Neil Minkoff, MD: Could you guys touch on why social isolation is such an important factor, maybe more than in some other disease states?
Michael Hess, MPH, RRT, RPFT: You’ve got a situation where people don’t want to be embarrassed, basically. They don’t want to be thought of as being ill. If you go out and have a sudden coughing fit or if you’re using oxygen, you are noticeably “abnormal.” You’re noticeably different. Whether it’s human nature or not, people don’t like to stand out in a crowd like that. As you start getting more of that stuff or if you start having family members say, “You don’t look sick, so how sick can you really be? You don’t look like there’s anything wrong with you,” you start to not want to put yourself in those positions anymore. And so you start getting isolated. You start feeling like you might be the only person who this is happening to. Then that leads into that whole depressive cycle.
But if you’re able to see other people on the path and not only see other people going through the same things but also learn from them in a peer-to-peer setting, that, by all accounts, is incredibly powerful. It’s probably more powerful than anything I or any of my clinical colleagues can tell somebody. Learning that from somebody else who is on that journey is very powerful.
Donald A. Mahler, MD:Just to expand on what Michael said, I agree with everything that he described. The pandemic has exacerbated the isolation issues for so many of our patients, and they’re literally afraid to leave home. They’re afraid to go to the grocery store. They’re afraid to talk to their neighbor across their yard or fence. Part of it is the media has clearly emphasized the dangers of the virus, and I’m not trying to downplay it. But we’re going to find that once the pandemic is over—hopefully that will be in spring or summer—people are going to be depressed. People are going to be more deconditioned and out of shape. I already have people telling me, “I’ve gained 20 or 25 pounds just in the last 6 months since I’m at home, and I don’t have anything to do but eat and watch television.” We need to get these people engaged. Telehealth is 1 way. Obviously, that’s just a brief interaction over 2, 3 months, 6 months. But we need to get people engaged through technology and then get them out as much as possible within their comfort zone.
Maria Lopes, MD, MS: I totally agree. We think of the home as the third LOCUS [level of care utilization system] of care and how COVID-19 [coronavirus disease 2019], to use Dr Drummond’s words, has accelerated much of what we had started to do. But telehealth really supports and sometimes makes it easier for multiple disciplinary teams to get together and for patients to also not have to travel. On the health plan side, we’ve eliminated co-pay barriers for telehealth visits—that is a $0 cost share. There are no limits to how many of these visits you can have, following Medicare’s lead. Being able to couple this with the appropriate treatments and ensuring that patients don’t run out of medications has been very beneficial.
You’ve seen a lot of health plans using mail order and providing patients with a 3-month supply so you don’t have 1 more inciting cause for ending up in the hospital. I totally agree that the more we can do around the efficiency in delivering care into the home and providing a level of peer support, the more that’s going to help patients with this condition—potentially on a multidimensional side and not just for COPD.
This activity is supported by an educational grant from Boehringer Ingelheim.
Video
Social Isolation and COPD
Considerations to help clinicians support patients with chronic obstructive pulmonary disease, especially during the pandemic, and to reduce social isolation associated with the disease.
EP: 1.COPD: Current Clinical and Economic Burden
EP: 2.The Quality of Life for a Patient With COPD
EP: 3.COPD and Inadequate Inhaler Use
EP: 4.Treatment Options for COPD
EP: 5.COPD: Inhaler Selection and PIF
EP: 6.COPD: The GOLD Criteria
EP: 7.COPD Device Selection: Payer Reflections
EP: 8.COPD: Individualizing Therapy
EP: 9.COPD: Current Uptake of Treatment Guidelines
EP: 10.COPD: Evaluating Treatment Efficacy
EP: 11.Dry Powder Inhaler Use for COPD
EP: 12.COPD: Patient Support Programs
EP: 13.Assessing Treatment Adherence in COPD
EP: 14.Smoking Cessation and COPD
EP: 15.Pulmonary Rehabilitation and COPD
EP: 16.Social Isolation and COPD
EP: 17.COPD Screening and COVID-19
EP: 18.Improving Patient-Centered Care in COPD
Neil Minkoff, MD: Could you guys touch on why social isolation is such an important factor, maybe more than in some other disease states?
Michael Hess, MPH, RRT, RPFT: You’ve got a situation where people don’t want to be embarrassed, basically. They don’t want to be thought of as being ill. If you go out and have a sudden coughing fit or if you’re using oxygen, you are noticeably “abnormal.” You’re noticeably different. Whether it’s human nature or not, people don’t like to stand out in a crowd like that. As you start getting more of that stuff or if you start having family members say, “You don’t look sick, so how sick can you really be? You don’t look like there’s anything wrong with you,” you start to not want to put yourself in those positions anymore. And so you start getting isolated. You start feeling like you might be the only person who this is happening to. Then that leads into that whole depressive cycle.
But if you’re able to see other people on the path and not only see other people going through the same things but also learn from them in a peer-to-peer setting, that, by all accounts, is incredibly powerful. It’s probably more powerful than anything I or any of my clinical colleagues can tell somebody. Learning that from somebody else who is on that journey is very powerful.
Donald A. Mahler, MD:Just to expand on what Michael said, I agree with everything that he described. The pandemic has exacerbated the isolation issues for so many of our patients, and they’re literally afraid to leave home. They’re afraid to go to the grocery store. They’re afraid to talk to their neighbor across their yard or fence. Part of it is the media has clearly emphasized the dangers of the virus, and I’m not trying to downplay it. But we’re going to find that once the pandemic is over—hopefully that will be in spring or summer—people are going to be depressed. People are going to be more deconditioned and out of shape. I already have people telling me, “I’ve gained 20 or 25 pounds just in the last 6 months since I’m at home, and I don’t have anything to do but eat and watch television.” We need to get these people engaged. Telehealth is 1 way. Obviously, that’s just a brief interaction over 2, 3 months, 6 months. But we need to get people engaged through technology and then get them out as much as possible within their comfort zone.
Maria Lopes, MD, MS: I totally agree. We think of the home as the third LOCUS [level of care utilization system] of care and how COVID-19 [coronavirus disease 2019], to use Dr Drummond’s words, has accelerated much of what we had started to do. But telehealth really supports and sometimes makes it easier for multiple disciplinary teams to get together and for patients to also not have to travel. On the health plan side, we’ve eliminated co-pay barriers for telehealth visits—that is a $0 cost share. There are no limits to how many of these visits you can have, following Medicare’s lead. Being able to couple this with the appropriate treatments and ensuring that patients don’t run out of medications has been very beneficial.
You’ve seen a lot of health plans using mail order and providing patients with a 3-month supply so you don’t have 1 more inciting cause for ending up in the hospital. I totally agree that the more we can do around the efficiency in delivering care into the home and providing a level of peer support, the more that’s going to help patients with this condition—potentially on a multidimensional side and not just for COPD.
This activity is supported by an educational grant from Boehringer Ingelheim.