Digital Health Technology and Telemedicine-Based Hospital and Home Programs in Pulmonary Medicine During the COVID-19 Pandemic

Abstract

Background: The current coronavirus disease 2019 (COVID-19) pandemic has caused a significant strain on medical resources throughout the world. A major shift to telemedicine and mobile health technologies has now taken on an immediate urgency. Newly developed devices designed for home use have facilitated remote monitoring of various physiologic parameters relevant to pulmonary diseases. These devices have also enabled home-based pulmonary rehabilitation programs. In addition, telemedicine and home care services have been leveraged to rapidly develop acute care hospital-at-home programs for the treatment of mild-to-moderate COVID-19 illness. Areas of Uncertainty: The benefit of remote monitoring technologies on patient outcomes has not been established in robust trials. Furthermore, the use of these devices, which can increase the burden of care, has not been integrated into current clinical workflows and electronic medical records. Finally, reimbursement for these telemedicine and remote monitoring services is variable. Data Sources: Literature review. Therapeutic Advances: Advances in digital technology have improved remote monitoring of physiologic parameters relevant to pulmonary medicine. In addition, telemedicine services for the provision of pulmonary rehabilitation and novel hospital-at-home programs have been developed. These new home-based programs have been adapted for COVID-19 and may also be relevant for the management of acute and chronic pulmonary diseases after the pandemic. Conclusion: Digital remote monitoring of physiologic parameters relevant to pulmonary medicine and novel hospital-at-home programs are feasible and may improve care for patients with acute and chronic respiratory-related disorders.

Evaluation of m‐Health‐rehabilitation for respiratory disorders: A systematic review

“…Pulmonary rehabilitation has been shown to improve quality of life, exercise tolerance, shortness of breath, and improve symptoms in patients with COPD. 54 Also, the benefits of pulmonary rehabilitation are such that they have been compared to other strategies such as optimal drug treatment in terms of cost‐effectiveness. 5 The mentioned materials can be the reason for the interest of the research community in this population.…”

“…Recently, various approaches have been used to manage this disease, including pulmonary rehabilitation using m‐Health. Pulmonary rehabilitation has been shown to improve quality of life, exercise tolerance, shortness of breath, and improve symptoms in patients with COPD 54 . Also, the benefits of pulmonary rehabilitation are such that they have been compared to other strategies such as optimal drug treatment in terms of cost‐effectiveness 5 .…”

Good practice statements for antithrombotic therapy in the management of COVID‐19: Guidance from the SSC of the ISTH

“… 1 In general, two patient types with COVID‐19 have been described in this outpatient (non‐hospitalized) period: those with mild‐severity disease, who are hemodynamically stable and have a resting room air oxygen saturation ≥ 94%, or those with moderate‐severity disease who are hemodynamically stable, but have a resting room air oxygen saturation 90%–94% and require advanced care such as a “hospital‐at‐home” program, especially when hospitals are over capacity. 2 , 3 , 4 One placebo‐controlled randomized trial—the ACTIV 4b trial—that compared usual care to treatment with the direct oral anticoagulant (DOAC) apixaban at therapeutic (5 mg twice daily) and prophylactic (2.5 mg twice daily) doses or 81 mg of aspirin daily, in addition to unadjusted cohort studies, has not shown benefit of initiating antithrombotic therapy during the outpatient period in COVID‐19. 2 However, the results of other large placebo‐controlled randomized trials in COVID‐19 outpatients with similar inclusion criteria (including advanced age and cardiovascular risk factors) using LMWH and the DOAC rivaroxaban, respectively, are still pending.…”

Role of digital health in pulmonary rehabilitation and beyond: shaping the future

“…Research suggests that HCPs perceive the lack of evidence demonstrating the effectiveness of digital health interventions on patient outcomes as a salient barrier to them adopting this model of care [76]. Although digitally enabled PR has accelerated during the pandemic, there is agreement on the need for large-scale, longitudinal studies to demonstrate the cost and clinical effectiveness of digitally enabled PR [70,77]. Cardiac tele-rehabilitation, for instance, has developed a strong evidence-base, including a Cochrane review demonstrating that this model reduces re-hospitalisations and is equally cost-effective to standard rehabilitation programmes [78,79].…”