Tele-assistance in chronic respiratory failure patients: a randomised clinical trial

Abstract

Chronic respiratory patients requiring oxygen or home mechanical ventilation experience frequent exacerbations and hospitalisations with related costs. Strict monitoring and care have been recommended. The aim of the present study was to primarily evaluate reduction in hospitalisations and, secondly, exacerbations, general practitioner (GP) calls and related costeffectiveness of tele-assistance (TA) for these patients.A total of 240 patients (101 with chronic obstructive pulmonary disease (COPD)) were randomised to two groups: an intervention group entered a 1-yr TA programme while controls received traditional care.No anthropometric and clinical differences were found between groups both in baseline and in mortality (18% for TA, 23% for controls). Compared with controls, the TA group experienced significantly fewer hospitalisations (-36%), urgent GP calls (-65%) and acute exacerbations (-71%). Only COPD patients, as a separate group, had fewer hospitalisations, emergency room admissions, urgent GP calls or exacerbations. Each patient referred to staff a mean¡SD 36¡25 times. After deduction of TA costs, the average overall cost for each patient was 33% less than that for usual care.In chronic respiratory failure patients on oxygen or home mechanical ventilation, a nursecentred tele-assistance prevents hospitalisations while it is cost-effective. The chronic obstructive pulmonary disease group seems to have a greater advantage from tele-assistance.

The Empirical Foundations of Telemedicine Interventions for Chronic Disease Management

“…In chronological order, these were the Veterans Affairs CCHT program for Veterans with chronic conditions by Darkins et al 48 (published in 2008), the TelAssistance program for COPD by Vitacca et al 120 (published in 2009), and the Georgia/Mayo Clinic hub-and-spoke networks serving ischemic stroke patients by Switzer et al 102 (published in 2013).…”

“…'' 120,121 The first was an RCT of 240 patients allocated to either an intervention or a control group and observed over a 1-year period, 120 and the second was an observational study of 396 patients over a 5-year period. 121 In the first study, in total, 866 patients were discharged from the respiratory unit, but only 240 met the selection criteria for the clinical trial.…”

Accuracy of Estimates of Step Frequency From a Wearable Gait Monitor

“…Tri-axial accelerometers fixed on the human body allow quantitative analysis of gait patterns and offer the advantage that they are not limited to a laboratory setting 3 . Accelerometry-based assessment has become more and more accessible, with examples of new applications being: real-time gait parameter recognition 4 , continuous activity monitoring 5 and telerehabilitation 6 .…”

Tele-monitoring of ventilator-dependent patients: a European Respiratory Society Statement

“…Table 3 shows the few studies reporting the cost-effectiveness of remote monitoring in VDIs. For example, the study by VITACCA et al [23] concluded that tele-monitoring was cost-effective in case of severe and frail patients when LTOT and/or either NIV ventilator or invasive mechanical ventilation are needed, considering activation and healthcare service provision costs. Constant costs were mainly based on the number of calls, and savings in healthcare services costs were mainly due to the prevented hospitalisations.…”