Geertjan Wesseling endowed professor of Pulmonology
‘If only it were so easy’
It’s the title of Geertjan Wesseling’s inaugural lecture at UM: ‘If only it were so easy’. But the aim is not to discourage, says the endowed professor in Management of Chronic Obstructive Pulmonary Disease (COPD). On the contrary: “I’m targeting precisely those challenges that we face in treating chronically ill patients.”
In his inaugural lecture on April 21st, Wesseling directed attention to the care for a sizeable patient group: people with COPD and asthma. “Around 4% to 5% of the population has one of these disorders. We have thousands of patients in this region alone. So by improving the care for this group, we could make real gains.”
As a lung specialist at the Maastricht academic hospital, Wesseling is confronted with these patients almost every day. He is also joint programme leader for Asthma and COPD within CAPHRI. “I’ve been focusing on these disorders for 15 years now and I see it as my task not only to treat these patients, but also to improve the level of care that they receive.”
And he has achieved a great deal in recent years, together with his colleagues in transmural care. The static care model – that is, in which the GP and the lung specialist are each responsible for separate aspects of the care for these COPD patients – is disintegrating. “GPs and specialists are working together more, which allows for a more differentiated care offer. As far as possible, we start from the idea that what can be done in primary care also happens in general practice. The patient only goes to the specialist when necessary, for example for further diagnostics.”
Support for practice
Transferring some aspects of hospital care to general practice makes this care more affordable. “And the GP is closer to the patient.” Still, Wesseling sees more room for improvement. In his view, for instance, nurse practitioners can play a significantly bigger role in the care for these and other chronically ill patients, for example by taking over the standard checks of stable patients from specialists. “In which case, good support in expertise is needed.”
But transferring such tasks is no simple matter, because it means that the hospital loses the income from carrying out these standard checks. “So that’s an example of ‘if only it were so easy’”, says Wesseling. “Having said that, it’s turned out better than expected when it comes to this loss of income. Thanks to the present cooperation, more disease burden is coming to the fore and GPs are referring patients to specialists more often.”
Lifestyle advice
Another important challenge lies in promoting adherence to the prescribed course of treatment: currently, only about 40% of patients take their medication as prescribed. Applying new insights in the practice of patient care is a difficult task as well; for instance, translating the results of research on different medications into health improvements for the individual patient. Or applying new knowledge about giving lifestyle advice focused on behaviour change. Every doctor, for example, will first advise COPD patients to quit smoking. “But in practice, only 3% to 4% patients succeed in doing so. That says something about the quality of our advice as well as about the addictive nature of smoking.” By applying new knowledge and techniques in the area of lifestyle advice, real gains can clearly be made. A good example is motivational interviewing, says Wesseling, because this approach helps patients to recognise their problems and spurs them on to make changes. “It’s important that we as doctors don’t push our own agendas, but instead try to figure out what agenda the patient personally has and wants. We also have to make much bigger efforts in the area of self-management, for example by making more use of internet-based programmes.” Finally, he points out that it is crucial that education is up to date. “We have to ensure that medical students will soon be able to do what we can’t yet.”