Telehealth reduces hospital admission rates in patients with COPD
Blikk på forskning i Fysioterapeuten 11/2013.
Blikk på forskning utarbeides i samarbeid med Journal of Physiotherapy (Australia), som trykker forskningspresentasjonene under betegnelsen Critically appraised Papers, CAPs.
Summary of: Dinesen B, et al (2012) Using preventative home monitoring to reduce hospital admission rates and reduce costs: a case study of telehealth among chronic obstructive pulmonary disease patients. J Telemed Telecare 18: 22–225. [Prepared by Kylie Hill, CAP Editor.]
Question: Does telehealth reduce the hospital admission rate and cost for people with chronic obstructive pulmonary disease (COPD)?
Design: Randomised controlled trial with concealed allocation.
Setting: The participants’ homes in Aalborg, Denmark. Participants were linked with healthcare professionals at primary and secondary healthcare facilities using telehealth technology. Participants: Adults were included if they had severe or very severe COPD, lived in Aalborg, and were free from other diseases that limited function (eg, heart disease). Randomisation allocated 60 to the intervention group and 51 to the control group.
Interventions: Participants in the intervention group had a telehealth monitoring device installed in their home for four months and were taught how to monitor their symptoms, measure clinical data (eg, spirometry), use a step counter, and given instructions about home exercise. Health-care professionals accessed the data to monitor their disease and provide advice. Once a month, the telehealth team met via video to co-ordinate and discuss each participant’s rehabilitation program. Those in the control group were instructed regarding home exercises, but had no planned contact with healthcare professionals.
Outcome measures: Hospital admission rate and cost of hospitalisation over a 10-month period. Results: A total of 105 participants completed the study. Over the follow-up period, the admission rate per patient was lower in the intervention group compared with the control group (0.49 vs 1.17, p = 0.041). The cost of hospitalisations appeared to be lower in the intervention group.
Conclusion: Telehealth strategies that promote rehabilitation and early detection of an acute exacerbation reduced hospital admission rates in people with severe and very severe COPD.
There is considerable interest in the role of telehealth for people with COPD. A systematic review has shown that telemonitoring of physiology and symptoms reduces emergency department visits and hospitalisations (McLean et al 2011). However the use of telehealth strategies to deliver home-based exercise training is in its infancy, despite the central role of pulmonary rehabilitation in COPD care.
In the study by Dinesen and colleagues, participants who received telerehabilitation had a lower rate of hospital admission than those who received usual care. Participants had severe to very severe COPD, which reflects the group most commonly seen in pulmonary rehabilitation. However, telerehabilitation did not include supervised exercise training, and the number of contacts with clinicians during the intervention period was not reported. Participants also engaged in "preventive self-monitoring using a telehealth monitor". Therefore it is difficult to assess the effect the exercise program had on reducing hospitalisations, over and above the gains expected following self-management training on this outcome (Effing et al 2007).
This trial suggests that exercise participation can be encouraged using telemonitoring. However it remains uncertain whether telerehabilitation is as effective as best practice COPD care. Whilst it was stated that the usual care group in this study underwent the standard regimen for rehabilitation, this consisted of once-off instruction in home exercises, which does not meet the current definition of pulmonary rehabilitation (Nici et al 2006). This trial therefore does not allow us to compare the outcomes of telerehabilitation to those of standard, highly effective,pulmonary rehabilitation programs (Lacasse et al 2006). Until such comparisons are undertaken in robust trials, telerehabilitation remains a useful second-line treatment for those with COPD who, for reasons of geography or disability, cannot undertake supervised pulmonary rehabilitation programs.
Anne Holland, Department of Physiotherapy, Alfred Health, and Alfred Health Clinical School, La Trobe University, Australia.
Effing T et al (2007) Cochrane Database Syst Rev: CD002990.
Lacasse Y et al (2006) Cochrane Database Syst Rev: CD003793.
McLean S et al (2011) Cochrane Database Syst Rev: CD007718.
Nici L et al (2006) Am J Respir Crit Care Med 173: 1390–1413.