G Segrelles Calvo1, C Gómez-Suárez2, J B Soriano3, E Zamora4, A Gónzalez-Gamarra5, M González-Béjar6, A Jordán2, E Tadeo2, A Sebastián7, G Fernández8, J Ancochea4. 1. Pneumology Service, La Princesa Institute for Health Research (IP), Hospital Universitario de la Princesa, Madrid, Spain. Electronic address: gsegrelles@hotmail.com. 2. Linde Healthcare, The Linde Group, Spain. 3. Epidemiology and Clinical Research Program, CIMERA, Bunyola, Illes Balears, Spain. 4. Pneumology Service, La Princesa Institute for Health Research (IP), Hospital Universitario de la Princesa, Madrid, Spain. 5. Goya Primary Care Center, Spain. 6. Montesa Primary Care Center, Spain. 7. Hospital Universitario de la Princesa, Madrid, Spain. 8. Department of Medical Research and Documentation, Hospital Universitario de la Princesa, Madrid, Spain.
Abstract
BACKGROUND: Acute exacerbations of chronic obstructive pulmonary disease (AECOP) are key events in the natural history of the disease. Patients with more AECOPD have worse prognosis. There is a need of innovative models of care for patients with severe COPD and frequent AECOPD, and Telehealth (TH) is part of these programs. METHODS: In a cluster assignment, controlled trial study design, we recruited 60 patients, 30 in home telehealth (HT) and 30 in conventional care (CC). All participants had a prior diagnosis of COPD with a post-bronchodilator forced expiratory volume (FEV1)% predicted <50%, age ≥50 years, were on long-term home oxygen therapy, and non-smokers. Patients in the HT group measured their vital signs on a daily bases, and data were transmitted automatically to a Clinical Monitoring Center for followed-up, and who escalated clinical alerts to a Pneumologist. RESULTS: After 7-month of monitoring and follow-up, there was a significant reduction in ER visits (20 in HT vs. 57 in CC), hospitalizations (12 vs. 33), length of hospital stay in (105 vs. 276 days), and even need for non-invasive mechanical ventilation (0 vs. 8), all p < 0.05. Time to the first severe AECOPD increased from 77 days in CC to 141 days in HT (K-M p < 0.05). There was no study withdrawals associated with technology. All patients showed a high level of satisfaction with the HT program. CONCLUSIONS: We conclude that HT in elderly, severe COPD patients with multiple comorbidities is safe and efficacious in reducing healthcare resources utilization.
RCT Entities:
BACKGROUND: Acute exacerbations of chronic obstructive pulmonary disease (AECOP) are key events in the natural history of the disease. Patients with more AECOPD have worse prognosis. There is a need of innovative models of care for patients with severe COPD and frequent AECOPD, and Telehealth (TH) is part of these programs. METHODS: In a cluster assignment, controlled trial study design, we recruited 60 patients, 30 in home telehealth (HT) and 30 in conventional care (CC). All participants had a prior diagnosis of COPD with a post-bronchodilator forced expiratory volume (FEV1)% predicted <50%, age ≥ 50 years, were on long-term home oxygen therapy, and non-smokers. Patients in the HT group measured their vital signs on a daily bases, and data were transmitted automatically to a Clinical Monitoring Center for followed-up, and who escalated clinical alerts to a Pneumologist. RESULTS: After 7-month of monitoring and follow-up, there was a significant reduction in ER visits (20 in HT vs. 57 in CC), hospitalizations (12 vs. 33), length of hospital stay in (105 vs. 276 days), and even need for non-invasive mechanical ventilation (0 vs. 8), all p < 0.05. Time to the first severe AECOPD increased from 77 days in CC to 141 days in HT (K-M p < 0.05). There was no study withdrawals associated with technology. All patients showed a high level of satisfaction with the HT program. CONCLUSIONS: We conclude that HT in elderly, severe COPDpatients with multiple comorbidities is safe and efficacious in reducing healthcare resources utilization.
Authors: Kristen S Willard; Jamie B Sullivan; Byron M Thomashow; Catherine S Jones; Leonard Fromer; Barbara P Yawn; Alpesh Amin; Jean M Rommes; Rhonda Rotert Journal: Chronic Obstr Pulm Dis Date: 2016-10-06
Authors: Nancy L Dawson; Bryan P Hull; Priyanka Vijapura; Adrian G Dumitrascu; Colleen T Ball; Kay M Thiemann; Michael J Maniaci; M Caroline Burton Journal: J Gen Intern Med Date: 2021-01-27 Impact factor: 5.128
Authors: Narelle S Cox; Simone Dal Corso; Henrik Hansen; Christine F McDonald; Catherine J Hill; Paolo Zanaboni; Jennifer A Alison; Paul O'Halloran; Heather Macdonald; Anne E Holland Journal: Cochrane Database Syst Rev Date: 2021-01-29