Effect of tele health care on exacerbations and hospital admissions in patients with chronic obstructive pulmonary disease: a randomized clinical trial

TY - JOUR

T1 - Effect of tele health care on exacerbations and hospital admissions in patients with chronic obstructive pulmonary disease

T2 - a randomized clinical trial

AU - Ringbæk, Thomas

AU - Green, Allan

AU - Laursen, Lars Christian

AU - Frausing, Ejvind

AU - Brøndum, Eva

AU - Ulrik, Charlotte Suppli

PY - 2015/9/2

Y1 - 2015/9/2

N2 - Background and objective: Tele monitoring (TM) of patients with chronic obstructive pulmonary disease (COPD) has gained much interest, but studies have produced conflicting results. Our aim was to investigate the effect of TM with the option of video consultations on exacerbations and hospital admissions in patients with severe COPD. Materials and methods: Patients with severe COPD at high risk of exacerbations were eligible for the study. Of 560 eligible patients identified, 279 (50%) declined to participate. The remaining patients were equally randomized to either TM (n=141) or usual care (n=140) for the 6-month study period. TM comprised recording of symptoms, saturation, spirometry, and weekly video consultations. Algorithms generated alerts if readings breached thresholds. Both groups received standard care. The primary outcome was number of hospital admissions for exacerbation of COPD during the study period. Results: Most of the enrolled patients had severe COPD (forced expiratory volume in 1 second <50%pred in 86% and ≥hospital admission for COPD in the year prior to enrollment in 45%, respectively, of the patients). No difference in drop-out rate and mortality was found between the groups. With regard to the primary outcome, no significant difference was found in hospital admissions for COPD between the groups (P=0.74), and likewise, no difference was found in time to first admission or all-cause hospital admissions. Compared with the control group, TM group patients had more moderate exacerbations (ie, treated with antibiotics/corticosteroid, but not requiring hospital admission; P<0.001), whereas the control group had more visits to outpatient clinics (P<0.001). Conclusion: Our study of patients with severe COPD showed that TM including video consultations as add-on to standard care did not reduce hospital admissions for exacerbated COPD, but TM may be an alternative to visits at respiratory outpatient clinics. Further studies are needed to establish the optimal role of TM in the management of severe COPD.

AB - Background and objective: Tele monitoring (TM) of patients with chronic obstructive pulmonary disease (COPD) has gained much interest, but studies have produced conflicting results. Our aim was to investigate the effect of TM with the option of video consultations on exacerbations and hospital admissions in patients with severe COPD. Materials and methods: Patients with severe COPD at high risk of exacerbations were eligible for the study. Of 560 eligible patients identified, 279 (50%) declined to participate. The remaining patients were equally randomized to either TM (n=141) or usual care (n=140) for the 6-month study period. TM comprised recording of symptoms, saturation, spirometry, and weekly video consultations. Algorithms generated alerts if readings breached thresholds. Both groups received standard care. The primary outcome was number of hospital admissions for exacerbation of COPD during the study period. Results: Most of the enrolled patients had severe COPD (forced expiratory volume in 1 second <50%pred in 86% and ≥hospital admission for COPD in the year prior to enrollment in 45%, respectively, of the patients). No difference in drop-out rate and mortality was found between the groups. With regard to the primary outcome, no significant difference was found in hospital admissions for COPD between the groups (P=0.74), and likewise, no difference was found in time to first admission or all-cause hospital admissions. Compared with the control group, TM group patients had more moderate exacerbations (ie, treated with antibiotics/corticosteroid, but not requiring hospital admission; P<0.001), whereas the control group had more visits to outpatient clinics (P<0.001). Conclusion: Our study of patients with severe COPD showed that TM including video consultations as add-on to standard care did not reduce hospital admissions for exacerbated COPD, but TM may be an alternative to visits at respiratory outpatient clinics. Further studies are needed to establish the optimal role of TM in the management of severe COPD.

KW - Aged

KW - Algorithms

KW - Ambulatory Care

KW - Anthropometry

KW - Anti-Bacterial Agents

KW - Body Weight

KW - Denmark

KW - Disease Progression

KW - Emergency Service, Hospital

KW - Female

KW - Forced Expiratory Volume

KW - Humans

KW - Lung

KW - Male

KW - Middle Aged

KW - Oximetry

KW - Patient Admission

KW - Predictive Value of Tests

KW - Pulmonary Disease, Chronic Obstructive

KW - Severity of Illness Index

KW - Spirometry

KW - Steroids

KW - Telemedicine

KW - Telemetry

KW - Time Factors

KW - Treatment Outcome

KW - Videoconferencing

U2 - 10.2147/COPD.S85596

DO - 10.2147/COPD.S85596

M3 - Journal article

C2 - 26366072

SN - 1176-9106

VL - 10

SP - 1801

EP - 1808

JO - International Journal of COPD

JF - International Journal of COPD

IS - 1

ER -