Effectiveness of Telemonitoring in Patients with Chronic Obstructive Pulmonary Disease in Taiwan-A Randomized Controlled Trial

Abstract

Chronic obstructive pulmonary disease (COPD) is the leading cause of death worldwide, and poses a substantial economic and social burden. Telemonitoring has been proposed as a solution to this growing problem, but its impact on patient outcome is equivocal. This randomized controlled trial aimed to investigate effectiveness of telemonitoring in improving COPD patient outcome. In total, 106 subjects were randomly assigned to the telemonitoring (n = 53) or usual care (n = 53) group. During the two months following discharge, telemonitoring group patients had to report their symptoms daily using an electronic diary. The primary outcome measure was time to first re-admission for COPD exacerbation within six months of discharge. During the follow-up period, time to first re-admission for COPD exacerbation was significantly increased in the telemonitoring group than in the usual care group (p = 0.026). Telemonitoring was also associated with a reduced number of all-cause re-admissions (0.23 vs. 0.68/patient; p = 0.002) and emergency room visits (0.36 vs. 0.91/patient; p = 0.006). In conclusion, telemonitoring intervention was associated with improved outcomes among COPD patients admitted for exacerbation in a country characterized by a small territory and high accessibility to medical services. The findings are encouraging and add further support to implementation of telemonitoring as part of COPD care.

Longitudinal change of COPD assessment test (CAT) in a telehealthcare cohort is associated with exacerbation risk

“…There are only few randomized controlled trials (RCTs) investigating THC for COPD and even less investigating HRQoL. [16][17][18][19][20][21][22][23] A study from the UK over 12 months found 20 It is important to mention that the THC interventions differed considerably between these studies. The "reaction interval" varied daily, weekly, every 2 weeks and monthly.…”

“…Further, the kind of intervention was very heterogeneous and could consist of measuring heart rate, physical activity, temperature and/or oxygen saturation, online questionnaires based on symptoms, web-based exercising, selfmanagement instructions or spirometry. [16][17][18][19][20][21][22][23] To the best of our knowledge, the CAT has never been assessed as an endpoint for HRQoL in an RCT investigating THC for COPD, despite being recommended as a first-line tool in the assessment of COPD by the GOLD. 1 The fact that the CAT was improved or stable in nearly two-thirds of COPD patients in our THC cohort is promising and could indicate the potential of our proposed THC procedure to significantly improve HRQoL.…”

Associations among chronic obstructive pulmonary disease with asthma, pneumonia, and corticosteroid use in the general population

“…A care system for chronic diseases has been well established in Taiwan, including telemonitoring in patients with COPD [70]. Lee et al found that the NHI program is associated with substantial reductions in deaths from infections such as pneumonia [71].…”

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

“…Koff et al [39] specified thresholds of 90% and 88%, Ho et al [40] on 92% and 90% and Colantonio et al [41] made the distinction between breathing room air (thresholds of 92% and 90%) and breathing O 2 (thresholds of 93%, 90% and 80%). Three studies that applied individual thresholds did not specify the method for determining the threshold values [42][43][44].…”