Effects of Telemonitoring in Patients with Chronic Obstructive Pulmonary Disease

Abstract

The objective of this study was to determine the effects of a homebased telemonitoring device, The Health Buddy (HB), on health consumption and health-related quality of life (HRQoL) in patients with moderate to severe chronic obstructive pulmonary disease (COPD). The HB provides daily symptom-surveillance by a case manager and education to enhance disease knowledge and self-management. A nonrandomized controlled multicenter study was established comparing the effectiveness of telemonitoring as an add-on to care as usual with a follow-up of 6 months. Four hospitals took part in the experimental group and 2 hospitals formed an equivalent control group with 59 and 56 patients, respectively. HRQoL was measured by the Clinical COPD Questionnaire. Healthcare consumption was assessed using medical records in the 6 months preceding study entry and during the study. Compared with the control group, the HB group showed a significant decrease in hospital admission rates (HB -0.11 +/- 1.16 vs. control +0.27 +/- 1.0, p = 0.02) and in the total number of exacerbations (HB -0.35 +/- 1.4 vs. control +0.32 +/- 1.2, p = 0.004). There was a tendency toward decreased hospital days and outpatient visits. No significant changes in HRQoL were observed at follow-up between both study groups. Despite inherent limitations of the study, these findings suggest that adopting telemonitoring in everyday clinical practice is feasible and can substantially improve care and decrease healthcare utilization of patients with moderate to severe COPD.

Are Primary Healthcare Organizational Attributes Associated with Patient Self-Efficacy for Managing Chronic Disease?

“…Yet, most self-management interventions remain concentrated in episodic programs and are seldom integrated into mainstream primary healthcare (PHC) (Kreindler 2009 conditions, they represent an ideal setting for the provision of timely and tailored self-management education and support. Strategies to incorporate self-management into PHC, such as written information, meetings with a nurse or health educator, follow-up calls, telemonitoring or newsletters, have not had consistent results on health outcomes, although improvements in self-management knowledge and techniques have been reported (Eakin et al 2007;Jordan and Osborne 2007;mcGeoch et al 2006;Trappenburg et al 2008;Wood-baker et al 2006). Integration of self-management support into existing care appears more effective if combined with organizational strategies such as reimbursement policies, a multidisciplinary approach and appropriate training for clinicians (blakeman et al 2006; Commissaire à la santé et au bien-être 2010;dennis et al 2008;Harris et al 2008).…”

Technology and its role in respiratory care

“…31 This would seem to be an area where good studies are needed to determine whether technology can aid identification of those making a delayed recovery and to prompt identification of those needing further treatment or readmission. Recent studies have not provided the evidence needed to support the addition of technology and have contained methodological issues concerning small sample sizes, 32-34 lack of allocation concealment, 35 and additional access to health services available to patients in the technology arm. 36 Patients with recurrent AECOPD have been identified as having a more rapid decline in lung function 37 and a reduced quality of life.…”

The Acceptance of e-Health Solutions Among Patients with Chronic Respiratory Conditions

“…Subjective assessment of the disease course and certain simple measurements, such as the peak expiratory flow rate in bronchial asthma or blood glucose in diabetes, remain the mainstay of effective monitoring. [15][16][17] Involving patients in monitoring their own symptoms leads to improved awareness and competence in disease management. [18][19][20] Widespread use of e-health systems in chronic care depends on several factors; the acceptance and ability to use information technology tools are of key importance, alongside understanding of the disease and therapeutic measures.…”