Advanced nursing practice in COPD exacerbations: the solution for a gap in Switzerland?

Area of Science:

• Pulmonary Medicine
• Healthcare Management
• Nursing Practice

Background:

• Current chronic obstructive pulmonary disease (COPD) care models in Switzerland require adaptation, especially concerning acute exacerbations.
• Integrated care approaches involving advanced nursing practice are being explored to meet evolving patient needs.

Purpose of the Study:

• To assess the need for adapting the Swiss COPD care model, focusing on acute exacerbations.
• To evaluate the potential of integrated care, including advanced nursing practice, in addressing these needs.

Main Methods:

• A state analysis using the PEPPA framework was conducted by the University Hospital Zürich.
• Systematic literature searches covered Swiss COPD care and international patient perspectives on exacerbations.
• Focus-group interviews with healthcare providers explored their perspectives on current care provision.

Main Results:

• A lack of systematic, state-of-the-art patient self-management support was identified in Switzerland.
• COPD care, while comprehensive within sectors, is highly fragmented across inpatient, outpatient, rehabilitation, and home settings.
• Fragmentation and inadequate self-management support negatively impact patient disease management.

Conclusions:

• Coordinating transitions between healthcare sectors and enhancing self-management support are crucial.
• A multi-professional team approach is necessary to address organizational boundaries in COPD care.
• Advanced practice nurses show potential for coordination and addressing self-management needs, but legal and reimbursement frameworks are lacking for long-term implementation.