Optimizing Disease Management of Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a major public health problem worldwide. It is the fourth leading cause of chronic morbidity and mortality in the US, and is projected to rank seventh in burden of disease worldwide by 2020. In contrast with a number of chronic diseases, COPD is most often associated with one or more co-morbid conditions, and this requires a complexity of care that demands an even higher level of coordination of care. The coordination that characterizes disease management enables physicians to identify and treat all co-morbid conditions that, if not addressed, could seriously compromise the care of COPD. The requirements for high-quality 21st century care are stringent; some examples are (i) patient-centered care; (ii) adherence to evidence-based medicine that seeks standardization of care; (iii) integration of myriad medical disciplines and the care of multiple physicians; (iv) patient empowerment through collaborative self-management and shared decision making; (v) ongoing home monitoring and feedback to allow for early intervention; and (vi) formalized efforts to improve patient-physician and patient-nurse communication.The true value of disease management resides in its capacity to improve patient care, based as it is on heightened physician communication, evidence-based medicine, and adherence to guidelines, the principle of patient-centered care that facilitates collaborative self-management and concern with patient satisfaction. We provide evidence that patients want and respond to patient-centered care — care that is not technology, doctor, hospital, nor disease centered. Care that encourages patient participation in the establishment and implementation of care, respects the patient’s desire for information, seeks to understand and respond to patient emotional needs, and strengthens the patient-physician relationship.