Effectiveness of Telemonitoring in Patients with Chronic Obstructive Pulmonary Disease in Taiwan-A Randomized Controlled Trial Home telemonitoring and quality of life in stable, optimised chronic obstructive pulmonary disease Exploring telemonitoring and self-management by patients with chronic obstructive pulmonary disease: a qualitative study embedded in 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. Does Home Telemonitoring after Pulmonary Rehabilitation Reduce Healthcare Use in Optimized COPD?? A Pilot Randomized Trial Telemonitoring in Chronic Obstructive Pulmonary Disease (CHROMED). A Randomized Clinical Trial Telemonitoring for chronic obstructive pulmonary disease: a cost and cost-utility analysis of a randomised controlled trial A randomised clinical trial of the effectiveness of home-based health care with telemonitoring in patients with COPD Telemedicine Experience for Chronic Care in COPD Efficacy of multiparametric telemonitoring on respiratory outcomes in elderly people with COPD: a randomized controlled trial Effectiveness of telemonitoring integrated into existing clinical services on hospital admission for exacerbation of chronic obstructive pulmonary disease: researcher blind, multicentre, randomised controlled trial Home telemonitoring for patients with acute exacerbation of chronic obstructive pulmonary disease: a randomized controlled trial
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 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 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 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 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 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 ) 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 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 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 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 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 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
Patients were generally satisfied and found the systems useful to help them manage their disease and improve healthcare provision .
Nevertheless , they reported some difficulties in their use , which in some studies were related to lower compliance rates .
AIM This systematic review aim ed to provide a comprehensive description of the method ologies used in home telemonitoring interventions for Chronic Obstructive Pulmonary Disease ( COPD ) and to explore patients ' adherence and satisfaction with the use of telemonitoring systems .