The effect of real-time teleconsultations between hospital-based nurses and patients with severe COPD discharged after an exacerbation

Abstract

We investigated the effect of daily real-time teleconsultations for one week between hospital-based nurses specialised in respiratory diseases and patients with severe COPD discharged after acute exacerbation. Patients admitted with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) at two hospitals were recruited at hospital discharge. They were randomly assigned to intervention or control. The telemedicine equipment consisted of a briefcase with built-in computer including a web camera, microphone and measurement equipment. The primary outcome was the mean number of total hospital readmissions within 26 weeks of discharge. A total of 266 patients (mean age 72 years) were allocated to either intervention (n = 132) or control (n = 134). There was no significant difference in the unconditional total mean number of hospital readmissions after 26 weeks: mean 1.4 (SD 2.1) in the intervention group and 1.6 (SD 2.4) in the control group. In a secondary analysis, there was no significant difference between the two groups in mortality, time to readmission, mean number of total hospital readmissions, mean number of readmissions with AECOPD, mean number of total hospital readmission days or mean number of readmission days with AECOPD calculated at 4, 8, 12 and 26 weeks. Thus the addition of one week of teleconsultations between hospital-based nurses and patients with severe COPD discharged after hospitalisation did not significantly reduce readmissions or affect mortality.

The Empirical Foundations of Telemedicine Interventions for Chronic Disease Management

“…Two RCT studies reported neutral findings, but one of these studies followed up patients for only 1 week. 123 An observational study found ''some positive benefits vis-a`-vis COPD mortality'' 2 months after discharge from the hospital. 130 Likely positive effects of telepulmonology include fewer exacerbations in the disease and improvements in quality of life and exercise capacity.…”

“…123 Patients in both the intervention and control groups were offered outpatient clinic consultations with a nurse at 4-and 12-week intervals. The intervention group was offered daily consultations by video for about 7 days (range, 5-9 days) that included, when indicated, smoking cessation, physical training, and rehabilitation followed by telephone consultations.…”

Business models for telehealth in the US: analyses and insights

“…58,73 While the many studies conducted show the potential cost savings due to telehealth and remote monitoring, both in the US and in other countries, the fact that most of these studies still involve small sample sizes with diverse types and doses for telehomecare intervention and for select chronic illnesses, such as heart failure and COPD presents a challenge to the revenue model. 27,[74][75][76][77][78] Also, other studies argue that the outcome of telemedicine in these areas is not conclusive due to definition and measurement issues. 79,80 A 1992 study by the Arthur D. Little Consulting Company which estimated then, that telemedicine would have resulted in savings of $36 billion annually, was perhaps the first, and one of the few, comprehensive studies that tried to estimate the potential savings from telemedicine.…”

Personalized Telehealth in the Future: A Global Research Agenda

“…8 Some telehealth models of care show benefits for patients with chronic disease that incorporate patients and family members into the care team, 9 whereas others have not been able to demonstrate significant improvements. 10 These models, which frequently involve remote patient monitoring (RPM), show promise in getting and maintaining patients to achieve their healthcare goal and, in some cases, lowering the incidence of avoidable hospitalizations and rehospitalizations for patients with chronic conditions. 3,10,12 In the U.S. and the EU, telehealth technologies have also been effective in small-scale studies of patients with chronic diseases; nevertheless, adoption of telehealth solutions remains limited.…”

“…10 These models, which frequently involve remote patient monitoring (RPM), show promise in getting and maintaining patients to achieve their healthcare goal and, in some cases, lowering the incidence of avoidable hospitalizations and rehospitalizations for patients with chronic conditions. 3,10,12 In the U.S. and the EU, telehealth technologies have also been effective in small-scale studies of patients with chronic diseases; nevertheless, adoption of telehealth solutions remains limited. 5,13,14 There are several obstacles to achieving widespread adoption of telehealth: acceptance technology by patients and clinicians, sustainable reimbursement systems; interoperability between electronic patient record systems; and technological capacity in smaller hospitals, clinics, and in the home.…”