The Role of Telemedicine in Extending and Enhancing Medical Management of the Patient with Chronic Obstructive Pulmonary Disease

Abstract

Medical management of a chronic obstructive pulmonary disease (COPD) patient must incorporate a broadened and holistic approach to achieve optimal outcomes. This is best achieved with integrated care, which is based on the chronic care model of disease management, proactively addressing the patient’s unique medical, social, psychological, and cognitive needs along the trajectory of the disease. While conceptually appealing, integrated care requires not only a different approach to disease management, but considerably more health care resources. One potential way to reduce this burden of care is telemedicine: technology that allows for the bidirectional transfer of important clinical information between the patient and health care providers across distances. This not only makes medical services more accessible; it may also enhance the efficiency of delivery and quality of care. Telemedicine includes distinct, often overlapping interventions, including telecommunication (enhancing lines of communication), telemonitoring (symptom reporting or the transfer of physiological data to health care providers), physical activity monitoring and feedback to the patient and provider, remote decision support systems (identifying “red flags,” such as the onset of an exacerbation), tele-consultation (directing assessment and care from a distance), tele-education (through web-based educational or self-management platforms), tele-coaching, and tele-rehabilitation (providing educational material, exercise training, or even total pulmonary rehabilitation at a distance when standard, center-based rehabilitation is not feasible). While the above components of telemedicine are conceptually appealing, many have had inconsistent results in scientific trials. Interventions with more consistently favorable results include those potentially modifying physical activity, non-invasive ventilator management, and tele-rehabilitation. More inconsistent results in other telemedicine interventions do not necessarily mean they are ineffective; rather, more data on refining the techniques may be necessary. Until more outcome data are available clinicians should resist being caught up in novel technologies simply because they are new.

Efficacy of Web-Based Supportive Interventions in Quality of Life in COPD Patients, a Systematic Review and Meta-Analysis

“…The web-based supportive interventions of each study were covered in Table 2 by the content of the comparison group approach, the content of the experimental interventions, the intervention duration, the outcome measures, and main results. Table 2 also includes nine web content elements that were identified as important to the technical characteristics of internet-supported therapeutic interventions [ 27 , 62 ] as well as for evidence-based web interventions: 1, tele-education content; 2, symptom and mood telemonitoring; 3, physical activity monitoring and personalized feedback to the patient; 4, tele-education in self-management skills; 5, tele-consultation with healthcare professionals; 6, tele-communication with other patients; 7, remote decision support systems; 8, tele-diagnosis and 9, tele-rehabilitation [ 63 , 64 ].…”

“…The most recent systematic reviews and meta-analyses [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ] on telehealth care analyze teleassessment, telephone assistance, mobile app development, and website assistance in depth, but they need to be analyzed separately [ 8 ].…”

“…COPD patients demand access to information about their health status, related to the disease itself and to the improvement of quality of life [ 8 ]. Different mechanisms related to a perception of health-related needs, such as health education, self-management [ 36 ], and family and social support, have a significant influence on the quality of life of patients using web-based interventions [ 12 , 21 , 27 , 37 , 38 , 39 ].…”

“…Web-based interventions can encompass several distinct, often overlapping interventions, including: (1) tele-education content; (2) symptom and mood telemonitoring; (3) physical activity monitoring and personalized feedback to the patient; (4) tele-education in self-management skills; (5) tele-consultation with healthcare professionals; (6) tele-communication with other patients; (7) remote decision support systems; (8) tele-diagnosis; and (9) tele-rehabilitation [ 27 , 40 , 41 ].…”

Artificial Intelligence in Orthodontic Smart Application for Treatment Coaching and Its Impact on Clinical Performance of Patients Monitored with AI-TeleHealth System

“…TeleHealth solutions are currently driven with AI implementations in various medical fields from treatments of chronic pulmonary diseases, depressions or intellectual disabilities to other chronic diseases [ 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 ].…”