https://immattersacp.org/weekly/archives/2013/10/29/4.htm

Telemonitoring for COPD may not affect exacerbation readmissions, quality of life

Telemonitoring in chronic obstructive pulmonary disease (COPD) patients at high risk for exacerbations did not affect hospital readmissions or improve quality of life, according to a new study.


Telemonitoring in chronic obstructive pulmonary disease (COPD) patients at high risk for exacerbations did not affect hospital readmissions or improve quality of life, according to a new study.

Researchers in Scotland performed a researcher-blinded multicenter randomized, controlled trial to determine whether telemonitoring incorporated into existing clinical services was effective at improving COPD care. Patients who had been admitted to the hospital at least once for COPD in the year before randomization were assigned to receive telemonitoring or conventional self-monitoring. Those who had other significant lung disease, who could not provide informed consent or complete the study, or who had other social and clinical problems as identified by their general practitioner were excluded.

Patients in the telemonitoring group had telemonitoring equipment and a secure broadband link installed in their homes and received instruction on how to use them, as well as self-management education. They used a touch screen to transmit answers to a daily questionnaire about their symptoms and treatments and monitored their oxygen saturation; a symptom score was developed based on their data, with low scores being better and high scores being worse. The data were transmitted securely to the patients' clinical team for monitoring and review, and the team received alerts if data were not submitted or if patients scored a 4 or a 5. Each patient's monitoring clinician then decided on the next action to take, usually a telephone call to the patient to determine further management. Patients in the usual care group received the same clinical care as those in the intervention group, including self-management advice, since the researchers wanted to test only the effect of the telemonitoring technology.

The study's main outcome measure was time to hospital admission for COPD exacerbation 1 year after randomization, while secondary outcome measures included number and duration of hospital admissions and assessment by questionnaire of health-related quality of life, anxiety and/or depression, self-efficacy, knowledge and adherence to treatment. The study results were published online Oct. 17 by BMJ.

Study recruitment took place between May 21, 2009, and March 28, 2011. Two hundred fifty-six patients completed the study, 128 who were assigned to telemonitoring and 128 who were assigned to usual care. The mean age was 69.4 years, and 45% of the patients were men. Time to hospital admission did not differ between groups (adjusted hazard ratio, 0.98; 95% CI, 0.66 to 1.44), and the mean number of COPD admissions over 1 year was similar (1.2 admissions per person in the intervention group vs. 1.1 in the control group; P=0.59). The mean duration of COPD admissions over 1 year was also similar (9.5 days per person vs. 8.8 days, respectively; P=0.88). Health-related quality of life and other secondary outcome measures did not differ between groups.

The authors acknowledged that smaller clinically meaningful differences may not have been detected by their trial. In addition, they noted that most of the study patients did not live far from clinical care facilities and that telemonitoring may have a greater effect in more rural areas. However, they concluded that telemonitoring did not extend time to hospital admission and did not improve quality of life in patients with a history of hospitalization for COPD exacerbations. Positive effects in previous trials could have been related to enhanced clinical services in the intervention groups instead of to telemonitoring itself, they said.

“This trial suggests that the addition of telemonitoring to the management of high risk patients, over and above the backdrop of self management education and a good clinical service, is costly and ineffective,” an accompanying editorial said. The editorialists stressed that the most effective components of self-management in COPD still need to be identified. “Perhaps we should be putting more emphasis on a more ‘upstream’ approach for preventing exacerbations,” the editorialists wrote. “Exacerbations are usually caused by viruses, and interventions that incorporate simple public health approaches for infection control may be worth pursuing.”