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

Ringbæk T, Green A, Laursen LC, Frausing E, Brøndum E, Ulrik CS - Int J Chron Obstruct Pulmon Dis (2015)

Bottom Line: Both groups received standard care.No difference in drop-out rate and mortality was found between the groups.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).

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary Medicine, Hvidovre Hospital, Hvidovre, Denmark ; Institute of Clinical Medicine, University of Copenhagen, Herlev, Denmark.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus

Flowchart of patients with COPD identified as eligible for inclusion into the study investigating the effect of add-on tele health care, including video consultations, to standard care on hospital admissions for COPD.
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f1-copd-10-1801: Flowchart of patients with COPD identified as eligible for inclusion into the study investigating the effect of add-on tele health care, including video consultations, to standard care on hospital admissions for COPD.

Mentions: Four patients (three in the TM group) withdrew their consent within the first 2 weeks of the study period. Seventeen patients died during the study period, and another 12 patients dropped out for various reasons (Figure 1). No significant differences in drop-out rates (P=0.79) or mortality were found between the groups (P=0.87).


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

Ringbæk T, Green A, Laursen LC, Frausing E, Brøndum E, Ulrik CS - Int J Chron Obstruct Pulmon Dis (2015)

Flowchart of patients with COPD identified as eligible for inclusion into the study investigating the effect of add-on tele health care, including video consultations, to standard care on hospital admissions for COPD.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4562759&req=5

f1-copd-10-1801: Flowchart of patients with COPD identified as eligible for inclusion into the study investigating the effect of add-on tele health care, including video consultations, to standard care on hospital admissions for COPD.
Mentions: Four patients (three in the TM group) withdrew their consent within the first 2 weeks of the study period. Seventeen patients died during the study period, and another 12 patients dropped out for various reasons (Figure 1). No significant differences in drop-out rates (P=0.79) or mortality were found between the groups (P=0.87).

Bottom Line: Both groups received standard care.No difference in drop-out rate and mortality was found between the groups.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).

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary Medicine, Hvidovre Hospital, Hvidovre, Denmark ; Institute of Clinical Medicine, University of Copenhagen, Herlev, Denmark.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus