Effectiveness of Telemonitoring in Patients with Chronic Obstructive Pulmonary Disease in Taiwan-A Randomized Controlled Trial Effects of home telemonitoring to support improved care for chronic obstructive pulmonary diseases. Continuity, but at what cost? The impact of telemonitoring COPD on continuities of care: a qualitative study. Home telemonitoring and quality of life in stable, optimised chronic obstructive pulmonary disease Telemonitoring for chronic obstructive pulmonary disease: a cost and cost-utility analysis of a randomised controlled trial Exploring telemonitoring and self-management by patients with chronic obstructive pulmonary disease: a qualitative study embedded in a randomized controlled trial. Telemonitoring in Chronic Obstructive Pulmonary Disease (CHROMED). A Randomized Clinical Trial A Randomized Trial of Telemonitoring Heart Failure Patients Effectiveness of telemonitoring integrated into existing clinical services on hospital admission for exacerbation of chronic obstructive pulmonary disease: researcher blind, multicentre, randomised controlled trial Effects of telemonitoring in patients with chronic obstructive pulmonary disease. Does Home Telemonitoring after Pulmonary Rehabilitation Reduce Healthcare Use in Optimized COPD?? A Pilot Randomized Trial Using the Roper, Logan and Tierney model in care of people with COPD. Efficacy of multiparametric telemonitoring on respiratory outcomes in elderly people with COPD: a randomized controlled trial Home telemonitoring for patients with acute exacerbation of chronic obstructive pulmonary disease: a randomized controlled trial Telemedicine Experience for Chronic Care in COPD A randomised clinical trial of the effectiveness of home-based health care with telemonitoring in patients with COPD Guidelines versus clinical practice in the treatment of chronic obstructive pulmonary disease Effectiveness of a partnership-based self-management programme for patients with mild and moderate chronic obstructive pulmonary disease: a pragmatic randomized controlled trial. Neuromuscular electrical stimulation as an adjunct to endurance and resistance training during pulmonary rehabilitation in stable chronic obstructive pulmonary disease The effect of transcutaneous electrical nerve stimulation in patients with acute exacerbation of chronic obstructive pulmonary disease: randomised controlled trial Prevalence of comorbidity in patients with a chronic airway obstruction and controls over the age of 40. Results of a telehealth-enabled chronic care management service to support people with long-term conditions at home Effect of counselling during pulmonary rehabilitation on self-determined motivation towards physical activity in people with chronic obstructive pulmonary disease – protocol of a mixed methods study The effect of non-pharmacological staged interventions on fatigue and dyspnoea in patients with chronic obstructive pulmonary disease: a randomized controlled trial. Effects of nurse-initiated telephone follow-up on self-efficacy among patients with chronic obstructive pulmonary disease. Effect of tiotropium and olodaterol on symptoms and patient-reported outcomes in patients with COPD: results from four randomised, double-blind studies 'It's not worth stopping now': why do smokers with chronic obstructive pulmonary disease continue to smoke? A qualitative study.
Chronic obstructive pulmonary disease ( COPD ) is the leading cause of death worldwide , and poses a substantial economic and social burden . Telemonitoring has been proposed as a solution to this growing problem , but its impact on patient outcome is equivocal . This r and omized controlled trial aim ed to investigate effectiveness of telemonitoring in improving COPD patient outcome . In total , 106 subjects were r and omly assigned to the  telemonitoring  ( n = 53 ) or  usual care ( n = 53 ) group . During the two months following discharge , telemonitoring group patients had to report their symptoms daily using an electronic diary . The primary outcome measure was time to first re-admission for COPD exacerbation within six months of discharge . During the follow-up period , time to first re-admission for COPD exacerbation was significantly increased in the telemonitoring group than in the usual care group ( p = 0.026 ) . Telemonitoring was also associated with a reduced number of all-cause re-admissions ( 0.23 vs. 0.68/patient ; p = 0.002 ) and emergency room visits ( 0.36 vs. 0.91/patient ; p = 0.006 ) . In conclusion , telemonitoring intervention was associated with improved outcomes among COPD patients admitted for exacerbation in a country characterized by a small territory and high accessibility to medical services . The findings are encouraging and add further support to implementation of telemonitoring as part of COPD care OBJECTIVE To assess the impact of a home telemonitoring technology on patients with chronic obstructive pulmonary disease in terms of care satisfaction , patient empowerment , improved quality of life , and utilization of hospital and home care . DESIGN A quasi-experimental retrospective and prospect i ve design was developed with a matched control group to compare the effects of telemonitoring  ( the experimental group , n = 23 ) with the traditional homecare offering  ( the control group , n = 23 ) . MEASUREMENTS Satisfaction , patient empowerment , and quality of life were measured using vali date d Likert scales , whereas the data on care utilization were collected from the participating patients ' medical record . RESULTS Mixed results were observed . The clinical effects of home telemonitoring were very positive in terms of patients ' satisfaction and empowerment . The perceptions of care providers as well as those of patients were congruent in this respect . Also , the study suggests that telemonitoring may have a positive effect on quality of life for patients with chronic obstructive pulmonary diseases . In contrast , the results were disappointing in terms of re source savings for the use of both homecare and hospital care . CONCLUSION Capturing the full potential of these new technologies will require a much more fundamental reorganization of work than just a simple deployment of the technology BACKGROUND Continuity of care is widely regarded as an important marker of quality in the management of patients with long-term conditions . New services that integrate telemonitoring into care pathways have potential to change aspects of continuity in both positive and negative ways . AIMS A telemonitoring service for patients with chronic obstructive pulmonary disease ( COPD ) was introduced in Lothian , Scotl and , in 2009 . A qualitative study , nested within the TELESCOT COPD r and omised control trial , was undertaken to explore the views of patients and professionals on  telemonitoring . The perceived impact of telemonitoring on continuity of care was investigated as part of the research . METHODS Semi-structured interviews were undertaken with 38 patients ( 47 % male , mean age 67.5 years ) . A maximum variation sample in relation to age , sex , socio-economic background , disease severity , and compliance with telemonitoring was recruited . Thirty-two stakeholders ( healthcare professionals and managers ) were interviewed . Transcribed coded data were analysed thematically using the framework approach . Interpretation was supported by multidisciplinary discussion . RESULTS Patients and healthcare professionals considered that relationship-based continuity of care was important in the delivery of telemonitoring services . Managers placed emphasis on improved continuity of clinical management as a means of reducing healthcare costs . However , professionals described many operational challenges arising from the ' bolting-on ' of telemonitoring provision to existing usual care provision which , they considered , result ed in the proliferation of additional managerial discontinuities . CONCLUSIONS Managers and healthcare professionals face major challenges in meeting dem and s for both relationship continuity and continuity of clinical management in the development of telemonitoring services We conducted a six-month r and omised controlled trial of home telemonitoring for patients with chronic obstructive pulmonary disease ( COPD ) . A total of 40 stable patients with moderate to severe COPD who had completed pulmonary rehabilitation took part . They were r and omised to receive st and ard care ( controls ) or st and ard care plus home telemonitoring ( intervention ) . During the monitoring period , patients in the telemonitoring group recorded their symptoms and physical observations twice daily . The data were transmitted automatically at night via the home telephone line . Nurses could access the data through a website and receive alerting email messages if certain conditions were detected . The patients completed the St George 's Respiratory Question naire , Hospital Anxiety and Depression and the EuroQoL EQ-5D quality of life scores before and after pulmonary rehabilitation , and then periodically during the trial . There were significant and clinical ly important improvements in the scores immediately following pulmonary rehabilitation , but thereafter there were no differences in quality of life scores between the groups at any time , or consistently within either group over time . The study showed that telemonitoring was safe but , despite being well used , it was not associated with changes in quality of life in patients who had stable COPD We compared the costs and cost-effectiveness of telemonitoring vs usual care for patients with chronic obstructive pulmonary disease ( COPD ) . A total of 256 patients were r and omised to either telemonitoring or usual care . In the telemonitoring arm , the touch-screen telemonitoring equipment transmitted data to clinical teams monitoring the patients . Total healthcare costs were estimated over a 12-month period from a National Health Service perspective and quality adjusted life year ( QALYs ) were estimated by the EQ-5D tool . Telemonitoring was not significantly more costly than usual care ( mean difference per patient £ 2065.90 ( P < 0.18 ) . The increased costs were predominantly due to telemonitoring service costs and non-significantly higher secondary care costs . Telemonitoring for COPD was not cost-effective at a base case of £ 137,277 per QALY with only 15 % probability of being cost-effective at the usual threshold of £ 30,000 per QALY . Although there was some statistical and method ological uncertainty in the measures used , telemonitoring was not cost-effective in the sensitivity analyses performed . It seems unlikely that a telemonitoring service of the kind that was trialled would be cost-effective in providing care for people with COPD OBJECTIVE To explore patient and professional views on self-management in the context of telemonitoring in chronic obstructive pulmonary disease ( COPD ) . METHODS Semi-structured interviews with patients with COPD and healthcare professionals participating in a r and omized controlled trial of telemonitoring in Lothian , Scotl and , explored experiences of using telemonitoring , and dynamics in patient-practitioner relationships . Transcribed data were analyzed using the Framework approach . RESULTS 38 patients ( mean age 67.5 years ) and 32 professionals provided 70 interviews . Patients considered that telemonitoring empowered self-management by enhancing their underst and ing of COPD and providing additional justification for their decisions to adjust treatment or seek professional advice . Professionals discussed telemonitoring as promoting compliance with medical advice and encouraged patients to exercise personal responsibility within clinical parameters , but expressed concerns about promoting the sick role and creating dependence on telemonitoring . CONCLUSION Telemonitoring assisted many patients to embrace greater responsibility for their health but the model of service provision remained clinician-centered . A medical model of ' compliant self-management ' may paradoxically have promoted dependence on professionals . PRACTICE IMPLICATION S Patients and professionals shared responsibility for meeting the central objective of prompt management of exacerbations of COPD . Care is needed , however , to minimize the risk in some patients , of telemonitoring increasing dependence on practitioner support Rationale : Early detection of chronic obstructive pulmonary disease ( COPD ) exacerbations using telemonitoring of physiological variables might reduce the frequency of hospitalization . Objectives : To evaluate the efficacy of home monitoring of lung mechanics by the forced oscillation technique and cardiac parameters in older patients with COPD and comorbidities . Methods : This multicenter , r and omized clinical trial recruited 312 patients with Global Initiative for Chronic Obstructive Lung Disease grade s II to IV COPD ( median age , 71 yr [ interquartile range , 66‐76 yr ] ; 49.6 % grade II , 50.4 % grade s III‐IV ) , with a history of exacerbation in the previous year and at least one nonpulmonary comorbidity . Patients were r and omized to usual care ( n = 158 ) or telemonitoring ( n = 154 ) and followed for 9 months . All telemonitoring patients self‐assessed lung mechanics daily , and in a subgroup with congestive heart failure ( n = 37 ) cardiac parameters were also monitored . An algorithm identified deterioration , triggering a telephone contact to determine appropriate interventions . Measurements and Main Results : Primary outcomes were time to first hospitalization ( TTFH ) and change in the EuroQoL EQ‐5D utility index score . Secondary outcomes included : rate of antibiotic/corticosteroid prescription ; hospitalization ; the COPD Assessment Tool , Patient Health Question naire‐9 , and Minnesota Living with Heart Failure question naire scores ; quality ‐adjusted life years ; and healthcare costs . Telemonitoring did not affect TTFH , EQ‐5D utility index score , antibiotic prescriptions , hospitalization rate , or question naire scores . In an exploratory analysis , telemedicine was associated with fewer repeat hospitalizations ( −54 % ; P = 0.017 ) . Conclusions : In older patients with COPD and comorbidities , remote monitoring of lung function by forced oscillation technique and cardiac parameters did not change TTFH and EQ‐5D . Clinical trial registered with www . clinical trials.gov ( NCT 01960907 ) EXECUTIVE SUMMARY The purpose of this study was to measure the ability of telemonitoring to reduce hospital days and total costs for Medicare managed care enrollees diagnosed with heart failure . Patients were recruited and r and omly assigned for six months to either  telemonitoring or st and ard care . Telemonitoring transmitted vital signs and clinical alerts daily to a central nursing station . Utilization of covered services was analyzed for the six‐month telemonitoring period to test for hypothesized reductions in hospital days and changes in utilization of the emergency department ( ED ) , urgent care , and primary care . Negative binomial regressions adjusted for gender , age , co‐occurring diabetes , co‐occurring chronic obstructive pulmonary disease , and residence neighborhood were used to analyze units of service , and two‐part ( hurdle ) multivariable models were used for expenditures . The main finding was a tendency for lower total number of hospital days for patients assigned to telemonitoring . Results for other covered services were generally consistent with hypothesized direction and magnitude ; however , statistical power was reduced because of lowerthan‐expected recruitment rates into the study . Within a managed‐care environment , telemonitoring appears to facilitate better ambulatory management of heart failure patients  , including fewer ED visits , which were offset by more frequent primary care and urgent care visits Objective To test the effectiveness of telemonitoring integrated into existing clinical services such that intervention and control groups have access to the same clinical care . Design Research er blind , multicentre , r and omised controlled trial . Setting UK primary care ( Lothian , Scotl and ) . Participants Adults with at least one admission for chronic obstructive pulmonary disease ( COPD ) in the year before r and omisation . We excluded people who had other significant lung disease , who were unable to provide informed consent or complete the study , or who had other significant social or clinical problems . Interventions Participants were recruited between 21 May 2009 and 28 March 2011 , and central ly r and omised to receive telemonitoring or conventional self monitoring . Using a touch screen , telemonitoring participants recorded a daily question naire about symptoms and treatment use , and monitored oxygen saturation using linked instruments . Algorithms , based on the symptom score , generated alerts if readings were omitted or breached thresholds . Both groups received similar care from existing clinical services . Main outcome measures The primary outcome was time to hospital admission due to COPD exacerbation up to one year after r and omisation . Other outcomes included number and duration of admissions , and vali date d question naire assessment s of health related quality of life ( using St George ’s respiratory question naire ( SGRQ ) ) , anxiety or depression ( or both ) , self efficacy , knowledge , and adherence to treatment . Analysis was intention to treat . Results Of 256 patients completing the study , 128 patients were r and omised to telemonitoring and 128 to usual care ;  baseline characteristics of each group were similar . The number of days to admission did not differ significantly between groups ( adjusted hazard ratio 0.98 , 95 % confidence interval 0.66 to 1.44 ) . Over one year , the mean number of COPD admissions was similar in both groups ( telemonitoring 1.2 admissions per person ( st and ard deviation 1.9 ) v control 1.1 ( 1.6 ) ; P=0.59 ) . Mean duration of COPD admissions over one year was also similar between groups ( 9.5 days per person ( st and ard deviation 19.1 ) v 8.8 days ( 15.9 ) ; P=0.88 ) . The intervention had no significant effect on SGRQ scores between groups ( 68.2 ( st and ard deviation 16.3 ) v 67.3 ( 17.3 ) ; adjusted mean difference 1.39 ( 95 % confidence interval −1.57 to 4.35 ) ) , or on other question naire outcomes . Conclusions In participants with a history of admission for exacerbations of COPD , telemonitoring was not effective in postponing admissions and did not improve quality of life . The positive effect of telemonitoring seen in previous trials could be due to enhancement of the underpinning clinical service rather than the telemonitoring communication . Trial registration IS RCT N96634935 . Funding : The trial was funded by an NHS applied research programme grant from the Chief Scientist Office of the Scottish government ( ARPG/07/03 ) . The funder had no role in study design and the collection , analysis , and interpretation of data and the writing of the article and the decision to su bmi t it for publication . NHS Lothian supported the telemonitoring service and the clinical services The objective of this study was to determine the effects of a homebased telemonitoring device , The Health Buddy ( HB ) , on health consumption and health-related quality of life ( HRQoL ) in patients with moderate to severe chronic obstructive pulmonary disease ( COPD ) . The HB provides daily symptom-surveillance by a case manager and education to enhance disease knowledge and self-management . A nonr and omized controlled multicenter study was established comparing the effectiveness of telemonitoring as an add-on to care as usual with a follow-up of 6 months . Four hospitals took part in the experimental group and 2 hospitals formed an equivalent control group with 59 and 56 patients , respectively .  HRQoL was measured by the Clinical COPD Question naire . Healthcare consumption was assessed using medical records in the 6 months preceding study entry and during the study . Compared with the control group , the HB group showed a significant decrease in hospital admission rates ( HB -0.11 + /- 1.16 vs. control + 0.27 + /- 1.0 , p = 0.02 ) and in the total number of exacerbations ( HB -0.35 + /- 1.4 vs. control + 0.32 + /- 1.2 , p = 0.004 ) . There was a tendency toward decreased hospital days and outpatient visits . No significant changes in HRQoL were observed at follow-up between both study groups . Despite inherent limitations of the study , these findings suggest that adopting telemonitoring in everyday clinical practice is feasible and can substantially improve care and decrease healthcare utilization of patients with moderate to severe COPD ABSTRACT Aim . To see if home telemonitors reduce healthcare use in those with optimized chronic obstructive pulmonary disease ( COPD ) . Methods . We r and omized 40 stable patients with moderate to severe COPD , who had completed at least 12 sessions of outpatient pulmonary rehabilitation ( PR ) , to receive st and ard care ( Controls ) for 52 weeks or st and ard care plus Docobo HealthHUB monitors at home for 26 weeks followed by 26 weeks st and ard care ( Tm Group ) . During the monitoring period , the Tm Group completed  symptoms and physical observations  twice daily which were stored and then uploaded at 2 am through a freephone l and line . Nurses could access the data through a secure web site and received alerting e-mails if certain combinations of data occurred . Results . There were fewer primary care contacts for chest problems ( p < 0.03 ) in the Tm group , but no differences between the groups in emergency room visits , hospital admissions , days in hospital or contacts to the specialist COPD community nurse team , during the monitoring period . After the monitors were removed , there were no differences between the groups for any of the health care contacts ( p > 0.20 throughout ) . Conclusion . In stable , optimized COPD patients who have already completed PR , telemonitoring in addition to best care , reduces primary care chest contacts but not hospital or specialist team utilization AIM To determine whether the Roper , Logan and Tierney Model of nursing care affects the outcomes of patients with chronic obstructive pulmonary disease . BACKGROUND Chronic obstructive pulmonary disease is a leading chronic health problem throughout the world . Although there are numerous studies on patients with chronic obstructive pulmonary disease , no studies have been found regarding patient care with chronic obstructive pulmonary disease investigated from the Roper , Logan and Tierney Model perspective . METHODS The study design was an experimental style . The sample consisted of 60 subjects with a diagnosis of chronic obstructive pulmonary disease who were hospitalized in a university hospital in Erzurum , Turkey , in 2001 and r and omly selected into control and experimental groups . On admission , the research er completed a nursing diagnosis form for chronic obstructive pulmonary disease for each patient , consisting of demographic characteristics and an assessment nursing diagnosis for each of the patients . Control group patients were treated by routine nursing care while the experimental group patients were treated by nursing care according to the Roper , Logan and Tierney Model . Upon discharge , nursing diagnoses were assessed again in both control and experimental groups . Results . Although there was no statistically significant decrease in most nursing diagnoses in the control group , there was a statistically significant decrease in nursing diagnoses in favour of the experimental group . CONCLUSION This study demonstrated that there were improvements in patient 's outcomes in the concept of holistic and individualized nursing care of patients with chronic obstructive pulmonary disease according to the Roper , Logan and Tierney model . RELEVANCE TO CLINICAL PRACTICE The findings of this study have practical importance for nursing practise . Using the Roper , Logan and Tierney Model in care of patients with chronic obstructive pulmonary disease may serve as a guide for nurses working with chronic obstructive pulmonary disease patients to participate patient and her/his family to patient care and to facilitate the effectiveness of patient care Background Chronic obstructive pulmonary disease ( COPD ) is a highly prevalent condition associated with a high health care re source consumption and health care expenditures , driven mainly by exacerbations-related hospitalizations . Telemedicine has been proposed as a mean for timely detection of exacerbation , but the available evidence is inadequate to provide conclusive information on its efficacy . The aim of this study is to evaluate the efficacy of a telemonitoring system in reducing COPD -related hospitalizations in an elderly population with COPD . Methods This is a parallel arms , r and omized trial including patients aged 65 or older with COPD in GOLD stages II and III enrolled in a Pulmonary Medicine outpatient facility . Patients were r and omly assigned to receive a non-invasive system able to telemonitor vital signs ( oxygen saturation , heart rate , near-body temperature , overall physical activity ) or st and ard care , and were followed up for 9 months . The outcome measures were the number of exacerbations and exacerbation-related hospitalization . Results Fifty patients were included in the telemonitoring group and 49 in the control group . The incidence rate of respiratory events was 28/100 person/years in the telemonitoring group vs. 42/100 person/years in the control group ( incidence rate ratio : 0.67 , 95 % CI : 0.32 – 1.36 ) . The corresponding figures for hospital admissions where 13/100 person/years and 20/100 person/years , respectively ( IRR : 0.66 , 95 % CI : 0.21 – 1.86 ) . Conclusions In our study , COPD patients followed up with the aid of a multiparametric remote monitoring system experienced a lower rate of exacerbations and COPD -related hospitalizations compared to patients followed up using the st and ard model of care . These results need to be replicated in larger studies before they can be applied to the general COPD population . Trial registration number : NCT01481506 ( clinical trials.gov ) . Funding : co-financed by Lazio Region and Intersistemi Background Although a number of studies have suggested that the use of Telemonitoring ( TM ) in patients with Chronic Obstructive Pulmonary Disease ( COPD ) can be useful and efficacious , its real utility in detecting Acute Exacerbation ( AE ) signaling the need for prompt treatment is not entirely clear . The current study aim ed to investigate the benefits of a TM system in managing AE in advanced-stage COPD patients to improve their Health-Related Quality of Life ( HRQL ) and to reduce utilization of healthcare services . Methods A 12-month R and omised Controlled Trial ( RCT ) was conducted in the Veneto region ( Italy ) . Adult patients diagnosed with Class III-IV COPD in accordance with the Global Initiative for Chronic Obstructive Lung Disease ( GOLD ) classification were recruited and provided a TM system to alert the clinical staff via a trained operator whenever variations in respiratory parameters fell beyond the individual ’s normal range . The study ’s primary endpoint was HRQL , measured by the Italian version of the two Short Form 36-item Health Survey ( SF36v2 ) . Its secondary endpoints were : scores on the Hospital Anxiety and Depression Scale ( HADS ) ; the number and duration of hospitalizations ; the number of readmissions ; the number of appointments with a pulmonary specialist ; the number of visits to the emergency department ; and the number of deaths . Results Three hundred thirty-four patients were enrolled and r and omized into two groups for a 1 year period . At its conclusion , changes in the SF36 Physical and Mental Component Summary scores did not significantly differ between the TM and control groups [ ( -2.07 ( 8.98 ) vs -1.91 ( 7.75 ) ; p = 0.889 and -1.08 ( 11.30 ) vs -1.92 ( 10.92 ) ; p = 0.5754 , respectively ] . Variations in HADS were not significantly different between the two groups [ 0.85 ( 3.68 ) vs 0.62 ( 3.6 ) ; p = 0.65 and 0.50 ( 4.3 ) vs 0.72 ( 4.5 ) ; p = 0.71 ] . The hospitalization rate for AE COPD and /or for any cause was not significantly different in the two groups [ IRR = 0.89 ( 95 % CI 0.79–1,04 ) ; p = 0.16 and IRR = 0.91 ( 95 % CI 0,75 – 1.04 ) ; p = 0.16 , respectively ] . The readmission rate for AE COPD and /or any cause was , however , significantly lower in the TM group with respect to the control one [ IRR = 0.43 ( 95 % CI 0.19–0.98 ) ; p = 0.01 and 0.46 ( 95 % CI 0.24–0.89 ) ; p = 0.01 , respectively ] . ConclusionS tudy results showed that in areas where medical services are well established , TM does not significantly improve HRQL  in patients with COPD who develop AE . Although not effective in reducing hospitalizations , TM can nevertheless facilitate continuity of care during hospital-to-home transition by reducing the need for early readmission . Trial registration Retrospectively registered on January 2012 , Clinical Trials.gov Identifier : NCT01513980 Information and telecommunication technologies are called to play a major role in the changes that healthcare systems have to face to cope with chronic disease . This paper reports a telemedicine experience for the home care of chronic patients suffering from chronic obstructive pulmonary disease ( COPD ) and an integrated system design ed to carry out this experience . To determine the impact on health , the chronic care telemedicine system was used during one year ( 2002 ) with 157 COPD patients in a clinical experiment ; endpoints were readmissions and mortality . Patients in the intervention group were followed up at their homes and could contact the care team at any time through the call center . The care team shared a unique electronic chronic patient record ( ECPR ) accessible through the web-based patient management module or the home visit units . Results suggest that integrated home telemedicine services can support health professionals caring for patients with chronic disease , and improve their health . We have found that simple telemedicine services ( ubiquitous access to ECPR , ECPR shared by care team , accessibility to case manager , problem reporting integrated in ECPR ) can increase the number of patients that were not readmitted ( 51 % intervention , 33 % control ) , are acceptable to professionals , and involve low installation and exploitation costs . Further research is needed to determine the role of telemonitoring and televisit services for this kind of We studied the effect of telemonitoring in addition to usual care compared to usual care alone in patients with chronic obstructive pulmonary disease ( COPD ) . A total of 110 patients with moderate to severe COPD were recruited from a specialist respiratory service in Northern Irel and . Patients had at least two of : emergency department admissions , hospital admissions or emergency general practitioner ( GP ) contacts in the 12 months before the study . Exclusion criteria were patients who had any respiratory disorder other than COPD , or were cognitively unable to learn the process of monitoring . Patients were r and omised to receive six months of home telemonitoring with usual care , or six months of usual care . The primary outcome measure was disease-specific quality of life , as measured by the St George ’s Respiratory Question naire for COPD patients ( SGRQ-C ) . Of 100 patients completing the study , 48 patients were r and omised to telemonitoring and 52 patients were r and omised to the control group . The SGRQ-C scores improved significantly in the intervention group compared to usual care ( P = 0.001 ) . The HADS anxiety score was significantly higher in the telehealth group compared to the usual care group ( P = 0.01 ) . There were significantly more contacts with the Community Respiratory Team in the telemonitoring group compared to the control group ( P = 0.029 ) . There were no significant between group differences in EQ-5D scores , HADS depression scores , GP activity , emergency department visits , hospital admissions or exacerbations . The total cost to the health service of the intervention over the 6-month study period was £ 2039 , giving an estimated ICER of £ 203,900 . In selected patients with COPD , telemonitoring was effective in improving health-related quality of life and anxiety , but was not a cost-effective intervention The main purpose of this study was to assess whether pharmacological treatments prescribed by respiratory physicians to patients with chronic obstructive pulmonary disease ( COPD ) were consistent with the guidelines . The treatments prescribed by respiratory physicians to 631 consecutive patients with COPD , compared to 879 asthmatics were prospect ively recorded . All subjects underwent peak expiratory flow rate measurement , spirometry and assessment of recent evolution and dyspnoea ( visual analogue and Medical Research Council scales ) . Patients with COPD received more treatments than asthmatics ( mean±sd : 2.6±0.5 versus 2.2±0.4 , p<0.0001 ) . Treatments administered to patients with COPD were  β2-agonists  in 78 % ( versus 94 % in asthmatics ) ,  anticholinergic agents ( AC ) in 56 % ( versus 16 % in asthma ) ,  methylxanthines  in 31 % ( versus 15 % in asthma ) and  inhaled corticosteroids  in 76 % ( versus 85 % in asthma ) . Intensity of treatment was influenced by disease severity for all treatments except AC . In conclusion , pharmacological treatment of chronic obstructive pulmonary disease by respiratory physicians is only partially consistent with current guidelines , with a high proportion of inhaled corticosteroid prescriptions and a relative under-use of anticholinergic agents ; this most likely reflects the persistent uncertainties of physicians , and emphasizes that more efforts are required to improve implementation of chronic obstructive pulmonary disease guidelines and assess the efficacy and cost-effectiveness of recommended strategies AIMS To evaluate the effectiveness of a 6-month , partnership-based self-management programme for patients with mild and moderate chronic obstructive pulmonary disease . BACKGROUND Self-management is a widely valued concept used to address contemporary issues of chronic health problems . Findings of self-management programmes for people with chronic obstructive pulmonary disease are inconclusive . DESIGN Pragmatic r and omized control trial . METHODS Patients , 45 - 65 years old , with mild and moderate chronic obstructive pulmonary disease were invited with a family member . Experimental group ( n = 48 ) participated in a 6-month , partnership-based self-management programme consisting of : ( a ) three to four conversations between nurse and patient-family member ; ( b ) 6 months of smoking cessation ; and ( c ) interdisciplinary team-patient-family member group meeting . Control group ( n = 52 ) received usual care . Data were collected at months zero , six and 12 . The trial lasted from June 2009-March 2013 . RESULTS Patients with mild and moderate chronic obstructive pulmonary disease who participated in the partnership-based self-management programme perceived less intrusiveness of the disease and its treatment than patients in the control group . Patients in the experimental group did not have better health-related quality of life , less anxiety or depression , increased physical activity , fewer exacerbations or better smoking status than patients in the control group . Patients in both groups found participation in the research useful and important . CONCLUSION The partnership-based self-management programme had benefits concerning perception of the intrusiveness of chronic obstructive pulmonary disease and its treatment on lifestyles , activities and interests for young patients with the disease in its early stages . High satisfaction in control group , low family attendance and the relatively short treatment period may explain the less than expected benefits of the programme Aim : The purpose of this study was to investigate whether adding neuromuscular electrical stimulation ( NMES ) to a comprehensive pulmonary rehabilitation ( cPR ) program would have additive effects on clinical -functional outcomes . Methods : Twenty-seven chronic obstructive pulmonary disease patients participating in a 10-week cPR program were r and omly allocated to NMES + cPR ( n = 13 ) or Sham + cPR ( n = 14 ) groups . Quadriceps strength , exercise capacity , symptoms , mood , activities of daily living and quality of life were evaluated pre- and post- interventions . Results : There were no significant differences in any of the physiological and subjective improvements induced by NMES + cPR versus Sham + cPR ( p > 0.05 ) . In fact , the NMES + cPR group showed lower increases in incremental shuttle walk test ( ISWT ) distance ( 38.4 vs 69.2 m , respectively ) and % ISWT distance ( 5.1 vs 9 % , respectively ) compared with the Sham + cPR group ( p < 0.05 ) . Conclusion : The increase in exercise capacity is less important when NMES is used as an adjunct to the cPR AIMS AND OBJECTIVES The aim of the present study was to assess the efficacy of transcutaneous electrical nerve stimulation in patients with acute exacerbation of chronic obstructive pulmonary disease . BACKGROUND In patients with stable chronic obstructive pulmonary disease , transcutaneous electrical nerve stimulation has been known to attain improvement in forced expiratory volume in 1 seconds , physical activity , and quality of life . However , information about the effects of transcutaneous electrical nerve stimulation on acute exacerbation of chronic obstructive pulmonary disease is quite limited . DESIGN A single-blind , r and omised controlled trial . METHODS Data were collected between August 2013-May 2014 . Eighty-two patients who were hospitalised with a diagnosis of acute exacerbation of chronic obstructive pulmonary disease were r and omly assigned to a transcutaneous electrical nerve stimulation group receiving transcutaneous electrical nerve stimulation treatment for 20 seance over the acupuncture points with pharmacotherapy or placebo group receiving the same treatment without electrical current output from the transcutaneous electrical nerve stimulation device .  Pulmonary functional test , six-minute walking distance , dyspnoea and fatigue scale , and St. George 's Respiratory Question naire scores were assessed pre- and postprogram . The program started at the hospital by the research er was sustained in the patient 's home by the caregiver . RESULTS All patients were able to complete the program , despite the exacerbation . The 20 seance transcutaneous electrical nerve stimulation program provided clinical ly significant improvement in forced expiratory volume in 1 seconds 21 ml , 19·51 % but when compared with the placebo group , the difference was insignificant ( p > 0·05 ) . The six-minute walking distance increased by 48·10 m more in the placebo group ( p < 0·05 ) . There were no significant differences between the two groups ' St. George 's Respiratory Question naire , dyspnoea and fatigue score ( p > 0·05 ) . CONCLUSION Adding transcutaneous electrical nerve stimulation therapy to pharmacotherapy in patients with acute exacerbation of chronic obstructive pulmonary disease provided clinical improvement in forced expiratory volume in 1 seconds and add benefit in exercise capacity , but no significant effect on the other outcomes measured . RELEVANCE TO CLINICAL PRACTICE Transcutaneous electrical nerve stimulation can be used as a non-invasive complementary therapy due to its beneficial effects on forced expiratory volume in 1 seconds and exercise capacity in patients with acute exacerbation of chronic obstructive pulmonary disease The goal of this study is to determine the prevalence of 23 common diseases in subjects with a chronic airway obstruction and in controls . All subjects with a known diagnosis by their general practitioner of asthma or chronic obstructive pulmonary disease ( COPD ) , and who were 40 years and older were selected ( n = 1145 ) . Subjects who were willing to participate ( n = 591 ) and who appeared to have an irreversible airway obstruction ( n = 290 ) were included . To recruit controls , a r and om sample was taken of 676 individuals who were 40 years and older and who were not diagnosed as having asthma or COPD by their general practitioner . Of these 676 individuals 421 were willing to participate . The presence of diseases was determined by using a question naire . One hundred and ninety-four subjects ( 73 % ) and 229 controls ( 63 % ) were shown to be suffering from one or more ( other ) diseases . In both groups , locomotive diseases , high blood pressure , insomnia and heart disease were most common . Locomotive diseases , insomnia , sinusitis , migraine , depression , stomach or duodenal ulcers and cancer were significantly more common in the subject group than in the control group . For both clinical and research purpose s , it is important to consider the presence of diseases in patients with a chronic airway obstruction Both congestive heart failure and chronic obstructive pulmonary disease are more common among Māori than non-Māori people , and the cultural acceptability of home-based remote monitoring technology has not been tested . We conducted a 12-month pilot trial of home telemonitoring .  Patients were r and omly assigned to the control and intervention groups . Patients in the control group showed no clear differences in quality of life at the end of the trial . The telehealth group showed a consistent trend towards improved quality of life on several instruments , including the SF-36 , the St George Respiratory Question naire and the K10 question naire ; the improvement in the latter was significant . Hospitalizations were reduced in both the control ( −19 % ) and telehealth group ( −25 % ) . Patient interviews indicated that the technology was acceptable to most patients and their families , including the Māori . The results from the pilot trial suggest that wider implementation with a cost benefit evaluation could be worthwhile Background Physical activity promotion in people with Chronic Obstructive Pulmonary Disease ( COPD ) is focus of research and public health . Patient-centred interventions like counselling are promising approaches to help patients reducing sedentary behaviour . Aim of the present study is to investigate if a physical activity counselling program during pulmonary rehabilitation increases physical activity level in daily life in people with COPD . Methods A two-armed , single blind r and omised controlled trial including 56 people with COPD will be conducted in an outpatient pulmonary rehabilitation . Patients will participate in a 12-week-rehabilitation program ;  individuals r and omized to the interventional group will additionally participate in five counselling sessions with a physiotherapist , based on the principles of motivational interviewing . The participants ’ physical activity level will be measured using an accelerometer ( SenseWear Pro ® ) before , directly and 3 months after pulmonary rehabilitation . Semi-structured interviews will be conducted to learn more about barriers and facilitators regarding daily physical activity . Discussion If the strategy successfully improves the physical activity level in people with COPD , counselling might be implemented in pulmonary rehabilitation . Trial registration Clinical Trials.gov NCT02455206 ( 05/21/2015 ) , Swiss National Trails Portal SNCTP000001426 ( 05/21/2015 ) The aim of this study was to examine the effect of non-pharmacological staged interventions on fatigue and dyspnoea  in patients with chronic obstructive pulmonary disease . A r and omized controlled trial was conducted with 64 patients in a tertiary hospital in China from 2010 to 2011 . Patients were r and omly assigned to the control group ( n = 32 ) , who received routine care , and the intervention group ( n = 32 ) , who received additional non-pharmacological staged interventions .  The Multidimensional Fatigue Inventory and the five- grade Medical Research Council dyspnoea scale were used to collect data at baseline and after 6 weeks . Compared with the control group , patients in the intervention group had significantly lower scores on general fatigue ( P < 0.001 ) , physical fatigue ( P < 0.001 ) , reduced activity ( P < 0.001 ) and reduced motivation ( P = 0.03 ) and had better relief of dyspnoea ( P = 0.02 ) . Our study showed that non-pharmacological staged interventions were effective in relieving fatigue and dyspnoea in patients with chronic obstructive pulmonary disease AIM This paper reports a study to determine whether a nurse-initiated telephone follow-up programme could increase  patients ' self-efficacy  in managing dyspnoea and decrease health care service use . BACKGROUND Chronic obstructive pulmonary disease is a worldwide health problem and has been labelled a burdensome disease . Because of the fear of activity-induced dyspnoea , patients with chronic obstructive pulmonary disease lack the confidence to perform daily activities . Studies of cardiac and diabetic patients have shown that telephone follow-up care is an effective approach to increasing self-efficacy . However , little such research has been done with patients with chronic obstructive pulmonary disease . METHODS This was a r and omized controlled study . A total of 60 participants ( 30 telephone follow-up , 30 control ) with chronic obstructive pulmonary disease were recruited from an acute care hospital in Hong Kong . The Chinese Self-Efficacy Scale was used to assess self-efficacy . Measures of health care use were numbers of visits to an accident and emergency department , hospitalizations , and unscheduled visits by physicians . FINDINGS The self-efficacy scores ( U = 272.5 , P = 0.009 ) of patients who were followed up by telephone improved significantly compared with those of patients in the control group . Multiple regression analyses showed that telephone follow-up ( Beta = 0.33 , CI : 0.19 - 0.48 , P = 0.001 ) , the pulmonary rehabilitation programme ( Beta = 0.44 , CI : 0.16 - 0.72 , P = 0.003 ) , smoking ( Beta = 0.34 , CI : 0.09 - 0.57 , P = 0.009 ) , and health care use ( Beta = -0.27 , CI : -0.47-(-0.07 ) , P = 0.008 ) were significant factors in predicting patient self-efficacy . CONCLUSIONS Nurse-initiated telephone follow-up care was effective in increasing self-efficacy in managing dyspnoea . The study needs to be replicated in other setting to strengthen its external validity Chronic obstructive pulmonary disease is associated with significant morbidity and mortality . Trials of maintenance chronic obstructive pulmonary disease treatments focus on improvement in lung function and reductions in exacerbations , while patients are much more concerned about symptoms and health status . Our aim was to investigate the effects of tiotropium + olo date rol on  patient-reported health outcomes , breathlessness and night-time rescue medication use in patients with chronic obstructive pulmonary disease , compared to placebo , tiotropium or olo date rol monotherapy . Two pairs of replicate , phase III studies of 12 ( OTEMTO 1 + 2 ) and 52 weeks ’ ( TONADO 1 + 2 ) duration were evaluated , in which patients received either tiotropium + olo date rol 2.5/5 or 5/5 μg , tiotropium 2.5 or 5 μg , olo date rol 5 μg or placebo , all delivered once daily via Respimat inhaler . Patient-reported outcomes included breathlessness assessed by transition dyspnoea index focal score , health status assessed by St George ’s Respiratory Question naire total score and night-time rescue medication use at 12 or 24 weeks . Outcomes from the pooled study data are reported . Overall , 1621 and 5162 patients were treated in the OTEMTO and TONADO trials , respectively . Significantly larger improvements in St George ’s Respiratory Question naire and transition dyspnoea index focal scores were observed and a greater proportion of patients were responders to therapy ( based on minimum clinical ly important differences in St George ’s Respiratory Question naire and transition dyspnoea index ) with tiotropium + olo date rol compared to either monotherapy or to placebo . Tiotropium + olo date rol 5/5 µg significantly reduced night-time rescue medication usage . Chronic obstructive pulmonary disease : Combined inhaler proves effective Results from four in-depth studies show that a combined inhaler is very effective for treatment of moderate to severe chronic lung disease . Alleviating the symptoms of chronic obstructive pulmonary disease ( COPD ) , particularly sleep disturbance , is crucial to enhancing patients ’ quality of life . Gary Ferguson at the Pulmonary Research Institute of Southeast Michigan , together with other scientists across the USA and Germany , analysed data from four large-scale studies to evaluate the efficacy of STIOLTO Respimat , a combination of two bronchodilators — tiotropium , and olo date rol , which tackle airway obstruction and breathlessness , improving long-term lung function . They found that the new drug combination triggered significant improvements in patients ’ quality of life and levels of breathlessness . Use of night-time rescue medication in patients on STIOLTO  Respimat was considerably reduced . A greater number of patients responded positively to the combined inhaler than to monotherapy AIM This study aims to explore the experience of cigarette smokers with Chronic obstructive pulmonary disease ( COPD ) who have received smoking cessation support and describe their personal decision-making processes regarding their smoking behaviour . BACKGROUND Previous studies have demonstrated poor smoking cessation rates in people with COPD , despite this being the primary intervention for disease management . There is limited research exploring the reasons why this population continues to smoke . DESIGN Retrospective qualitative interviews were conducted and analysed using Giorgi 's ( 1985 ) process of analysis . METHOD Following a r and omised controlled trial to evaluate national smoking cessation guidelines , semi-structured interviews were conducted with a purposive sample ( n = 6 ) of those patients who were unable to stop smoking . RESULTS Six themes that typified patients ' decision-making were identified during six interviews ; too late to stop now , finding motivation , guilt about continued smoking , bargaining/contemplation , need to stop and reduced quality of life . CONCLUSION The reasons why smokers with COPD continue to smoke despite poor health and following support are complex . Cigarettes are regarded as friends , despite the knowledge that they are contributing to severe disability and poor quality of life . Owing to their inability to stop smoking , many patients avoid healthcare opportunities , further contributing to their poor health . RELEVANCE TO CLINICAL PRACTICE Smoking cessation is associated with ambivalence in this population . Health professionals need to underst and the volatility of patients ' decision-making and tailor advice and support to achieve more realistic goals such as reduced consumption
Subgroup analysis showed that telemonitoring reduced exacerbation rates when the intervention continued for longer than six months or pulmonary function was monitored .
Conclusions Telemonitoring for chronic obstructive pulmonary disease was unlikely to result in statistically significant improvements in health outcomes .
However , our novel finding was that at least six months of intervention duration and monitoring of pulmonary function play roles in activating the effects of telemonitoring
Aims The purpose of this research was to investigate the effectiveness of telemonitoring for chronic obstructive pulmonary disease .