Effectiveness of a Mobile Health and Self-Management App for High-Risk Patients With Chronic Obstructive Pulmonary Disease in Daily Clinical Practice: Mixed Methods Evaluation Study

Abstract

Background Mobile health and self-management interventions may positively affect behavioral change and reduce hospital admissions for patients with chronic obstructive pulmonary disease (COPD). However, not all patients qualify for these interventions, and systematic, comprehensive information on implementation- and compliance-related aspects of mobile self-management apps is lacking. Due to the tendency to target digital services to patients in stable phases of disease, it is especially relevant to focus on the use of these services in broad clinical practice for patients recently discharged from hospital. Objective This study aims to evaluate the effects of a mobile health and self-management app in clinical practice for recently discharged patients with COPD on use of the app, self-management, expectations, and experiences (technology acceptance); patients’ and nurses’ satisfaction; and hospital readmissions. Methods A prototype of the app was pilot tested with 6 patients with COPD. The COPD app consisted of an 8-week program including the Lung Attack Action Plan, education, medication overview, video consultation, and questionnaires (monitored by nurses). In the feasibility study, adult patients with physician-diagnosed COPD, access to a mobile device, and proficiency of the Dutch language were included from a large teaching hospital during hospital admission. Self-management (Partners in Health Scale), technology acceptance (Unified Theory Acceptance and Use of Technology model), and satisfaction were assessed using questionnaires at baseline, after 8 weeks, and 20 weeks. Use was assessed with log data, and readmission rates were extracted from the electronic medical record. Results A total of 39 patients were included; 76.4% (133/174) of patients had to be excluded from participation, and 48.9% of those patients (65/133) were excluded because of lack of digital skills, access to a mobile device, or access to the internet. The COPD app was opened most often in the first week (median 6.0; IQR 3.5-10.0), but its use decreased over time. The self-management element knowledge and coping increased significantly over time (P=.04). The COPD app was rated on a scale of 1-10, with an average score by patients of 7.7 (SD 1.7) and by nurses of 6.3 (SD 1.2). Preliminary evidence about the readmission rate showed that 13% (5/39) of patients were readmitted within 30 days; 31% (12/39) of patients were readmitted within 20 weeks, compared with 14.1% (48/340) and 21.8% (74/340) in a preresearch cohort, respectively. Conclusions The use of a mobile self-management app after hospital discharge seems to be feasible only for a small number of patients with COPD. Patients were satisfied with the service; however, use decreased over time, and only knowledge and coping changed significantly over time. Therefore, future research on digital self-management interventions in clinical practice should focus on including more difficult subgroups of target populations, a multidisciplinary approach, technology-related aspects (such as acceptability), and fine-tuning its adoption in clinical pathways. Trial Registration Clinicaltrials.gov NCT04540562; https://clinicaltrials.gov/ct2/show/NCT04540562.

Using Telemedicine to Provide Education for the Symptomatic Patient with Chronic Respiratory Disease

“…In adults, technology-enabled patient education showed an increased disease specific knowledge [12,21] and inhaler technique improved [13]. The perception of coping with the condition also increased [12]. Although not all studies found increases, reported no change in COPD knowledge [11].…”

“…A significant increase in measuring learning outcomes has occurred in the last decade with 6 of the 13 studies evaluating gain of skills, knowledge, and attitudes. In adults, technology-enabled patient education showed an increased disease specific knowledge [12,21] and inhaler technique improved [13]. The perception of coping with the condition also increased [12].…”

“…Specifically, participants in these studies were provided with a technology platform to access information and activities that develop new knowledge, skills, and attitudes for self-management of chronic respiratory disease (Table 1). The platforms have multiple forms, i.e., websites [5][6][7][8][9][10][11], apps [12][13][14], "serious games" [15], or virtual reality environments [16], incorporating activities for learning information and skills that can be applied to managing their condition.…”

“…For all studies that measured patient satisfaction, technology-enabled patient education was a positive experience by the majority of participants. The majority of participants would recommend the technology-enabled patient education to peers, finding the webbased and application-based education kept them motivated, was easy to use, and was relevant and perceived their knowledge and skills to have improved [5,6,9,12,[14][15][16]21,23]. Participants also found that the technology solution meant the information was always readily available and not able to be misplaced, and this was very helpful [6].…”

“…Programme content was well received for all approaches, with participants providing feedback that the symptom management, exercise/physical activity, inhaler, and healthy diet learning was most useful across studies [14]. Where technology was used to synchronously connect with healthcare professionals, most participants found this to save time and a welcomed approach [12]. Discussion forums with peers were met with varied enthusiasm, with some studies reporting patients contacted peers readily [7] and other authors stating 75% of participants were not interested [11].…”