A small-scale randomised controlled trial of home telemonitoring in patients with severe chronic obstructive pulmonary disease

Shany, Tal; Hession, Michael; Pryce, D.W.; Roberts, Mary M.; Basilakis, Jim; Redmond, Stephen J.; Lovell, Nigel H.; Schreier, G.

doi:10.1177/1357633x16659410

Cited by 48 publications

(72 citation statements)

References 19 publications

(37 reference statements)

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“… 45 There is evidence from a pilot randomised controlled trial that telemonitoring of oxygen saturation levels along with other measures can reduce COPD-related ED presentations. 46 However, there are also concerns that the high level of health professional support required to interpret telemonitoring data may increase patient dependency and undermine self-efficacy. 47 Taking all these considerations into account, it is difficult to provide evidence-based recommendations for the use of oximetry in monitoring and ED-related decision-making.…”

Section: Discussionmentioning

confidence: 99%

Insights from Australians with respiratory disease living in the community with experience of self-managing through an emergency department ‘near miss’ for breathlessness: a strengths-based qualitative study

et al. 2017

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ObjectivesBreathlessness ‘crises’ in people with chronic respiratory conditions are a common precipitant for emergency department (ED) presentations, many of which might be avoided through improved self-management and support. This study sought insights from people with experience of ED ‘near misses’ where they considered going to the ED but successfully self-managed instead.Design and methodsA qualitative approach was used with a phenomenological orientation. Participants were eligible if they reported breathlessness on most days from a diagnosed respiratory condition and experience of ≥1 ED near miss. Recruitment was through respiratory support groups and pulmonary rehabilitation clinics. Semistructured interviews were conducted with each participant via telephone or face-to-face. Questions focused on ED-related decision-making, information finding, breathlessness management and support. This analysis used an integrative approach and independent coding by two researchers. Lazarus and Cohen’s Transactional Model of Stress and Coping informed interpretive themes.ResultsInterviews were conducted with 20 participants, 15 of whom had chronic obstructive pulmonary disease. Nineteen interviews were conducted via telephone. Analysis identified important factors in avoiding ED presentation to include perceived control over breathlessness, self-efficacy in coping with a crisis and desire not to be hospitalised. Effective coping strategies included: taking a project management approach that involved goal setting, monitoring and risk management; managing the affective dimension of breathlessness separately from the sensory perceptual and building three-way partnerships with primary care and respiratory services.ConclusionsIn addition to teaching non-pharmacological and pharmacological management of breathlessness, interventions should aim to develop patients’ generic self-management skills. Interventions to improve self-efficacy should ensure this is substantiated by transfer of skills and support, including knowledge about when ED presentation is necessary. Complementary initiatives are needed to improve coordinated, person-centred care. Future research should seek ways to break the cyclical relationship between affective and sensory-perceptual dimensions of breathlessness.

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Section: Discussionmentioning

confidence: 99%

Insights from Australians with respiratory disease living in the community with experience of self-managing through an emergency department ‘near miss’ for breathlessness: a strengths-based qualitative study

et al. 2017

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“…Telephonic assessment and education of inhaler technique by pharmacist have shown significant improvement of inhaler technique [29] and patients were satisfied with home telecare [30–32]. Moreover, telemonitoring of patients with COPD lowers the rates of hospital admission, emergency department attendance, and interval of hospital readmission, together with cumulative length of stay [30, 33]. In addition, telemonitoring has also been known to be useful for treating acute exacerbation of COPD at home [34].…”

Section: Discussionmentioning

confidence: 99%

Do Face-to-Face Training and Telephonic Reminder Improve Dry Powder Inhaler Technique in Patients with COPD?

Poudel

Shrestha

Bhatta

et al. 2017

International Journal of Telemedicine and Applications

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Introduction. Current modes of instruction on inhaler technique are inadequate. We aimed to evaluate the value of face-to-face training and telephonic reminder (FFTTR) for improving Rotahaler technique in experienced patients with COPD. Materials and Methods. A single group pre-/postinterventional study was conducted at Chitwan Medical College Teaching Hospital, Nepal. We assessed the Rotahaler technique of thirty consecutive patients using Rotahaler device for more than one year. Patients with incorrect technique (n = 20) were instructed and trained by a pharmacist. Telephonic reminder was used to reinstruct patients on the correct technique on weekly basis for two weeks and technique was reassessed after 4 weeks of their first training. Descriptive statistics including Wilcoxon Signed Rank test were applied. Results. The mean age was 66.06 ± 10.6. Of 30 patients, 10 (33.3%) performed Rotahaler technique correctly at baseline and were excluded from FFTTR intervention. FFTTR corrected the technique in 18 (90%) patients and the median (IQR) score increased from 6 (5-6) to 8 (8-8) (p < 0.001). The most incorrect steps were “breathe out gently but not towards the inhaler mouthpiece” (16, 80%) and “hold breath for about 10 seconds” (18, 90%) at baseline which improved after intervention. Conclusion. FFTTR approach markedly improved Rotahaler technique in patients with COPD.

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“…Jodar-Sanchez et al [30] specified that measurements were taken 20 minutes after taking medication while seated, rested and on oxygen therapy. Shany et al [31] had patients perform measurements after taking medications and while on oxygen therapy.…”

Section: Measurements Oximeters and Telemonitoring Systemsmentioning

confidence: 99%

Oxygen saturation measurements in telemonitoring of patients with COPD: a systematic review

Buekers

Boever

Vaes

et al. 2017

Expert Review of Respiratory Medicine

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Telemonitoring applications are expected to become a key component in future healthcare. Despite the frequent use of SpO measurements in telemonitoring of patients with chronic obstructive pulmonary disease (COPD), no profound overview is available about these measurements. Areas covered: A systematic search identified 71 articles that performed SpO measurements in COPD telemonitoring. The results indicate that long-term follow-up of COPD patients using daily SpO spot checks is practically feasible. Very few studies specified protocols for performing these measurements. In many studies, deviating SpO values were used to raise alerts that led to immediate action from healthcare professionals. However, little information was available about the exact implementation and performance of these alerts. Therefore, no firm conclusions can be drawn about the real value of SpO measurements. Future research could optimize performance of alerts using individualized, time-dependent thresholds or predictive algorithms to account for individual differences and SpO baseline changes. Additionally, the value of performing continuous measurements should be examined. Expert commentary: Standardization of the measurements, data science techniques and advancing technology can still boost performance of telemonitoring applications. All these opportunities should be thoroughly explored to assess the real value of SpO in COPD telemonitoring.

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A small-scale randomised controlled trial of home telemonitoring in patients with severe chronic obstructive pulmonary disease

Cited by 48 publications

References 19 publications

Insights from Australians with respiratory disease living in the community with experience of self-managing through an emergency department ‘near miss’ for breathlessness: a strengths-based qualitative study

Insights from Australians with respiratory disease living in the community with experience of self-managing through an emergency department ‘near miss’ for breathlessness: a strengths-based qualitative study

Do Face-to-Face Training and Telephonic Reminder Improve Dry Powder Inhaler Technique in Patients with COPD?

Oxygen saturation measurements in telemonitoring of patients with COPD: a systematic review

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