMC) six years ago. He experienced first-hand the benefits of knowing the details of your own disease. "You know the pros and cons of the various choices you can make. You can participate in formulating a treatment plan with the physician."
Direct patient involvement leads to fewer complications
Early 2007, David started the Managed Selfcare Institute (sBZ) for thrombosis, together with internal medicine specialist Sabine Pinedo. The institute advocates a thrombosis service doing double duty as a self-care center. This "primary care and-a-half" concept is the future, according to Kat. In the outpatient clinic, Sabine often met thrombosis patients that knew very little about their own disease", says Kat. "Patients know little about the factors that influence anti-coagulation medication. This can lead to over-diagnosis and unnecessary complications".
The institute's internal medicine specialists (with the Vascular Care department of AMC as a backup) coach thrombosis patients in measuring anti-coagulation levels in their blood. The patients have direct contact with their coaches via the Internet. The specialist monitor the blood test results and stay in direct contact with the patient during a self-care session. "We bring the point-of-care to the patient. Our self-care method results in better informed patients, closer involvement by the patient in their therapy and ultimately in fewer complications."
How does assisted self-care work?
"After subscribing to the service (by either the patient or the treating physician) the patient can follow an online self-care training session. Afterward we like to see the patient for a "test". We have multiple locations in Amsterdam, and about 20 supporting locations throughout the country at pharmacies. These pharmacies are trained to conduct the intake process and the test. Patients will also have a medication check done at that point. Once they are participating in the program, the patients return once every three months for a checkup. We'll check their condition, how they use their equipment, and if necessary provide further instructions."
What is involved in this online self-care training session?
"Before starting the self-care process, the patient gets a training via the Internet. In other words: E-Learning. The patient learns about the particulars of the disease and the equipment used to measure coagulation levels. After finishing the online course, the patient will come by for a visit in which they'll be subjected to a test. That will be the first time they get to actually use the equipment, and if they pass the test they can take the equipment home."
What is a point-of-care device?
"This is a device that uses nano-technology to analyze just a single drop of blood. For thrombosis patients this is quite an improvement. Collecting a blood sample from a vain every few weeks is both inconvenient and time-consuming. Plus, the point-of-care device immediately provides the test result. That means you can quickly react in case of abnormal results, and prevent complications from happening."
How do you coach the patients?
"Patients get easy access to their care provider via an Internet based portal. They enter the test result data from their point-of-care device into their personal record. We can view that data, and with the patient's consent we can share that data with the physician and with specialists. Self-care patients can email and call us. It's a low barrier. They can contact us for any question or with any uncertainties. This way the patient stays alert, learns about their disease and we can quickly adjust treatment if something is off target. We also maintain in contact via Skype. For instance, if someone has a question about the equipment, we can use the video conferencing capabilities of Skype to easily show them what they need to know."
What is the physician's role in the self-care process?
"In our opinion it is very important to involve the physician in the self-care process. So far it was more typical for the physician to only know the diagnosis. The patiently subsequently deals with the thrombosis service for that problem, and discusses other issues with the physician. In this case however, we give the physician access to the patient's record in the patient portal (with the patient's consent). This way the physician can stay up to date on test results and medication changes."
How does the expertise of the specialist get to the point-of-care?
"For 'primary care and-a-half' is it essential that medical specialists have an avenue to transfer knowledge to the physician. We do that for instance with our newsletter that tells them about the latest developments in medical research. This way physicians get access to relevant research material that otherwise only is read by the specialists. With our newsletter we keep both the physician and the pharmacist up-to-date. Our first newsletter will appear after the summer vacation (2010). Besides that, we encourage physicians to approach us with questions about thrombosis patients. Or about a thrombosis related symptom. Or something about the guidelines, or about other ways to interact."
How are pharmacists and nurses involved in the self-care process?
"In Amsterdam as well as in other regions in the country, the local nurses are involved in the thrombosis care. They help the elderly with home-measurements. They visit the patients at their home, know their situation and can monitor if the patient is sticking to the therapy. They provide feedback on what they see, so that we can together adjust where necessary. This way the dosage continues to closely match the actual situation. Pharmacists monitor the mixture of dispensed medication, and we let them know what we're changing, and vice versa. Primary care supports us with intake and periodic checkups. We want to bring specialist medical knowledge and expertise close to the patient."
How many thrombosis patients participate in self-care?
"In the Neterlands about 370,000 patients use medication for anti-coagulation. About 340,000 of them visit a thrombosis service point every few weeks to check their coagulation factor. About 100,000 patients should be able to monitor their disease by doing assisted self-care. Only about 30,000 patients currently use assisted self-care between ourselves and other centers."
Does it often concern thrombosis patients with complicated symptoms?
"We do often see patients with co-morbidities, referred to us from academic hospitals. For these patients it is extra important to monitor their disease and adjust treatment when necessary. Our patients come from all levels of society, from cleaners to professors. And notably, many physicians. They too see the importance of not only monitoring their disease, but receive specialist assistance. They often refer their own patients to us based on their experience."
How is this financed?
"Our care is provided through a not-for-profit institution, and paid for by basic insurance packages. In order to also provide self-care assistance to the elderly, we have received a government subsidy."
What is the mission of sBZ?
"We want to improve care according to the Chronic Care Model by the World Health Organization. WHO says that long term care is only affordable when delegating from specialist to primary care, from physician to nurse, and through self-care. We do not only want to facilitate this care process, but also contribute to medical science. We do this for instance by partnering with the VUmc and AMC.
What are the results?
"Satisfied patients, satisfied specialists and satisfied physcisians. The Free University (VU) and the University of Amsterdam (UvA) are doing research into the effectiveness of self-care, to see if it helps patients stick to their therapy. We'll have to wait for scientific proof, but through our positive patient interactions we see the fruits of our work. For example: cardioversion (an electric shock to correct an irregular heart rhythm) is only possible at acceptable levels of coagulation. It happens quite regularly that a hospital reserves a bed for that procedure, but the patient ends up being sent home because the coagulation level is not acceptable. This is inconvenient to the patient and expensive for the hospital. We let patient measure their coagulation level a day before a planned cardioversion procedure, so that we know in advance if the procedure can continue as planned. It is quite a satisfactory feeling when we can together make sure that patients can get treatments as planned."
Do you have future plans?
"We want to expand our assisted self-care service to other cardio-vascular diseases besides thrombosis. Patients want to know more and do more, and we want to support them. Assisted self-care helps improve the quality of care, and reduce the workload of the physician."
An interview with David Kat, innovation expert and secretary of the sBZ
A well informed thrombosis patient knows when to call for help. Plus, a person that understands their disease will be more faithful in taking their medications. The sBZ - Stichting Begeleide Ze
lfzorg (Managed Selfcare Institute), wants to show that many medication complications can be avoided, by providing better education to the patient, and through optimization of communication between physician, pharmacist and the thrombosis specialist.Better information to patient concerning disease
In the Netherlands, every year 34,000 people are hospitalized due to improper use of medication. In about 10% of these cases it concerns the use of anti-coagulation medication. A recent study (HARM) into safe self-medication concluded that the number of hospitalizations could be reduced by 50%. "A significant number of cases can be avoided by providing the patient with better information concerning their disease", says David Kat, innovation expert and secretary of the sBZ.
David Kat used to be a patient at the Amsterdam Medical Center (AMC) six years ago. He experienced first-hand the benefits of knowing the details of your own disease. "You know the pros and cons of the various choices you can make. You can participate in formulating a treatment plan with the physician."
Direct patient involvement leads to fewer complications
Early 2007, David started the Managed Selfcare Institute (sBZ) for thrombosis, together with internal medicine specialist Sabine Pinedo. The institute advocates a thrombosis service doing double duty as a self-care center. This "primary care and-a-half" concept is the future, according to Kat. In the outpatient clinic, Sabine often met thrombosis patients that knew very little about their own disease", says Kat. "Patients know little about the factors that influence anti-coagulation medication. This can lead to over-diagnosis and unnecessary complications".
The institute's internal medicine specialists (with the Vascular Care department of AMC as a backup) coach thrombosis patients in measuring anti-coagulation levels in their blood. The patients have direct contact with their coaches via the Internet. The specialist monitor the blood test results and stay in direct contact with the patient during a self-care session. "We bring the point-of-care to the patient. Our self-care method results in better informed patients, closer involvement by the patient in their therapy and ultimately in fewer complications."
How does assisted self-care work?
"After subscribing to the service (by either the patient or the treating physician) the patient can follow an online self-care training session. Afterward we like to see the patient for a "test". We have multiple locations in Amsterdam, and about 20 supporting locations throughout the country at pharmacies. These pharmacies are trained to conduct the intake process and the test. Patients will also have a medication check done at that point. Once they are participating in the program, the patients return once every three months for a checkup. We'll check their condition, how they use their equipment, and if necessary provide further instructions."
What is involved in this online self-care training session?
"Before starting the self-care process, the patient gets a training via the Internet. In other words: E-Learning. The patient learns about the particulars of the disease and the equipment used to measure coagulation levels. After finishing the online course, the patient will come by for a visit in which they'll be subjected to a test. That will be the first time they get to actually use the equipment, and if they pass the test they can take the equipment home."
What is a point-of-care device?
"This is a device that uses nano-technology to analyze just a single drop of blood. For thrombosis patients this is quite an improvement. Collecting a blood sample from a vain every few weeks is both inconvenient and time-consuming. Plus, the point-of-care device immediately provides the test result. That means you can quickly react in case of abnormal results, and prevent complications from happening."
How do you coach the patients?
"Patients get easy access to their care provider via an Internet based portal. They enter the test result data from their point-of-care device into their personal record. We can view that data, and with the patient's consent we can share that data with the physician and with specialists. Self-care patients can email and call us. It's a low barrier. They can contact us for any question or with any uncertainties. This way the patient stays alert, learns about their disease and we can quickly adjust treatment if something is off target. We also maintain in contact via Skype. For instance, if someone has a question about the equipment, we can use the video conferencing capabilities of Skype to easily show them what they need to know."
What is the physician's role in the self-care process?
"In our opinion it is very important to involve the physician in the self-care process. So far it was more typical for the physician to only know the diagnosis. The patiently subsequently deals with the thrombosis service for that problem, and discusses other issues with the physician. In this case however, we give the physician access to the patient's record in the patient portal (with the patient's consent). This way the physician can stay up to date on test results and medication changes."
How does the expertise of the specialist get to the point-of-care?
"For 'primary care and-a-half' is it essential that medical specialists have an avenue to transfer knowledge to the physician. We do that for instance with our newsletter that tells them about the latest developments in medical research. This way physicians get access to relevant research material that otherwise only is read by the specialists. With our newsletter we keep both the physician and the pharmacist up-to-date. Our first newsletter will appear after the summer vacation (2010). Besides that, we encourage physicians to approach us with questions about thrombosis patients. Or about a thrombosis related symptom. Or something about the guidelines, or about other ways to interact."
How are pharmacists and nurses involved in the self-care process?
"In Amsterdam as well as in other regions in the country, the local nurses are involved in the thrombosis care. They help the elderly with home-measurements. They visit the patients at their home, know their situation and can monitor if the patient is sticking to the therapy. They provide feedback on what they see, so that we can together adjust where necessary. This way the dosage continues to closely match the actual situation. Pharmacists monitor the mixture of dispensed medication, and we let them know what we're changing, and vice versa. Primary care supports us with intake and periodic checkups. We want to bring specialist medical knowledge and expertise close to the patient."
How many thrombosis patients participate in self-care?
"In the Neterlands about 370,000 patients use medication for anti-coagulation. About 340,000 of them visit a thrombosis service point every few weeks to check their coagulation factor. About 100,000 patients should be able to monitor their disease by doing assisted self-care. Only about 30,000 patients currently use assisted self-care between ourselves and other centers."
Does it often concern thrombosis patients with complicated symptoms?
"We do often see patients with co-morbidities, referred to us from academic hospitals. For these patients it is extra important to monitor their disease and adjust treatment when necessary. Our patients come from all levels of society, from cleaners to professors. And notably, many physicians. They too see the importance of not only monitoring their disease, but receive specialist assistance. They often refer their own patients to us based on their experience."
How is this financed?
"Our care is provided through a not-for-profit institution, and paid for by basic insurance packages. In order to also provide self-care assistance to the elderly, we have received a government subsidy."
What is the mission of sBZ?
"We want to improve care according to the Chronic Care Model by the World Health Organization. WHO says that long term care is only affordable when delegating from specialist to primary care, from physician to nurse, and through self-care. We do not only want to facilitate this care process, but also contribute to medical science. We do this for instance by partnering with the VUmc and AMC.
What are the results?
"Satisfied patients, satisfied specialists and satisfied physcisians. The Free University (VU) and the University of Amsterdam (UvA) are doing research into the effectiveness of self-care, to see if it helps patients stick to their therapy. We'll have to wait for scientific proof, but through our positive patient interactions we see the fruits of our work. For example: cardioversion (an electric shock to correct an irregular heart rhythm) is only possible at acceptable levels of coagulation. It happens quite regularly that a hospital reserves a bed for that procedure, but the patient ends up being sent home because the coagulation level is not acceptable. This is inconvenient to the patient and expensive for the hospital. We let patient measure their coagulation level a day before a planned cardioversion procedure, so that we know in advance if the procedure can continue as planned. It is quite a satisfactory feeling when we can together make sure that patients can get treatments as planned."
Do you have future plans?
"We want to expand our assisted self-care service to other cardio-vascular diseases besides thrombosis. Patients want to know more and do more, and we want to support them. Assisted self-care helps improve the quality of care, and reduce the workload of the physician."
| Physician practice | : Stichting Begeleide Zelfzorg |
| Location | : Amsterdam |
| Contact person | : David Kat |
| : kat@begeleidezelfzorg.nl | |
| Status | : Operational, structural activity |
| Website | : www.begeleidezelfzorg.nl |
