Effectiveness of a novel, automated telephone intervention on time to hospitalisation in patients with COPD: A randomised controlled trial

Abstract

Introduction Owing to its capacity to perform remote assessments, telemedicine is rising as a new force in chronic obstructive pulmonary disease (COPD) management. We conducted an eight month randomised-controlled-trial to study the effect of an automated telemedicine intervention on patients’ time-to-hospitalisation. Methods A total of 168 patients with a diagnosis of COPD in the past 24 months were enrolled to receive the intervention at a primary care clinic. The treatment group received daily phone messages from an automated system asking them to report if they were breathing better than, worse than, or the same as the day prior. Patients reported their breathing status by responding to the text message or call. If a patient reported breathing worse, an alert was sent directly to that patient’s provider within the clinic. The control group received the same daily phone messages as the treatment group. However, no proactive breathing alerts were ever generated to the provider for these subjects. The primary outcome was the subjects’ time-to-first-COPD-related hospitalisation following the start of messages. Results The treatment group’s time-to-hospitalisation was significantly different than the control group’s with a hazard ratio of 2.36 (95% confidence interval 1.02–5.45, p = 0.0443). The number needed-to-treat ratio was 8.62. Subject engagement consistently ranged between 60% and 75%. The treatment group received both proactive monitoring and follow-up care from the providers. Discussion Active monitoring with provider feedback enables the detection of exacerbation events early enough for subjects to avoid admissions. The use of non-smartphone interventions reduces barriers to care presented by more complicated and expensive technologies. This intervention represents a simple, innovative, and inexpensive tool for improved COPD management.

Does remote patient monitoring reduce acute care use? A systematic review

“…Two reported an increase in hospital admissions in the RPM group; 41 42 Witt Udsen et al 42 had the largest sample size (n=578/647 intervention/ control) of the trials. Across the RCTs, COPD-related hospitalisations differed from a mean difference of 10 fewer admissions in the intervention group of Sink et al 43 over 8 months (absolute risk reduction=11.6%; RPM=6 hospitalisations vs non-monitored=16 hospitalisations) to a slight increase in admissions over a 6-month period (RPM admissions=0.63 vs 0.32 in non-monitored mean difference: 0.32, p value: 0.026). 41 All cohort studies (n=9) reported a reduction in at least one measure of acute hospital use.…”

The Role of Digital Tools in the Timely Diagnosis and Prevention of Acute Exacerbations of COPD: A Comprehensive Review of the Literature

“…In an RCT with a different design, Sink et al [ 25 ] recruited 168 COPD patients with mild to very severe airflow obstruction. Patients allocated to the treatment group received a daily message regarding their breathing status.…”

“…The time to hospitalization was significantly different between the two groups, favoring the TM group (hazard ratio 2.36, 95% CI: 1.02–5.45; p = 0.043), while the same applied for the number of hospital admissions. The positive results were associated with the early intervention and proper consultation by the health staff, leading to the prompt detection and treatment of AECOPDs and finally to the reduction in hospital admissions [ 25 ].…”

Effectiveness of remote home monitoring for patients with Chronic Obstructive Pulmonary Disease (COPD): systematic review

“…Seventeen [ 19 – 35 ] of the 19 studies [ 19 – 38 ] compared remote home monitoring (RHM) to ‘no remote home monitoring’ (no RHM), and two [ 36 , 37 ] compared RHM with provider’s feedback to RHM without feedback. The 19 studies were conducted between 2006 and 2018 and had sample sizes ranging from 34 to 1,238 patients (details of participants' characteristics included in the studies are presented in online supplementary Table S3 ).…”

“…Ten studies [ 19 – 22 , 25 , 26 , 30 , 32 , 34 , 35 ] recruited patients from multiple centres, and one [ 21 ] spanned five European countries (Spain, the United Kingdom, Slovenia, Estonia and Sweden). The remaining eighteen studies were conducted in Australia (2) [ 24 , 27 ], Canada (1) [ 30 ], Denmark (1) [ 32 ], Germany (2) [ 28 , 37 ], Hong Kong (1) [ 31 ], Italy (1) [ 25 ], Netherlands (3) [ 20 , 22 , 23 ], South Korea (1) [ 19 ], Spain (2) [ 26 , 29 ], the United Kingdom (1) [ 33 ], and the United States (3) [ 34 – 36 ] (Table 2 ).…”