The evaluation of a remote support program on quality of life and evolution of disease in COPD patients with frequent exacerbations

Abstract

BackgroundChronic obstructive pulmonary disease (COPD) patients often present considerable individual medical burden in their symptoms, limitations, and well-being that complicate medical treatment. To improve their overall health status, while reducing the number of exacerbations, a multidisciplinary approach including different elements of care is needed. The aim of this study was to evaluate the effects of a remote support program on COPD patients at high risk of experiencing worsening of their disease and other health-related outcomes.MethodsAn observational, multicenter, prospective study aimed at evaluating the impact of a 7-month remote support program on COPD patients in exacerbations control and changes in health status measured with the COPD assessment test (CAT). Factors associated with a clinically relevant decrease in CAT were assessed using a logistic regression analysis.ResultsA total of 114 subjects started the program. The majority of the study population were males (81.6 %), retired (70.2 %), without academic qualifications or with a low level of education (68.4 %), and ex-smokers (79.8 %). The mean ± SD age was 69.6 ± 9.1 years and the BMI was 27.8 ± 5.5 Kg/m2. Overall, 41.9 % (95 % CI 31.9–52.0) patients, significantly improved health status (CAT decrease ≥ 2 points). Univariate analysis showed that significant improvement in CAT was associated with baseline CAT scores [high CAT score 19.2 (±7.5) vs. low CAT score 12.4 (±6.4); OR = 1.15, 95 % CI: 1.07–1.24; p < 0.001] and with being non-compliant [62.5 % (15/24) of non-compliant vs 34.7 % (24/69) of compliant patients significantly improved CAT scores; OR = 3.13, 95 % CI: 1.19–8.19; p = 0.021). After controlling for the effect of all variables in a multivariable logistic regression model, the only factor that remained significant was baseline CAT score. The proportion of smokers in the total population remained constant during the study. There was a significant reduction in the number of exacerbations after entering this remote support program with median -1 (IQR: -2, 0), (p < 0.001). The Morisky-Green questionnaire showed an increase of treatment compliance, namely at baseline, 25.8 % (24/93) of patients were noncompliant while in the end 66.7 % (16/24) of them became compliant) (p = 0.053).ConclusionsA remote support program for high-risk COPD patients results in an improvement of the patients’ health status, particularly in those with initially poor health status, and it helps to reduce COPD exacerbations.Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-016-0304-3) contains supplementary material, which is available to authorized users.

Effects of home‐based telehealth on the physical condition and psychological status of patients with chronic obstructive pulmonary disease: A systematic review and meta‐analysis

“…Witry et al (2018) revealed that patients with COPD who spent more time on the telehealth intervention had greater odds of a health status score >10. Alcazar et al (2016) conducted a remote support project for a population of high‐risk COPD patients. This programme consisted of sending e‐mails and text messages and regular telephone calls from qualified nurses to promote proper disease monitoring.…”

Telehealth mitigates COPD disease progression compared to standard of care: a randomized controlled crossover trial

“…In addition, there exists a wide variability of different interventions in TC, such as monitoring of physiological parameters and vital signs or self-reported symptoms [5]. It remains unclear which modalities should best be used to improve the patient's health status or to detect exacerbations [6,7]. AECOPD is characterized by symptoms, which often occur already days before the event [8].…”

Revealing the Nature of Chronic Obstructive Pulmonary Disease Using Self-tracking and Analysis of Contact Patterns: Longitudinal Study

“…Over the last decade, data from several randomized controlled trials examining the effect of telehealth and how it may assist self-monitoring and management in COPD have been reported [ 9 - 12 ]. Some studies suggest a potential beneficial effect with a reduction of exacerbations [ 13 ], acute hospital admissions, and mortality [ 14 ] and increased health-related quality of life [ 15 ] whereas others have not been able to verify these results [ 16 - 18 ]. In COPD, no studies have yet demonstrated conclusively that telehealth is neither superior nor inferior to usual care; it is noteworthy that telehealth interventions have not caused any harm to COPD patients and the technology has been welcomed by the users [ 10 , 19 , 20 ].…”