Technology-Enabled Self-Management of Chronic Obstructive Pulmonary Disease With or Without Asynchronous Remote Monitoring: Randomized Controlled Trial

Abstract

Background Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality and leads to frequent hospital admissions and emergency department (ED) visits. COPD exacerbations are an important patient outcome, and reducing their frequency would result in significant cost savings. Remote monitoring and self-monitoring could both help patients manage their symptoms and reduce the frequency of exacerbations, but they have different resource implications and have not been directly compared. Objective This study aims to compare the effectiveness of implementing a technology-enabled self-monitoring program versus a technology-enabled remote monitoring program in patients with COPD compared with a standard care group. Methods We conducted a 3-arm randomized controlled trial evaluating the effectiveness of a remote monitoring and a self-monitoring program relative to standard care. Patients with COPD were recruited from outpatient clinics and a pulmonary rehabilitation program. Patients in both interventions used a Bluetooth-enabled device kit to monitor oxygen saturation, blood pressure, temperature, weight, and symptoms, but only patients in the remote monitoring group were monitored by a respiratory therapist. All patients were assessed at baseline and at 3 and 6 months after program initiation. Outcomes included self-management skills, as measured by the Partners in Health (PIH) Scale; patient symptoms measured with the St George’s Respiratory Questionnaire (SGRQ); and the Bristol COPD Knowledge Questionnaire (BCKQ). Patients were also asked to self-report on health system use, and data on health use were collected from the hospital. Results A total of 122 patients participated in the study: 40 in the standard care, 41 in the self-monitoring, and 41 in the remote monitoring groups. Although all 3 groups improved in PIH scores, BCKQ scores, and SGRQ impact scores, there were no significant differences among any of the groups. No effects were observed on the SGRQ activity or symptom scores or on hospitalizations, ED visits, or clinic visits. Conclusions Despite regular use of the technology, patients with COPD assigned to remote monitoring or self-monitoring did not have any improvement in patient outcomes such as self-management skills, knowledge, or symptoms, or in health care use compared with each other or with a standard care group. This may be owing to low health care use at baseline, the lack of structured educational components in the intervention groups, and the lack of integration of the action plan with the technology. Trial Registration ClinicalTrials.gov NCT03741855; https://clinicaltrials.gov/ct2/show/ NCT03741855

Blended Self-Management Interventions to Reduce Disease Burden in Patients With Chronic Obstructive Pulmonary Disease and Asthma: Systematic Review and Meta-analysis

“…Of these studies, 11 were included in the meta-analysis [ 22 , 24 , 45 , 47 , 48 , 50 , 51 , 54 - 57 ]. The remaining 4 studies [ 46 , 49 , 52 , 53 ] were excluded because no available means and SDs were reported or obtained after contacting the authors. A total of 7 studies focused on patients with asthma [ 23 , 25 , 58 - 62 ].…”

“…A total of 15 COPD studies [ 22 , 24 , 45 - 57 ] were published between 2006 and 2020 and were conducted in China (n=5) [ 48 , 54 - 57 ], United States (n=2) [ 24 , 51 ], Denmark (n=2) [ 49 , 52 ], Canada (n=1) [ 53 ], England (n=1) [ 45 ], Spain (n=1) [ 22 ], Germany (n=1) [ 50 ], Australia (n=1) [ 46 ], and 1 in both Spain and Belgium [ 47 ]. The sample size ranged from 39 to 242 (with a total sample size of 1477).…”

“…Of the 15 COPD studies, 8 had UC as a CG [ 22 , 24 , 46 , 47 , 49 , 54 , 56 , 57 ], 5 had a visit as CG (meaning that the health care provider visited the patients’ home or patients visited the PC or SC) [ 45 , 48 , 51 , 52 , 54 ], and 2 studies had both UC and visits in the CG [ 50 , 53 ]. The settings were home and SC (n=9) [ 22 , 24 , 46 , 47 , 53 - 57 ], home care (n=2) [ 45 , 48 ], and home care and PC (n=4) [ 49 - 52 ]. The duration of the blended self-management interventions ranged from 4 to 48 weeks, with a mean of 22.13 weeks (SD 16.20).…”

Evaluating the Implementation of a Remote-Monitoring Program for Chronic Obstructive Pulmonary Disease: Qualitative Methods from a Service Design Perspective

“…This is a qualitative substudy of a randomized controlled trial [ 18 ]; both the randomized controlled trial and this qualitative study were conducted at a community-based hospital in a large city in Ontario, Canada, within a respiratory center that treats patients with COPD. The randomized controlled trial investigated the effectiveness of implementing a technology-enabled self-monitoring program or a technology enabled self- and remote-monitoring program in a COPD patient population compared to standard care.…”

Models of healthcare in respiratory diseases

“…The intervention included home spirometry, reporting of symptoms and side-effects, patient-reported outcomes, information, a medication coach, and online consultations [ 4 ]. In COPD, a three-arm randomised trial evaluating the effectiveness of a remote monitoring and a self-monitoring programme did not show any significant differences in self-management skills, knowledge, symptoms, or healthcare use compared with each other or with a standard care group [ 5 ].…”