Can a nurse and social worker telecare team improve quality of life for high-risk COPD patients?

For high-risk COPD patients who struggle with poor quality of life despite standard medical care, a team-based telecare approach combining a nurse and a social worker has been tested in a rigorous clinical trial. The ADAPT study found that this intervention significantly improved quality of life, disease-specific health status, depression, and anxiety compared to usual care ⁹. The team provided symptom management and psychosocial support over the phone, with weekly discussions involving primary care and palliative care physicians ⁹¹⁰.

What the research says

The ADAPT randomized clinical trial enrolled outpatients with COPD, heart failure, or interstitial lung disease who were at high risk of hospitalization or death and reported poor quality of life ⁹. The intervention consisted of six phone calls with a nurse for symptom management and six phone calls with a social worker for psychosocial care, along with weekly team meetings that included a primary care physician, a palliative care physician, and, as needed, a pulmonologist and cardiologist ⁹¹⁰. The trial found that the telecare team improved quality of life, disease-specific health status, depression, and anxiety compared to usual care ⁹¹⁰.

A separate analysis of the ADAPT trial detailed the intervention's content and cost. Participants averaged about 10 sessions with the nurse and 9.5 sessions with the social worker over roughly 115 days ⁵¹⁰. The team made an average of 7 recommendations per participant, most commonly referrals to other specialists (79.7%), medication additions (58.1%) or changes (31.8%), and tests (33.1%) ⁵¹⁰. The cost to deliver the intervention per patient was about $1,140 ⁵¹⁰.

It is important to note that the ADAPT trial included patients with COPD as well as heart failure and interstitial lung disease, so the results apply to a broader high-risk population ⁹. The intervention was delivered by phone, making it accessible for patients who may have difficulty traveling to appointments ⁹¹⁰.

What to ask your doctor

• Could a nurse and social worker telecare team be available for my COPD care?
• What types of symptom management or psychosocial support might a telecare team provide?
• How would a telecare team coordinate with my current doctors and specialists?
• Are there any costs or insurance coverage considerations for telecare services like this?
• Would I be a good candidate for a palliative care approach that includes a nurse and social worker?