Improving evidence-based COPD self-management with a decision support system in Finland

The Nursing Research Foundation (NRF) is a not-for-profit research and development organisation in Finland. The NRF promotes evidence-based nursing by coordinating the development of national clinical guidelines for nursing and supporting structures for evidence implementation. Besides its significant national role in promoting evidence-based nursing, the NRF hosts two international collaboration centres in Finland: the Finnish Centre for Evidence-Based Health Care: A JBI Centre of Excellence and the WHO Collaborating Centre for Nursing. This puts the NRF in an excellent position to follow the progression of evidence-based healthcare both nationally and internationally.

Even though Finland’s national legislation, the Health Care Act (1326/2010), imposes a requirement for evidence-based healthcare, there is still much work to be done. To promote evidence-based practices, especially in nursing, national support structures for evidence-based nursing are needed. This need is endemic to primary healthcare where the potential to promote evidence-based practices is more limited compared to specialised healthcare.

To provide these support structures for primary care nurses and translate evidence from clinical guidelines and JBI systematic reviews into practice, the NRF started a project called Developing Clinical Decision Support Systems (CDSS) for nurses. The aim of this project is to transfer evidence from clinical nursing guidelines and high-quality systematic reviews into a nationwide CDSS called Evidence-Based Medicine Electronic Decision Support (EBMEDS) in a practical format that supports nurses. The EBMEDS system gives context-sensitive guidance (patient-specific instructions, reminders and alerts) for healthcare professionals in primary healthcare. Currently, the content of EBMEDS is mainly intended for physicians; therefore, the NRF has started to develop CDSS content for nurses.

The work in developing CDSS for nurses began with COPD-specific evidence. Chronic obstructive pulmonary disease (COPD) is a long-term illness and is burdensome for both the people with the disease and their loved ones. In addition to human suffering, COPD is also a growing healthcare problem, as many primary healthcare visits are attributed to this patient group. 

The COPD-specific evidence used in the initial development of CDSS was synthesised into a JBI systematic review and national clinical guidelines. The aim of the JBI review was to identify and synthesise existing evidence on the experiences and expectations of self-management counselling of adult family members who are informal caregivers of people with COPD. The aim of the COPD-related national clinical guidelines was to focus on the content of health education concerning self-management of COPD. 

One of the key findings of the JBI systematic review was that the expectations of both people with COPD and their loved ones is crucial to supporting them in managing this disease. Healthcare professionals should offer family members information about COPD and social security benefits (Grade A) they may be eligible for.

The COPD-related national clinical guidelines consist of seven different self-management areas: i) smoking cessation in the treatment of COPD; ii) symptoms and mental well-being of a person with COPD; iii) implementation of drug therapy in the treatment of patients with COPD; iv) physical activity and exercise in people with COPD; v) nutrition for people with COPD; vi) prevention of COPD exacerbation; and vii) self-management counselling for people with COPD and their family members.

Both the JBI systematic review and the COPD-related national clinical guidelines were then translated into new nursing-specific CDSS scripts. The NRF project team collaborated with a group of expert nurses who meet COPD patients regularly. They helped the project team create scripts that are not only evidence-based, but also feasible and appropriate for nurses.

Researcher Hannele Siltanen, who has been involved in both the synthesis of COPD-related evidence and CDSS development, is pleased to be able to translate the work done in the JBI systematic review and national clinical guidelines into clinical practice.

‘Studies have shown that this group of patients lacks self-management support, and the JBI systematic review points out that family members need support as well. COPD exacerbation causes suffering for the persons with COPD and an economic burden to the healthcare system. By strengthening evidence-based health education related to self-management, it is possible to reduce the risk of hospitalisation. Nurses play a major role in this, which is why the self-management of COPD was a good starting point for the development of clinical decision support for nursing.’

The project team expects that the clinical guidelines, and evidence-based healthcare in general, will become more familiar and available to nurses, which in turn is expected to promote guideline and evidence implementation in decision-making, and thus promote better care for patients.

 
To measure the use and developmental needs of the CDSS for nurses, the team conducted a national survey about usage and nurses' needs related to the CDSS. The survey was distributed to 16 randomly selected Finnish municipalities based on predefined criteria. The results show that 91.8% of the respondents felt that developing nursing specific content to CDSS is essential. More than half of the respondents (58.8%) had never used CDSS in their work even though they had access to it. The next steps of the project are to report the survey answers in a scientific journal and to develop the CDSS further based on the project results.

‘Our mission is to provide nursing-specific evidence and clinical guidelines in a feasible way using the CDSS. There is still a lot of work to be done, but we see great potential for using this kind of digital tool in promoting evidence-based nursing’, says Heidi Parisod, researcher and deputy director of the WHO Collaborating Centre for Nursing in Finland. 

Further resources 
Electronic Decision Nursing Support (Hotus) 

Authors

Lotta Hamari^{1,2, 3}, Heidi Parisod^1,2,3, Hannele Siltanen^1,2,3, Kristiina Heikkilä^1,2,3, Arja Holopainen^1,2,3 
1. Nursing Research Foundation, Helsinki, Finland 
2. Finnish Centre for Evidence-Based Health Care: A JBI Centre of Excellence 
3. WHO Collaborating Centre for Nursing, Helsinki, Finland 

References
Health Care Act 1326/2010 (in English).

Siltanen H, Jylhä V, Holopainen A, Paavilainen E. Family members’ experiences and expectations of self-management counseling while caring for a person with chronic obstructive pulmonary disease: a systematic review of qualitative evidence. JBI Evidence Synthesis. 2019;17(11):2214-47.

Contents for Self-care Guidance for COPD (Hotus)

Disclaimers

Republished with permission from World Evidence-based Healthcare Day https://worldebhcday.org/stories/story?ebhc_impact_story_id=69