HOW IT WORKS
This program’s principal goal is to promote self-management among people with all stages of medically diagnosed chronic obstructive pulmonary disease (COPD), which is verified by post-bronchodilator pulmonary function testing. Once the COPD diagnosis is verified, patients decide whether they want to be included in the program. Coaches, together with program pulmonologists, make the final decision on eligibility after patient assessment. Patients can register online or are referred to the program by their general practitioner (GP) or a pulmonologist. Patients are often connected to this program through the Swiss Lung Association (Lungenliga Schweiz), a non-profit organization that supports people with lung diseases. In each of the seven cantons (regions) where the program has been implemented, a dedicated nurse or physiotherapist serves as the patients’ coach, with training provided by Lungenliga Schweiz. Data from the intake process are collected in a REDCap online database for quality monitoring.
This program has admitted 100 patients since it began in 2018. An evaluation is ongoing, and a program expansion to other cantons is planned based on positive results from studies of similar programs, such as the Canada’s Living Well with COPD. It is hoped that funding will be secured and centralized for long-term implementation of the program, whose goals align with the Triple Aim.
The patient’s GP or pulmonologist is responsible for medical care. The coach manages patient needs within the scope of the program. If patients have a GP (not required in Switzerland), the GP is contacted for updates and notification of any change in care that results from the intervention. Alternatively, the pulmonologist is contacted. The program involves nurses, physiotherapists, and pulmonologists; pharmacists take part only in one canton. Care is provided in a primary care outpatient setting. The coach may ask providers to meet to discuss patients but are otherwise not co-located.
This program has strong support for shared decision-making, including identifying and recording patient-defined care goals and developing individualized care plans based on patient input. Coaches are taught shared decision-making and motivational interviewing. The process of shared decision-making is embedded in the program through a self-assessment checklist. Relatives or friends can join the coaching modules but are not otherwise involved in the program, given its focus on patient self-management.
The program is a collaboration between the umbrella organization Lungenliga Schweiz and the Swiss Society for Pulmonology (SGP). Lungenliga Schweiz is responsible for project management, quality insurance, guidelines, etc. The organization cooperates with 20 independent regional suborganizations (Kantonale Lungenligen), who work directly with patients in this target population. An expert group of pulmonologists functions as a strategic steering committee. There also is a working group comprised of people from sites in different cantons that addresses operational processes, marketing and guidelines.
The program is currently funded through basic insurance (for individual coaching only, not group coaching), federal social insurance, and Lungenliga Schweiz. There is the potential for funding from another non-profit organization for health prevention. One of the project’s goals is to get the full cost of the program covered by basic insurance by 2022. The 2018 pilot was mainly financed by Lungenliga Schweiz and seven Kantonale Lungenligen. Pulmonologists in the program are paid a flat rate for their work, while coaches are employed by the responsible Kantonale Lungenliga.