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Liu P, Li G, Jiang S, Liu Y, Leng M, Zhao J, Wang S, Meng X, Shang B, Chen L, Huang SH. The effect of smart homes on older adults with chronic conditions: A systematic review and meta-analysis. Geriatr Nurs 2019; 40:522-530. [PMID: 31029481 DOI: 10.1016/j.gerinurse.2019.03.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 03/26/2019] [Accepted: 03/29/2019] [Indexed: 11/19/2022]
Abstract
As populations continue to age, the prevalence of multiple chronic conditions in older adults grows. The purpose of this study was to evaluate the effect of smart homes on older patients with chronic conditions. A review and meta-analysis were conducted after searching both English and Chinese databases. Fifteen RCTs were included in the review, with six studies qualifying for the meta-analysis. The meta-analysis revealed no significant effects on measures of hospital admissions (RR =0.90, 95% CI (0.57, 6.34), P = 0.65) or emergency department admissions (RR =0.99, 95% CI (0.34, 2.91), P = 0.98). Likewise, no effects were observed for tele-monitoring on days spent in the hospital (MD =-0.90, 95% CI (-3.34, 1.55), P = 0.47) or quality of life. However, almost all participants were satisfied with the smart homes. The effect of tele-exercise on cognitive functioning was unclear. However, the smart homes did have an effect on physical functioning and depression in older adults with chronic conditions. Future studies should focus on the economic effectiveness, security, accessibility and practicality of smart homes on older adults with chronic conditions.
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Affiliation(s)
- Peng Liu
- School of Mechanical and Aerospace Engineering, Jilin University, China.
| | - Guichen Li
- School of Nursing, Jilin University, China.
| | - Shengqian Jiang
- School of Mechanical Science and Engineering, Jilin University, China
| | - Yufei Liu
- School of Nursing, Jilin University, China
| | | | | | - Shuo Wang
- School of Nursing, Jilin University, China
| | | | | | - Li Chen
- School of Nursing, Jilin University, China.
| | - Samuel H Huang
- School of Dynamic Systems, University of Cincinnati, USA.
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Jones A, Bronskill SE, Agarwal G, Seow H, Feeny D, Costa AP. The primary care and other health system use of home care patients: a retrospective cohort analysis. CMAJ Open 2019; 7:E360-E370. [PMID: 31123086 PMCID: PMC6533106 DOI: 10.9778/cmajo.20190038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Robust and integrated primary care and home care are core components of effective chronic disease management in the community. We described the primary care and other health system use by a cohort of home care patients. METHODS We conducted a population-based retrospective cohort study of patients who received publicly funded home care in Ontario, Canada, from October 2014 to September 2016. Primary outcomes were primary care physician visits including coordination with home care, home visits and visits after hours or on weekends or holidays within 6 months of a home care assessment. Secondary outcomes included specialist physician visits, emergency department use, home care visits and placement in a long-term care home. Multivariable models examined associations between patient characteristics and subsequent primary care use. RESULTS There were 226 054 home care patients in our cohort, with a median age of 81 years. Following assessment, home care patients visited primary care physicians at a rate of 0.78 visits per month. Physician-based home care coordination codes were billed for 3.9% of patients. Primary care home visits were received by 13.1% of patients, and 15.1% of patients used primary care after hours or on weekends or holidays. INTERPRETATION Patients receiving publicly funded home care frequently visited a primary care physician. Physician billings for coordination between primary care and home care were infrequent but were more common in interprofessional primary care practices. Physician home visits were more likely to be received by the oldest and most functionally impaired patients, suggesting that home visits are responsive to the needs of home care patients.
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Affiliation(s)
- Aaron Jones
- Department of Health Research Methods, Evidence, and Impact (Jones, Agarwal, Seow, Costa), McMaster University, Hamilton, Ont.; ICES (Bronskill), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Bronskill), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Departments of Family Medicine (Agarwal), Oncology (Seow), Economics (Feeny) and Medicine (Costa), McMaster University, Hamilton, Ont.
| | - Susan E Bronskill
- Department of Health Research Methods, Evidence, and Impact (Jones, Agarwal, Seow, Costa), McMaster University, Hamilton, Ont.; ICES (Bronskill), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Bronskill), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Departments of Family Medicine (Agarwal), Oncology (Seow), Economics (Feeny) and Medicine (Costa), McMaster University, Hamilton, Ont
| | - Gina Agarwal
- Department of Health Research Methods, Evidence, and Impact (Jones, Agarwal, Seow, Costa), McMaster University, Hamilton, Ont.; ICES (Bronskill), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Bronskill), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Departments of Family Medicine (Agarwal), Oncology (Seow), Economics (Feeny) and Medicine (Costa), McMaster University, Hamilton, Ont
| | - Hsien Seow
- Department of Health Research Methods, Evidence, and Impact (Jones, Agarwal, Seow, Costa), McMaster University, Hamilton, Ont.; ICES (Bronskill), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Bronskill), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Departments of Family Medicine (Agarwal), Oncology (Seow), Economics (Feeny) and Medicine (Costa), McMaster University, Hamilton, Ont
| | - David Feeny
- Department of Health Research Methods, Evidence, and Impact (Jones, Agarwal, Seow, Costa), McMaster University, Hamilton, Ont.; ICES (Bronskill), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Bronskill), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Departments of Family Medicine (Agarwal), Oncology (Seow), Economics (Feeny) and Medicine (Costa), McMaster University, Hamilton, Ont
| | - Andrew P Costa
- Department of Health Research Methods, Evidence, and Impact (Jones, Agarwal, Seow, Costa), McMaster University, Hamilton, Ont.; ICES (Bronskill), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Bronskill), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Departments of Family Medicine (Agarwal), Oncology (Seow), Economics (Feeny) and Medicine (Costa), McMaster University, Hamilton, Ont
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53
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Dandachi D, Lee C, Morgan RO, Tavakoli-Tabasi S, Giordano TP, Rodriguez-Barradas MC. Integration of telehealth services in the healthcare system: with emphasis on the experience of patients living with HIV. J Investig Med 2019; 67:815-820. [PMID: 30826803 DOI: 10.1136/jim-2018-000872] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2019] [Indexed: 01/18/2023]
Abstract
The US Health Resources and Services Administration defines telehealth as the use of electronic information and telecommunications technologies to support long-distance clinical healthcare, patient and professional health-related education, public health and health administration. Many studies have supported the use of telehealth to increase convenience to patients, improve patient satisfaction, diminish healthcare disparities, and reduce cost that will ultimately lead to improvement in clinical outcomes and quality of care. However, guaranteeing confidentiality, educating patients and providers, and obtaining insurance reimbursement are some of the challenges that face the implementation of telehealth program. The use of telehealth has been investigated in acute infections, such as endocarditis and chronic infections as in hepatitis C, and HIV. The purpose of this review is to focus on the use of telehealth services for people living with HIV (PLWH). For PLWH, telehealth could be particularly useful by connecting specialty providers to an underserved population and addressing many of the factors identified as barriers to HIV care. To date, the literature supports the use of telehealth for the management of chronic diseases including HIV. Most of the studies showed a high acceptability and positive experience with telehealth services among PLWH. However, fewer studies have evaluated telemedicine for chronic direct care of PLWH. Well-designed studies are needed to show that the implementation of telehealth could improve the HIV care continuum. In addition, future research should focus on identifying the group of patients that could benefit the most from such intervention.
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Affiliation(s)
- Dima Dandachi
- Internal Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA.,Internal Medicine, Section of Infectious Diseases, University of Missouri Health Care, Columbia, Missouri, USA.,University of Texas School of Public Health, Houston, Texas, USA
| | - Celine Lee
- University of Texas School of Public Health, Houston, Texas, USA
| | - Robert O Morgan
- University of Texas School of Public Health, Houston, Texas, USA
| | | | - Thomas P Giordano
- Internal Medicine, Section of Infectious Diseases, University of Missouri Health Care, Columbia, Missouri, USA
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Sul AR, Lyu DH, Park DA. Effectiveness of telemonitoring versus usual care for chronic obstructive pulmonary disease: A systematic review and meta-analysis. J Telemed Telecare 2018; 26:189-199. [PMID: 30541375 DOI: 10.1177/1357633x18811757] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
AIMS The purpose of this research was to investigate the effectiveness of telemonitoring for chronic obstructive pulmonary disease. METHODS We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and CINAHL up to September 2018. We selected randomised controlled trials comparing telemonitoring and control groups for chronic obstructive pulmonary disease management. Two reviewers independently examined articles based on eligibility, extracted data and evaluated the risk of bias. The Cochrane tool was applied for assessing the risk of bias. The 95% confidence interval was calculated. RESULTS A total of 28 randomised controlled trials were included. Meta-analysis revealed that there were no variables showing a statistically significant difference between telemonitoring and control groups. Chronic obstructive pulmonary disease exacerbation rate (six studies) was not different between two groups (risk ratio 0.67, 95% confidence interval 0.31-1.42). Subgroup analysis showed that telemonitoring reduced exacerbation rates when the intervention continued for longer than six months or pulmonary function was monitored. No differences between groups were noticed for mortality (seven studies, risk ratio 0.89, 95% confidence interval 0.60-1.34). Similarly, no differences between groups were observed in the patient-reported outcomes (St George's Respiratory Questionnaire, Chronic Respiratory Disease Questionnaire-Dyspnea score) and for health service utilization (length of hospital stay, number of hospital admissions, number of emergency room visits). CONCLUSIONS Telemonitoring for chronic obstructive pulmonary disease was unlikely to result in statistically significant improvements in health outcomes. However, our novel finding was that at least six months of intervention duration and monitoring of pulmonary function play roles in activating the effects of telemonitoring.
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Affiliation(s)
- Ah-Ram Sul
- Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Republic of Korea
| | - Da-Hyun Lyu
- Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Republic of Korea
| | - Dong-Ah Park
- Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Republic of Korea
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Adamse C, Dekker-Van Weering MG, van Etten-Jamaludin FS, Stuiver MM. The effectiveness of exercise-based telemedicine on pain, physical activity and quality of life in the treatment of chronic pain: A systematic review. J Telemed Telecare 2018; 24:511-526. [PMID: 28696152 DOI: 10.1177/1357633x17716576] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Introduction The aim of this study was to systematically review the evidence on the effectiveness of exercise-based telemedicine in chronic pain. Methods We searched the Cochrane, PubMed, MEDLINE, EMBASE, CINAHL and PEDRO databases from 2000 to 2015 for randomised controlled trials, comparing exercise-based telemedicine intervention to no intervention or usual care in adults with chronic pain. Primary outcome data were pooled using random effect meta-analysis. Primary outcomes were pain, physical activity (PA), limitations in activities of daily living (ADL) and quality of life (QoL). Secondary outcomes were barriers, facilitators and usability of telemedicine. Results Sixteen studies were included. Meta-analyses were performed in three subgroups of studies with comparable control conditions. Telemedicine versus no intervention showed significantly lower pain scores (MD -0.57, 95% CI -0.81; -0.34), but not for telemedicine versus usual care (MD -0.08, 95% CI -0.41; 0.26) or in addition to usual care (MD -0.25, 95% CI -1.50; 1.00). Telemedicine compared to no intervention showed non-significant effects for PA (MD 19.93 min/week, 95% CI -5.20; 45.06) and significantly diminished ADL limitations (SMD -0.20, 95% CI -0.29; -0.12). No differences were found for telemedicine in addition to usual care for PA or for ADL (SMD 0.16, 95% CI -0.66; 0.34). Telemedicine versus usual care showed no differences for ADL (SMD 0.08, 95% CI -0.37; 0.53). No differences were found for telemedicine compared to the three control groups for QoL. Limited information was found on the secondary outcomes. Conclusions Exercise-based telemedicine interventions do not seem to have added value to usual care. As substitution of usual care, telemedicine might be applicable but due to limited quality of the evidence, further exploration is needed for the rapidly developing field of telemedicine.
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Affiliation(s)
- Corine Adamse
- 1 Physiotherapy Department, Antonius Hospital, Sneek, The Netherlands
| | | | | | - Martijn M Stuiver
- 4 Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, The Netherlands
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Bohingamu Mudiyanselage S, Stevens J, Watts JJ, Toscano J, Kotowicz MA, Steinfort CL, Bell J, Byrnes J, Bruce S, Carter S, Hunter C, Barrand C, Hayles R. Personalised telehealth intervention for chronic disease management: A pilot randomised controlled trial. J Telemed Telecare 2018; 25:343-352. [PMID: 29793387 DOI: 10.1177/1357633x18775850] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The aim of this study was to assess the impact of home-based telehealth monitoring on health outcomes, quality of life and costs over 12 months for patients with diabetes and/or chronic obstructive pulmonary disease (COPD) who were identified as being at high risk of readmission to hospital. METHODS This pilot study was a randomised controlled trial combined with an economic analysis to examine the outcomes of standard care versus home-based telehealth for people with diabetes and/or COPD who were at risk of hospital readmission within one year. The primary outcomes were (i) hospital admission and length of stay (LOS); and (ii) health-related quality of life (HRQOL); and the secondary outcomes were (i) health-related clinical outcomes; (ii) anxiety and depression scores; and (iii) health literacy. The costs of the intervention and hospitalisations were included. RESULTS A total of 86 and 85 participants were randomised to the intervention and control groups respectively. The difference between groups in hospital LOS was -3.89 (95% confidence interval (CI): -9.40, 1.62) days, and for HRQOL, 0.09 (95% CI: 0.05, 0.14) in favour of the telehealth monitoring group. There was a saving of AUD$6553 (95% CI: -12145, -961) in the cost of hospitalisation over 12 months, which offset the increased cost of tele-monitoring. The intervention group showed an improvement in anxiety, depression and health literacy at 12 months, and in the diabetes group, a reduction in microalbuminuria. DISCUSSION The telehealth monitoring intervention improved patient's health outcomes and quality of life at no additional cost.
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Affiliation(s)
| | - Jo Stevens
- 2 Barwon Health, University Hospital Geelong, Geelong, Australia
| | - Jennifer J Watts
- 1 Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Australia
| | - Julian Toscano
- 2 Barwon Health, University Hospital Geelong, Geelong, Australia
| | - Mark A Kotowicz
- 2 Barwon Health, University Hospital Geelong, Geelong, Australia.,3 Deakin University School of Medicine, Geelong, Australia.,4 Melbourne Medical School - Western Campus, Department of Medicine, The University of Melbourne, St Albans, Australia
| | - Christopher L Steinfort
- 2 Barwon Health, University Hospital Geelong, Geelong, Australia.,3 Deakin University School of Medicine, Geelong, Australia
| | - Jennifer Bell
- 2 Barwon Health, University Hospital Geelong, Geelong, Australia
| | - Janette Byrnes
- 2 Barwon Health, University Hospital Geelong, Geelong, Australia
| | - Stephanie Bruce
- 2 Barwon Health, University Hospital Geelong, Geelong, Australia
| | - Sarah Carter
- 2 Barwon Health, University Hospital Geelong, Geelong, Australia
| | - Claire Hunter
- 2 Barwon Health, University Hospital Geelong, Geelong, Australia
| | - Chris Barrand
- 2 Barwon Health, University Hospital Geelong, Geelong, Australia
| | - Robyn Hayles
- 2 Barwon Health, University Hospital Geelong, Geelong, Australia
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Martín-Lesende I, Orruño E, Mateos M, Recalde E, Asua J, Reviriego E, Bayón JC. Telemonitoring in-home complex chronic patients from primary care in routine clinical practice: Impact on healthcare resources use. Eur J Gen Pract 2018; 23:135-142. [PMID: 28446045 PMCID: PMC5965896 DOI: 10.1080/13814788.2017.1306516] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Recent evidence indicates that home telemonitoring of chronic patients reduces the use of healthcare resources. However, further studies exploring this issue are needed in primary care. Objectives: To assess the impact of a primary care-based home telemonitoring intervention for highly unstable chronic patients on the use of healthcare resources. Methods: A one-year follow-up before and after exploratory study, without control group, was conducted. Housebound patients with heart failure or chronic lung disease, with recurrent hospital admissions, were included. The intervention consisted of patient’s self-measurements and responses to a health status questionnaire, sent daily from smartphones to a web-platform (aided by an alert system) reviewed by healthcare professionals. The primary outcome measure was the number of hospital admissions occurring 12 months before and after the intervention. Secondary outcomes were length of hospital stay and number of emergency department attendances. Primary care nurses were mainly in charge of the telemonitoring process and were assisted by the general practitioners when required. Results: For the 28 patients who completed the follow-up (out of 42 included, 13 patients died and 1 discontinued the intervention), a significant reduction in hospitalizations, from 2.6 admissions/patient in the previous year (standard deviation, SD: 1.6) to 1.1 (SD: 1.5) during the one-year telemonitoring follow-up (P <0.001), and emergency department attendances, from 4.2 (SD: 2.6) to 2.1 (SD: 2.6) (P <0.001) was observed. The length of hospital stay was reduced non-significantly from 11.4 to 7.9 days. Conclusion: In this small exploratory study, the primary care-based telemonitoring intervention seemed to have a positive impact decreasing the number of hospital admissions and emergency department attendances.
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Affiliation(s)
- Iñaki Martín-Lesende
- a San Ignacio General Practice, Basque Health Service-Osakidetza , Bilbao-Basurto Integrated Healthcare Organization (IHO) , Bizkaia , Spain
| | - Estibalitz Orruño
- b Basque Office for Health Technology Assessment (OSTEBA) , Ministry for Health, Basque Government , Vitoria-Gasteiz , Araba , Spain
| | - Maider Mateos
- b Basque Office for Health Technology Assessment (OSTEBA) , Ministry for Health, Basque Government , Vitoria-Gasteiz , Araba , Spain
| | - Elizabete Recalde
- c Santutxu-Solokoetxe General Practice, Basque Health Service-Osakidetza , Bilbao Basurto IHO , Bizkaia , Spain
| | - José Asua
- b Basque Office for Health Technology Assessment (OSTEBA) , Ministry for Health, Basque Government , Vitoria-Gasteiz , Araba , Spain
| | - Eva Reviriego
- b Basque Office for Health Technology Assessment (OSTEBA) , Ministry for Health, Basque Government , Vitoria-Gasteiz , Araba , Spain
| | - Juan Carlos Bayón
- b Basque Office for Health Technology Assessment (OSTEBA) , Ministry for Health, Basque Government , Vitoria-Gasteiz , Araba , Spain
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Ketchell RI. Telemedicine is the way forward for the management of cystic fibrosis - the case in favour. Paediatr Respir Rev 2018; 26:19-21. [PMID: 28416301 DOI: 10.1016/j.prrv.2017.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 03/07/2017] [Indexed: 10/20/2022]
Abstract
Despite rapid changes in Information and Communication Technology, outpatient chronic disease management has changed very little in decades. However, the introduction of Telemedicine defined here as the use of remote patient-centred clinical services including the use of video and audio connections, telemonitoring and mobile applications provides us with an ideal opportunity to revolutionise care. Its appeal in cystic fibrosis (CF) care is clear offering better access to services, the opportunity of earlier intervention and improved monitoring and self management through virtual clinics and the use of real-time applications for adherence monitoring. It has the potential to reduce costs and has been shown to be effective in other chronic disease conditions. There is a lack of good quality data in CF and studies are needed to provide supportive evidence. Nonetheless, it would seem that telemedicine is the future of CF care.
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Mirón Rubio M, Ceballos Fernández R, Parras Pastor I, Palomo Iloro A, Fernández Félix BM, Medina Miralles J, Zamudio López E, González Pastor J, Amador Lorente C, Mena Hortelano N, Domínguez Sánchez A, Alonso-Viteri S. Telemonitoring and home hospitalization in patients with chronic obstructive pulmonary disease: study TELEPOC. Expert Rev Respir Med 2018; 12:335-343. [PMID: 29460648 DOI: 10.1080/17476348.2018.1442214] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a major consumer of healthcare resources, with most costs related to disease exacerbations. Telemonitoring of patients with COPD may help to reduce the number of exacerbations and/or the related costs. On the other hand, home hospitalization is a cost-saving alternative to inpatient hospitalization associated with increased comfort for patients. The results are reported regarding using telemonitoring and home hospitalization for the management of patients with COPD. METHODS Twenty-eight patients monitored their health parameters at home for six months. A nurse remotely revised the collected parameters and followed the patients as programmed. A home care unit was dispatched to the patients' home if an alarm signal was detected. The outcomes were compared to historical data from the same patients. RESULTS The number of COPD exacerbations during the study period did not reduce but the number of hospital admissions decreased by 60% and the number of emergency room visits by 38%. On average, costs related to utilization of healthcare resources were reduced by €1,860.80 per patient per year. CONCLUSIONS Telemonitoring of patients with COPD combined with home hospitalization may allow for a reduction in healthcare costs, although its usefulness in preventing exacerbations is still unclear.
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Affiliation(s)
- Manuel Mirón Rubio
- a Home Hospitalization Unit , Torrejón University Hospital, Universidad Francisco de Vitoria , Madrid , Spain
| | | | | | - Amaya Palomo Iloro
- a Home Hospitalization Unit , Torrejón University Hospital, Universidad Francisco de Vitoria , Madrid , Spain
| | - Borja Manuel Fernández Félix
- d Biostatistic Unit , University Ramón y Cajal Hospital (IRYCIS), CIBER epidemiología y salud pública (CIBERESP) , Madrid , Spain
| | - Jenifer Medina Miralles
- a Home Hospitalization Unit , Torrejón University Hospital, Universidad Francisco de Vitoria , Madrid , Spain
| | - Esther Zamudio López
- a Home Hospitalization Unit , Torrejón University Hospital, Universidad Francisco de Vitoria , Madrid , Spain
| | - Javier González Pastor
- a Home Hospitalization Unit , Torrejón University Hospital, Universidad Francisco de Vitoria , Madrid , Spain
| | - Caridad Amador Lorente
- a Home Hospitalization Unit , Torrejón University Hospital, Universidad Francisco de Vitoria , Madrid , Spain
| | - Nazaret Mena Hortelano
- a Home Hospitalization Unit , Torrejón University Hospital, Universidad Francisco de Vitoria , Madrid , Spain
| | - Alejandro Domínguez Sánchez
- a Home Hospitalization Unit , Torrejón University Hospital, Universidad Francisco de Vitoria , Madrid , Spain
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Gandrud L, Altan A, Buzinec P, Hemphill J, Chatterton J, Kelley T, Vojta D. Intensive remote monitoring versus conventional care in type 1 diabetes: A randomized controlled trial. Pediatr Diabetes 2018; 19:1086-1093. [PMID: 29464831 DOI: 10.1111/pedi.12654] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 12/22/2017] [Accepted: 01/24/2018] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE While frequent contact with diabetes care providers may improve glycemic control among patients with type 1 diabetes (T1D), in-person visits are labor-intensive and costly. This study was conducted to assess the impact of an intensive remote therapy (IRT) intervention for pediatric patients with T1D. METHODS Pediatric patients with T1D were randomized to IRT or conventional care (CC) for 6 months. Both cohorts continued routine quarterly clinic visits and uploaded device data; for the IRT cohort, data were reviewed and patients were contacted if regimen adjustments were indicated. Glycated hemoglobin (HbA1c) change from baseline was assessed at 6 and 9 months. Diabetes-related quality of life (QoL), healthcare services utilization, and hypoglycemic events were also tracked. RESULTS Among 117 enrollees (60 IRT, 57 CC), mean (SD) 6-month %HbA1c change for IRT vs CC was -0.34 (0.85) (-3.7 mmol/mol) vs -0.05 (0.74) (-0.5 mmol/mol) overall (P = .071); -0.15 (0.67) (1.6 mmol/mol) vs -0.02 (0.66) (0.2 mmol/mol) for ages 8 to 12 (P = .541); and -0.50 (0.95) (-5.5 mmol/mol) vs -0.06 (0.80) (-0.7 mmol/mol) for ages 13 to 17 (P = .056). Diabetes-related QoL increased by 6.5 and 1.3 points for IRT and CC, respectively (P = .062). Three months after intervention cessation, %HbA1c changed minimally among treated children aged 8 to 12 but increased by 0.22 (0.89) (2.4 mmol/mol) among those aged 13 to 17. CONCLUSIONS IRT substantially affected diabetes metrics and improved QoL among pediatric patients with T1D. Adolescents experienced a stronger treatment effect, but had difficulty in sustaining improved control after intervention cessation.
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Affiliation(s)
| | | | | | | | | | - Tina Kelley
- UnitedHealth Group Research & Development, Minnetonka, Minnesota
| | - Deneen Vojta
- UnitedHealth Group Research & Development, Minnetonka, Minnesota
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Deng N, Gu T, Zhao Q, Zhang X, Zhao F, He H. Effects of telephone support on exercise capacity and quality of life in patients with chronic obstructive pulmonary disease: a meta-analysis. PSYCHOL HEALTH MED 2018; 23:917-933. [PMID: 29320895 DOI: 10.1080/13548506.2018.1425462] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The aim of this meta-analysis was to evaluate the effects of disease education or pulmonary rehabilitation programs assisted with telephone support on physical capacity and quality of life (QOL) in chronic obstructive pulmonary disease (COPD) patients. A systematic search of PubMed, Embase, Web of Science and The Cochrane Library was conducted until May 2017. Randomized controlled trials (RCTs) examining the effects of telephone-assisted intervention versus a control group on exercise tolerance and QOL in patients with COPD were included. Two independent authors assessed the methodological quality of the trials using the Cochrane risk of bias tool. A meta-analysis was conducted with the Revman5.3 to quantify the effects of telephone-assisted interventions on walking capacity and QOL. In total, 10 studies involving 1037 participants were included. Due to the effect of telephone-assisted interventions, statistically significant results were found on Saint-George's Respiratory Questionnaire (SGRQ) symptom scores [standard mean difference (SMD) -.18, 95% confidence interval (CI) -.33, -.03, p-value .02)], SGRQ impact scores [SMD -.35, 95% CI -.60, -.10, p-value .006)], SGRQ activity scores [SMD -.30, 95% CI -.45, -.15, p-value < .0001)], SGRQ total score [SMD -.36, 95% CI -.51, -.21, p-value < .00001)]. The effects on 6-min walk test (6MWT) and all Chronic Respiratory Questionnaire (CRQ) subscales were not significant (p > .05) based on the insufficient evidence. In conclusion, the role of telephone-assisted interventions in the management of COPD remains equivocal. Some encouraging results were seen with regard to SGRQ symptom, SGRQ impact, SGRQ activity and SGRQ total score. We believe that more methodologically rigorous large-scale randomized controlled trials are necessary to answer this study question.
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Affiliation(s)
- Nan Deng
- a School of Nursing , Nantong University , Nantong , China
| | - Ting Gu
- a School of Nursing , Nantong University , Nantong , China
| | - Qian Zhao
- a School of Nursing , Nantong University , Nantong , China
| | - Xiaoyi Zhang
- b Department of Endocrinology , Affiliated Hospital of Nantong University , Nantong , China
| | - Fangfang Zhao
- a School of Nursing , Nantong University , Nantong , China
| | - Hong He
- c Department of Nursing , Affiliated Hospital of Nantong University , Nantong , China
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O'Hoski S, Butler S, Dubois-Webster J, Brooks D, Goldstein R. Use of telemedicine in the assessment of patients referred for pulmonary rehabilitation. CANADIAN JOURNAL OF RESPIRATORY, CRITICAL CARE, AND SLEEP MEDICINE 2018. [DOI: 10.1080/24745332.2017.1391055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Sachi O'Hoski
- School of Rehabilitation Science, McMaster University and West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Stacey Butler
- West Park Healthcare Centre, Toronto, Ontario, Canada
| | | | - Dina Brooks
- Department of Physical Therapy, University of Toronto and West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Roger Goldstein
- Departments of Medicine and Physical Therapy, University of Toronto and Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
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Orozco-Beltran D, Sánchez-Molla M, Sanchez JJ, Mira JJ. Telemedicine in Primary Care for Patients With Chronic Conditions: The ValCrònic Quasi-Experimental Study. J Med Internet Res 2017; 19:e400. [PMID: 29246881 PMCID: PMC5747596 DOI: 10.2196/jmir.7677] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 09/09/2017] [Accepted: 09/15/2017] [Indexed: 01/13/2023] Open
Abstract
Background The increase of chronic diseases prevalence has created the need to adapt care models and to provide greater home supervision. Objective The objective of our study was to evaluate the impact of telemonitoring on patients with long-term conditions at high risk for rehospitalization or an emergency department visit, in terms of target disease control (diabetes, hypertension, heart failure, and chronic obstructive pulmonary disease). Methods We conducted a quasi-experimental study with a before-and-after analysis to assess the effectiveness of the ValCrònic program after 1 year of primary care monitoring. The study included high-risk patients with 1 or more of the following conditions: diabetes, high blood pressure, heart failure, and chronic obstructive pulmonary disease. We assessed risk according to the Community Assessment Risk Screen. Participants used an electronic device (tablet) to self-report relevant health information, which was then automatically entered into their eHealth record for consultation. Results The total sample size was 521 patients. Compared with the preintervention year, there were significant reductions in weight (82.3 kg before vs 80.1 kg after; P=.001) and in the proportion of people with high systolic (≥140 mmHg; 190, 36.5% vs 170, 32.6%; P=.001) and diastolic (≥90 mmHg; 72, 13.8% vs 40, 7.7%; P=.01) blood pressures, and hemoglobin A1c ≥8% (186, 35.7% vs 104, 20.0%; P=.001). There was also a decrease in the proportion of participants who used emergency services in primary care (68, 13.1% vs 33, 6.3%; P<.001) and in hospital (98, 18.8% vs 67, 12.8%; P<.001). Likewise, fewer participants required hospital admission due to an emergency (105, 20.2% vs 71, 13.6%; P<.001) or disease exacerbation (55, 10.5% vs 42, 8.1%; P<.001). Conclusions The ValCrònic telemonitoring program in patients at high risk for rehospitalization or an emergency department visit appears to be useful to improve target disease control and to reduce the use of resources.
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Affiliation(s)
- Domingo Orozco-Beltran
- Catedra de Medicina de Familia, Department of Clinical Medicine, Miguel Hernandez University, San Juan de Alicante, Spain.,San Juan de Alicante Hospital, San Juan Health District, San Juan de Alicante, Spain
| | | | | | - José Joaquin Mira
- Alicante Sant Joan Health District, Alicante, Spain.,Health Psychology Department, Miguel Hernandez University, San Juan de Alicante, Spain
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- Ministry of Health of Valencia, Valencia, Spain
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Doshi R, Aseltine RH, Sabina AB, Graham GN. Interventions to Improve Management of Chronic Conditions Among Racial and Ethnic Minorities. J Racial Ethn Health Disparities 2017; 4:1033-1041. [PMID: 29067651 DOI: 10.1007/s40615-017-0431-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/05/2017] [Accepted: 09/07/2017] [Indexed: 11/25/2022]
Abstract
Digital and mhealth interventions can be effective in improving health outcomes among minority patients with diabetes, congestive heart failure, and chronic respiratory diseases. A number of electronic and digital approaches to individual and population-level interventions involving telephones, internet and web-based resources, and mobile platforms have been deployed to improve chronic disease outcomes. This paper summarizes the evidence supporting the efficacy of various behavioral and digital interventions targeting intermediate outcomes and hospitalizations with particular emphasis on studies examining the effects of these interventions on racial and ethnic minority population.
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Affiliation(s)
- Riddhi Doshi
- Department of Community Medicine and Healthcare, University of Connecticut Health Center, Farmington, CT, USA
| | - Robert H Aseltine
- Division of Behavioral Science and Community Health, University of Connecticut Health Center, 263 Farmington avenue MC 6030, Farmington, CT, 06030, USA.
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65
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Sumino K, Locke ER, Magzamen S, Gylys-Colwell I, Humblet O, Nguyen HQ, Thomas RM, Fan VS. Use of a Remote Inhaler Monitoring Device to Measure Change in Inhaler Use with Chronic Obstructive Pulmonary Disease Exacerbations. J Aerosol Med Pulm Drug Deliv 2017; 31:191-198. [PMID: 29035120 DOI: 10.1089/jamp.2017.1383] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Remote inhaler monitoring is an emerging technology that enables the healthcare team to monitor the time and location of a patient's inhaler use. We assessed the feasibility of remote inhaler monitoring for chronic obstructive pulmonary disease (COPD) patients and the pattern of albuterol inhaler use associated with COPD exacerbations. METHODS Thirty-five participants with COPD used an electronic inhaler sensor for 12 weeks which recorded the date and time of each albuterol actuation. Self-reported COPD exacerbations and healthcare utilization were assessed monthly. We used generalized estimating equations with a logit link to compare the odds of an exacerbation day to a nonexacerbation day by the frequency of daily albuterol use. RESULTS Average daily albuterol use on nonexacerbation days varied greatly between patients, ranging from 1.5 to 17.5 puffs. There were 48 exacerbation events observed in 29 participants during the study period, of which 16 were moderate-to-severe exacerbations. During the moderate-to-severe exacerbation days, the median value in average daily albuterol use increased by 14.1% (interquartile range: 2.7%-56.9%) compared to average nonexacerbation days. A 100% increase in inhaler use was associated with increased odds of a moderate-to severe exacerbation (odds ratio 1.54; 95% CI: 1.21-1.97). Approximately 74% of participants reported satisfaction with the sensor. CONCLUSIONS The electronic inhaler sensor was well received in older patients with COPD over a 12-week period. Increased albuterol use captured by the device was associated with self-reported episodes of moderate-to-severe exacerbations.
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Affiliation(s)
- Kaharu Sumino
- 1 Department of Medicine, Washington University School of Medicine , St. Louis, Missouri.,2 VA Saint Louis Health System, Saint Louis VA Medical Center , St. Louis, Missouri
| | - Emily R Locke
- 3 Department of Health Services Research and Development, VA Puget Sound Health Care System , Seattle, Washington
| | - Sheryl Magzamen
- 4 Environmental and Radiological Health Sciences, Colorado State University , Fort Collins, Colorado
| | - Ina Gylys-Colwell
- 3 Department of Health Services Research and Development, VA Puget Sound Health Care System , Seattle, Washington
| | | | - Huong Q Nguyen
- 6 Department of Research and Evaluation, Kaiser Permanente Southern California , Pasadena, California
| | - Rachel M Thomas
- 3 Department of Health Services Research and Development, VA Puget Sound Health Care System , Seattle, Washington
| | - Vincent S Fan
- 3 Department of Health Services Research and Development, VA Puget Sound Health Care System , Seattle, Washington.,7 Department of Medicine, University of Washington , Seattle, Washington
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Ambrosino N, Fracchia C. The role of tele-medicine in patients with respiratory diseases. Expert Rev Respir Med 2017; 11:893-900. [PMID: 28942692 DOI: 10.1080/17476348.2017.1383898] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Tele-medicine is a clinical application connecting a patient with specialized care consultants by means of electronic platforms, potentially able to improve patients' self-management and allow for the care of patients with limited access to health services. This article summarizes the use of tele-medicine as a tool in managing patients suffering from some pathological respiratory conditions. Areas covered: We searched papers published between 1990 and 2017 dealing with tele-medicine and respiratory diseases, chronic obstructive pulmonary disease, asthma, interstitial lung disease, chronic respiratory failure, neuromuscular diseases, critical illness, home mechanical ventilation, and also legal and economic issues. Controlled trials report different results on feasibility, cost-effectiveness, and safety of tele-medicine. Expert commentary: Progress in tele-medicine widens the horizons in respiratory medicine: this tool may potentially reduce health care costs by moving some medical interventions from centralized locations in to patient's home, also allowing for the delivery of care in countries with limited access to it. Legal, safety, and privacy problems, as well as reimbursement issues, must still be defined and solved. At present time, we still need much more evidence to consider this modality as a real option in the management of these patients.
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Affiliation(s)
- Nicolino Ambrosino
- a Istituti Clinici Scientifici Maugeri, Istituto di Montescano IRCCS , Pneumologia Riabilitativa , Montescano (PV) , Italy
| | - Claudio Fracchia
- a Istituti Clinici Scientifici Maugeri, Istituto di Montescano IRCCS , Pneumologia Riabilitativa , Montescano (PV) , Italy
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Lanssens D, Vandenberk T, Thijs IM, Grieten L, Gyselaers W. Effectiveness of Telemonitoring in Obstetrics: Scoping Review. J Med Internet Res 2017; 19:e327. [PMID: 28954715 PMCID: PMC5637065 DOI: 10.2196/jmir.7266] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 05/01/2017] [Accepted: 07/29/2017] [Indexed: 01/08/2023] Open
Abstract
Background Despite reported positive results of telemonitoring effectiveness in various health care domains, this new technology is rarely used in prenatal care. A few isolated investigations were performed in the past years but with conflicting results. Objective The aim of this review was to (1) assess whether telemonitoring adds any substantial benefit to this patient population and (2) identify research gaps in this area to suggest goals for future research. Methods This review includes studies exploring the effectiveness of telemonitoring interventions for pregnant women reported in the English language. Due to the paucity of research in this area, all reports including uncontrolled nonrandomized and randomized controlled studies were selected. Results Fourteen studies, which performed their data collection from 1988 to 2010, met the inclusion criteria and were published from 1995 to present; four of the 14 published papers were multicenter randomized controlled trials (RCTs), five papers were single-center RCTs, three papers were retrospective studies, one paper was an observational study, and one paper was a qualitative study. Of the 14 papers, nine were available for a risk of bias assessment: three papers were classified as low risk, one as medium risk, and five as high risk. Furthermore, of those 14 papers, 13 focused on telemonitoring for maternal outcomes, and nine of the 14 papers focused on telemonitoring for fetal or neonatal outcomes. The studies reviewed report that telemonitoring can contribute to significant reductions in health care costs, (unscheduled) face-to-face visits, low neonatal birth weight, and admissions to the neonatal intensive care unit (NICU), as well as prolonged gestational age and improved feelings of maternal satisfaction when compared with a control group. When only studies with low risk of bias were taken into account, the added value of telemonitoring became less pronounced: the only added value of telemonitoring is for pregnant women who transmitted their uterine activity by telecommunication. They had significant prolonged pregnancy survivals, and the newborns were less likely to be of low birth weight or to be admitted to the NICU. Following these results, telemonitoring can only be recommended by pregnant women at risk for preterm delivery. It is however important to consider that these studies were published in the mid-90s, which limits their direct applicability given the current technologies and practice. Conclusions This review shows that telemonitoring can be tentatively recommended for pregnant women at risk for preterm delivery. More recent RCTs with a blinded protocol are needed to strengthen the level of evidence around this topic and to have an insight in the added value of the technologies that are available nowadays. In addition, studies investigating patient satisfaction and economic effects in relation to telemonitoring are suggested for future research.
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Affiliation(s)
- Dorien Lanssens
- Mobile Health Unit, Facultiy of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Department of Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Thijs Vandenberk
- Mobile Health Unit, Facultiy of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Inge M Thijs
- Mobile Health Unit, Facultiy of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Department of Physiology, Hasselt University, Hasselt, Belgium
| | - Lars Grieten
- Mobile Health Unit, Facultiy of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Wilfried Gyselaers
- Mobile Health Unit, Facultiy of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Department of Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Department of Physiology, Hasselt University, Hasselt, Belgium
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Achelrod D, Schreyögg J, Stargardt T. Health-economic evaluation of home telemonitoring for COPD in Germany: evidence from a large population-based cohort. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2017; 18:869-882. [PMID: 27699567 PMCID: PMC5533837 DOI: 10.1007/s10198-016-0834-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 09/20/2016] [Indexed: 05/15/2023]
Abstract
INTRODUCTION Telemonitoring for COPD has gained much attention thanks to its potential of reducing morbidity and mortality, healthcare utilisation and costs. However, its benefit with regard to clinical and economic outcomes remains to be clearly demonstrated. OBJECTIVE To analyse the effect of Europe's largest COPD telemonitoring pilot project on direct medical costs, health resource utilisation and mortality at 12 months. METHODS We evaluated a population-based cohort using administrative data. Difference-in-difference estimators were calculated to account for time-invariant unobservable heterogeneity after removing dissimilarities in observable characteristics between the telemonitoring and control group with a reweighting algorithm. RESULTS The analysis comprised 651 telemonitoring participants and 7047 individuals in the standard care group. The mortality hazards ratio was lower in the intervention arm (HR 0.51, 95 % CI 0.30-0.86). Telemonitoring cut total costs by 895 € (p < 0.05) compared to COPD standard care, mainly driven by savings in COPD-related hospitalisations in (very) severe COPD patients (-1056 €, p < 0.0001). Telemonitoring enrolees used healthcare (all-cause and COPD-related) less intensely with shorter hospital stays, fewer inpatient stays and smaller proportions of people with emergency department visits and hospitalisations (all p < 0.0001). Reductions in mortality, costs and healthcare utilisation were greater for (very) severe COPD cases. CONCLUSION This is the first German study to demonstrate that telemonitoring for COPD is a viable strategy to reduce mortality, healthcare costs and utilisation at 12 months. Contrary to widespread fear, reducing the intensity of care does not seem to impact unfavourably on health outcomes. The evidence offers strong support for introducing telemonitoring as a component of case management.
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Affiliation(s)
- Dmitrij Achelrod
- Hamburg Center for Health Economics (HCHE), Universität Hamburg, Esplanade 36, 20354 Hamburg, Germany
| | - Jonas Schreyögg
- Hamburg Center for Health Economics (HCHE), Universität Hamburg, Esplanade 36, 20354 Hamburg, Germany
| | - Tom Stargardt
- Hamburg Center for Health Economics (HCHE), Universität Hamburg, Esplanade 36, 20354 Hamburg, Germany
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69
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Melchiorre MG, Papa R, Rijken M, van Ginneken E, Hujala A, Barbabella F. eHealth in integrated care programs for people with multimorbidity in Europe: Insights from the ICARE4EU project. Health Policy 2017; 122:53-63. [PMID: 28899575 DOI: 10.1016/j.healthpol.2017.08.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 06/25/2017] [Accepted: 08/05/2017] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Care for people with multimorbidity requires an integrated approach in order to adequately meet their complex needs. In this respect eHealth could be of help. This paper aims to describe the implementation, as well as benefits and barriers of eHealth applications in integrated care programs targeting people with multimorbidity in European countries, including insights on older people 65+. METHODS Within the framework of the ICARE4EU project, in 2014, expert organizations in 24 European countries identified 101 integrated care programs based on selected inclusion criteria. Managers of these programs completed a related on-line questionnaire addressing various aspects including the use of eHealth. In this paper we analyze data from this questionnaire, in addition to qualitative information from six programs which were selected as 'high potential' for their innovative approach and studied in depth through site visits. RESULTS Out of 101 programs, 85 adopted eHealth applications, of which 42 focused explicitly on older people. In most cases Electronic Health Records (EHRs), registration databases with patients' data and tools for communication between care providers were implemented. Percentages were slightly higher for programs addressing older people. eHealth improves care integration and management processes. Inadequate funding mechanisms, interoperability and technical support represent major barriers. CONCLUSION Findings seems to suggest that eHealth could support integrated care for (older) people with multimorbidity.
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Affiliation(s)
- Maria Gabriella Melchiorre
- Centre for Socio-Economic Research on Ageing, National Institute of Health and Science on Ageing (INRCA), Ancona, Italy.
| | - Roberta Papa
- Centre for Socio-Economic Research on Ageing, National Institute of Health and Science on Ageing (INRCA), Ancona, Italy
| | - Mieke Rijken
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Ewout van Ginneken
- European Observatory on Health Systems and Policies, Berlin University of Technology (TUB), Berlin, Germany
| | - Anneli Hujala
- Department of Health and Social Management, University of Eastern Finland (UEF), Kuopio, Finland
| | - Francesco Barbabella
- Centre for Socio-Economic Research on Ageing, National Institute of Health and Science on Ageing (INRCA), Ancona, Italy; Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
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Bourne S, DeVos R, North M, Chauhan A, Green B, Brown T, Cornelius V, Wilkinson T. Online versus face-to-face pulmonary rehabilitation for patients with chronic obstructive pulmonary disease: randomised controlled trial. BMJ Open 2017; 7:e014580. [PMID: 28716786 PMCID: PMC5541506 DOI: 10.1136/bmjopen-2016-014580] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 05/10/2017] [Accepted: 05/18/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To obtain evidence whether the online pulmonary rehabilitation(PR) programme 'my-PR' is non-inferior to a conventional face-to-face PR in improving physical performance and symptom scores in patients with COPD. DESIGN A two-arm parallel single-blind, randomised controlled trial. SETTING The online arm carried out pulmonary rehabilitation in their own homes and the face to face arm in a local rehabilitation facility. PARTICIPANTS 90 patients with a diagnosis of chronic obstructive pulmonary disease (COPD), modified Medical Research Council score of 2 or greater referred for pulmonary rehabilitation (PR), randomised in a 2:1 ratio to online (n=64) or face-to-face PR (n=26). Participants unable to use an internet-enabled device at home were excluded. MAIN OUTCOME MEASURES Coprimary outcomes were 6 min walk distance test and the COPD assessment test (CAT) score at completion of the programme. INTERVENTIONS A 6-week PR programme organised either as group sessions in a local rehabilitation facility, or online PR via log in and access to 'myPR'. RESULTS The adjusted mean difference for the 6 min walk test (6MWT) between groups for the intention-to-treat (ITT) population was 23.8 m with the lower 95% CI well above the non-inferiority threshold of -40.5 m at -4.5 m with an upper 95% CI of +52.2 m. This result was consistent in the per-protocol (PP) population with a mean adjusted difference of 15 m (-13.7 to 43.8). The CAT score difference in the ITT was -1.0 in favour of the online intervention with the upper 95% CI well below the non-inferiority threshold of 1.8 at 0.86 and the lower 95% CI of -2.9. The PP analysis was consistent with the ITT. CONCLUSION PR is an evidenced-based and guideline-mandated intervention for patients with COPD with functional limitation. A 6-week programme of online-supported PR was non-inferior to a conventional model delivered in face-to-face sessions in terms of effects on 6MWT distance, and symptom scores and was safe and well tolerated.
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Affiliation(s)
- Simon Bourne
- Portsmouth Hospitals NHS Trust, Portsmouth, UK
- myMHealth Ltd Bournemouth, UK
| | - Ruth DeVos
- Portsmouth Hospitals NHS Trust, Portsmouth, UK
- myMHealth Ltd Bournemouth, UK
| | | | | | - Ben Green
- Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | | | | | - Tom Wilkinson
- myMHealth Ltd Bournemouth, UK
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
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71
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Middlemass JB, Vos J, Siriwardena AN. Perceptions on use of home telemonitoring in patients with long term conditions - concordance with the Health Information Technology Acceptance Model: a qualitative collective case study. BMC Med Inform Decis Mak 2017. [PMID: 28651588 PMCID: PMC5485538 DOI: 10.1186/s12911-017-0486-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Health information technology (HIT) may be used to improve care for increasing numbers of older people with long term conditions (LTCs) who make high demands on health and social care services. Despite its potential benefits for reducing disease exacerbations and hospitalisations, HIT home monitoring is not always accepted by patients. Using the Health Information Technology Acceptance Model (HITAM) this qualitative study examined the usefulness of the model for understanding acceptance of HIT in older people (≥60 years) participating in a RCT for older people with Chronic Obstructive Pulmonary Disease (COPD) and associated heart diseases (CHROMED). Methods An instrumental, collective case study design was used with qualitative interviews of patients in the intervention arm of CHROMED. These were conducted at two time points, one shortly after installation of equipment and again at the end of (or withdrawal from) the study. We used Framework Analysis to examine how well the HITAM accounted for the data. Results Participants included 21 patients aged between 60–99 years and their partners or relatives where applicable. Additional concepts for the HITAM for older people included: concerns regarding health professional access and attachment; heightened illness anxiety and desire to avoid continuation of the ‘sick-role’. In the technology zone, HIT self-efficacy was associated with good organisational processes and informal support; while ease of use was connected to equipment design being suitable for older people. HIT perceived usefulness was related to establishing trends in health status, detecting early signs of infection and potential to self-manage. Due to limited feedback to users opportunities to self-manage were reduced. Conclusions HITAM helped understand the likelihood that older people with LTCs would use HIT, but did not explain how this might result in improved self-management. In order to increase HIT acceptance among older people, equipment design and organisational factors need to be considered. Trial registration ClinicalTrials.gov Identifier: NCT01960907 October 9 2013 (retrospectively registered) Clinical tRials fOr elderly patients with MultiplE Disease (CHROMED). Start date October 2012, end date March 2016. Date of enrolment of the first participant was February 2013. Electronic supplementary material The online version of this article (doi:10.1186/s12911-017-0486-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jo B Middlemass
- Community and Health Research Unit (CaHRU), University of Lincoln, Brayford Campus, Lincoln, LN6 7TS, UK
| | - Jolien Vos
- UCL Interaction Centre (UCLIC) University College London, 66-72 Gower Street, London, WC1E 6EA, UK
| | - A Niroshan Siriwardena
- Community and Health Research Unit (CaHRU), University of Lincoln, Brayford Campus, Lincoln, LN6 7TS, UK.
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Barken TL, Thygesen E, Söderhamn U. Unlocking the limitations: Living with chronic obstructive pulmonary disease and receiving care through telemedicine-A phenomenological study. J Clin Nurs 2017; 27:132-142. [PMID: 28425194 DOI: 10.1111/jocn.13857] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2017] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To describe the lived experiences of quality of life among a group of patients living with chronic obstructive pulmonary disease who were included in a telemedical intervention after hospitalisation for disease exacerbation. BACKGROUND Patients with chronic obstructive pulmonary disease have high symptom burden, poor control of symptoms and a need for greater requirements in care. Telemedicine can provide benefits for patients with chronic obstructive pulmonary disease by improving self-management. DESIGN Descriptive phenomenological approach. METHODS Ten in-depth interviews were conducted with chronic obstructive pulmonary disease patients participating in a telemedical intervention. The collected data were analysed using a descriptive phenomenological research method. RESULTS Living with chronic obstructive pulmonary disease was experienced as creating physical and mental limitations of the diseased body and an increasing identity as a patient, which led to impaired quality of life. Being included in the telemedicine intervention increased accessibility to healthcare services and support from telemedicine nurses. Self-measurement of health data increased participants' clinical insight and created a mutual clinical language in dialogue with telemedicine nurses, which led to increased quality of life. However, receiving care through telemedicine was also experienced as a dual chore. CONCLUSIONS Telemedicine can reduce the perceived limitations imposed by chronic obstructive pulmonary disease through four key elements: (i) improving accessibility to healthcare services, (ii) increasing support from health professionals, (iii) strengthening clinical insight and (iv) developing a mutual clinical language, thus increasing quality of life. The transparency facilitated through telemedicine in this healthcare context encourages open decision-making, where the participants can increase their knowledge and improve acknowledgement of and collaboration with telemedicine nurses. RELEVANCE TO CLINICAL PRACTICE Telemedicine can be beneficial when rethinking care for chronic obstructive pulmonary disease by providing knowledge on how living with chronic obstructive pulmonary disease can affect the experience of receiving care through telemedicine and further determine for whom telemedicine is useful.
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Affiliation(s)
- Tina Lien Barken
- Centre for eHealth, Centre for Care Research, Southern Norway, Department of Health and Nursing Sciences, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Elin Thygesen
- Centre for eHealth, Department of Health and Nursing Sciences, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Ulrika Söderhamn
- Centre for Care Research, Southern Norway, Department of Health and Nursing Sciences, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
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Tillis W, Bond WF, Svendsen J, Guither S. Implementation of Activity Sensor Equipment in the Homes of Chronic Obstructive Pulmonary Disease Patients. Telemed J E Health 2017; 23:920-929. [PMID: 28557641 DOI: 10.1089/tmj.2016.0201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Telemedicine care models for managing advanced chronic obstructive pulmonary disease (COPD) may benefit from the addition of motion sensing, spirometry, and tablet-based symptom diary tracking. METHODS We conducted a feasibility study of telemedicine in the home setting using multiple activity sensor monitoring equipment. Deployment and monitoring were supported by home health nurses with technical advice from the equipment makers as needed. Data analytics for motion sensing was provided by the research sponsor, but was not used for care decisions. On study intake, a health risk assessment, Quality of Life (SF-36) survey, and the St. George Respiratory Questionnaire were administered to assess patients' self-perception of quality of life, activities of daily life function, and difficulty living with COPD. RESULTS Twenty-eight patients were enrolled and data were gathered for a minimum of 6 months and maximum of 9 months. The researchers demonstrated that augmentation of traditional telemedicine methods with motion sensing, spirometry, and symptom diaries appears feasible. The technical, process, logistics barriers, and solutions required for system deployment are described. The researchers demonstrated that augmentation of traditional telemedicine methods with motion sensing, spirometry, and symptom diaries appears feasible. CONCLUSIONS Further exploration will be needed to determine the value of this information in preventing outcomes relevant to patients.
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Affiliation(s)
- William Tillis
- 1 OSF Healthcare, Illinois Lung Institute , Peoria, Illinois
| | - William F Bond
- 2 OSF Healthcare, Jump Trading Simulation and Education Center , Peoria, Illinois
| | - Jessica Svendsen
- 2 OSF Healthcare, Jump Trading Simulation and Education Center , Peoria, Illinois
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Hanlon P, Daines L, Campbell C, McKinstry B, Weller D, Pinnock H. Telehealth Interventions to Support Self-Management of Long-Term Conditions: A Systematic Metareview of Diabetes, Heart Failure, Asthma, Chronic Obstructive Pulmonary Disease, and Cancer. J Med Internet Res 2017; 19:e172. [PMID: 28526671 PMCID: PMC5451641 DOI: 10.2196/jmir.6688] [Citation(s) in RCA: 312] [Impact Index Per Article: 44.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 02/22/2017] [Accepted: 03/09/2017] [Indexed: 12/28/2022] Open
Abstract
Background Self-management support is one mechanism by which telehealth interventions have been proposed to facilitate management of long-term conditions. Objective The objectives of this metareview were to (1) assess the impact of telehealth interventions to support self-management on disease control and health care utilization, and (2) identify components of telehealth support and their impact on disease control and the process of self-management. Our goal was to synthesise evidence for telehealth-supported self-management of diabetes (types 1 and 2), heart failure, asthma, chronic obstructive pulmonary disease (COPD) and cancer to identify components of effective self-management support. Methods We performed a metareview (a systematic review of systematic reviews) of randomized controlled trials (RCTs) of telehealth interventions to support self-management in 6 exemplar long-term conditions. We searched 7 databases for reviews published from January 2000 to May 2016 and screened identified studies against eligibility criteria. We weighted reviews by quality (revised A Measurement Tool to Assess Systematic Reviews), size, and relevance. We then combined our results in a narrative synthesis and using harvest plots. Results We included 53 systematic reviews, comprising 232 unique RCTs. Reviews concerned diabetes (type 1: n=6; type 2, n=11; mixed, n=19), heart failure (n=9), asthma (n=8), COPD (n=8), and cancer (n=3). Findings varied between and within disease areas. The highest-weighted reviews showed that blood glucose telemonitoring with feedback and some educational and lifestyle interventions improved glycemic control in type 2, but not type 1, diabetes, and that telemonitoring and telephone interventions reduced mortality and hospital admissions in heart failure, but these findings were not consistent in all reviews. Results for the other conditions were mixed, although no reviews showed evidence of harm. Analysis of the mediating role of self-management, and of components of successful interventions, was limited and inconclusive. More intensive and multifaceted interventions were associated with greater improvements in diabetes, heart failure, and asthma. Conclusions While telehealth-mediated self-management was not consistently superior to usual care, none of the reviews reported any negative effects, suggesting that telehealth is a safe option for delivery of self-management support, particularly in conditions such as heart failure and type 2 diabetes, where the evidence base is more developed. Larger-scale trials of telehealth-supported self-management, based on explicit self-management theory, are needed before the extent to which telehealth technologies may be harnessed to support self-management can be established.
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Affiliation(s)
- Peter Hanlon
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Luke Daines
- Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Christine Campbell
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Brian McKinstry
- E-Health Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - David Weller
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Hilary Pinnock
- Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
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75
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Lilholt PH, Witt Udsen F, Ehlers L, Hejlesen OK. Telehealthcare for patients suffering from chronic obstructive pulmonary disease: effects on health-related quality of life: results from the Danish 'TeleCare North' cluster-randomised trial. BMJ Open 2017; 7:e014587. [PMID: 28490555 PMCID: PMC5623392 DOI: 10.1136/bmjopen-2016-014587] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 01/31/2017] [Accepted: 03/02/2017] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To assess the effect of telehealthcare compared with usual practice in patients with chronic obstructive pulmonary disease (COPD). DESIGN A cluster-randomised trial with 26 municipal districts that were randomly assigned either to an intervention group whose members received telehealthcare in addition to usual practice or to a control group whose members received usual practice only (13 districts in each arm). SETTING Twenty-six municipal districts in the North Denmark Region of Denmark. PARTICIPANTS Patients who fulfilled the Global Initiative for COPD guidelines and one of the following criteria: COPD Assessment Test score ≥10; or Medical Research Dyspnoea Council Scale ≥3; or Modified Medical Research Dyspnoea Council Scale ≥2; or ≥2 exacerbations during the past 12 months. MAIN OUTCOME MEASURES Health-related quality of life (HRQoL) assessed by the physical component summary (PCS) and mental component summary (MCS) scores of the Short Form 36-Item Health Survey, Version 2. Data were collected at baseline and at 12 month follow-up and analysed according to the intention-to-treat principle with complete cases, n=574 (258 interventions; 316 controls) and imputed data, n=1225 (578 interventions, 647 controls) using multilevel modelling. RESULTS In the intention-to-treat analysis (n=1225), the raw mean difference in PCS from baseline to 12 month follow-up was -2.6 (SD 12.4) in the telehealthcare group and -2.8 (SD 11.9) in the usual practice group. The raw mean difference in MCS scores in the same period was -4.7 (SD 16.5) and -5.3 (SD 15.5) for telehealthcare and usual practice, respectively. The adjusted mean difference in PCS and MCS between groups at 12 months was 0.1 (95% CI -1.4 to 1.7) and 0.4 (95% CI -1.7 to 2.4), respectively. CONCLUSIONS The overall sample and all subgroups demonstrated no statistically significant differences in HRQoL between telehealthcare and usual practice. TRIAL REGISTRATION NUMBER NCT01984840; Results.
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Affiliation(s)
| | - Flemming Witt Udsen
- Danish Center for Healthcare Improvements, Aalborg University, Aalborg, Denmark
| | - Lars Ehlers
- Danish Centre for Healthcare Improvements, Faculty of Social Sciences and Faculty of Medicine, Aalborg University, Aalborg Øst, Denmark
| | - Ole K Hejlesen
- Faculty of Medicine, Department of Health Science and Technology, Aalborg University, Aalborg Øst, Denmark
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76
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Murphy LA, Harrington P, Taylor SJ, Teljeur C, Smith SM, Pinnock H, Ryan M. Clinical-effectiveness of self-management interventions in chronic obstructive pulmonary disease: An overview of reviews. Chron Respir Dis 2017; 14:276-288. [PMID: 28774200 PMCID: PMC5720233 DOI: 10.1177/1479972316687208] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Self-management (SM) is defined as the provision of interventions to increase patients’ skills and confidence, empowering the individual to take an active part in their disease management. There is uncertainty regarding the optimal format and the short- and long-term benefits of chronic obstructive pulmonary disease (COPD) SM interventions in adults. Therefore, a high-quality overview of reviews was updated to examine their clinical effectiveness. Sixteen reviews were identified, interventions were broadly classified as education or action plans, complex interventions with an SM focus, pulmonary rehabilitation (PR), telehealth and outreach nursing. Systematic review and meta-analysis quality and the risk of bias of underlying primary studies were assessed. Strong evidence was found that PR is associated with significant improvements in health-related quality of life (HRQoL). Limited to moderate evidence for complex interventions (SM focus) with limited evidence for education, action plans, telehealth interventions and outreach nursing for HRQoL was found. There was strong evidence that education is associated with a significant reduction in COPD-related hospital admissions, moderate to strong evidence that telehealth interventions and moderate evidence that complex interventions (SM focus) are associated with reduced health care utilization. These findings from a large body of evidence suggesting that SM, through education or as a component of PR, confers significant health gains in people with COPD in terms of HRQoL. SM supported by telehealth confers significant reductions in healthcare utilization, including hospitalization and emergency department visits.
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Affiliation(s)
- Linda A Murphy
- 1 Health Technology Assessment, Health Information and Quality Authority, Dublin, Ireland
| | - Patricia Harrington
- 1 Health Technology Assessment, Health Information and Quality Authority, Dublin, Ireland
| | - Stephanie Jc Taylor
- 2 Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Conor Teljeur
- 1 Health Technology Assessment, Health Information and Quality Authority, Dublin, Ireland
| | - Susan M Smith
- 3 RCSI Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Hilary Pinnock
- 4 Asthma UK Centre for Applied Research, Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Scotland, Edinburgh, UK
| | - Máirín Ryan
- 1 Health Technology Assessment, Health Information and Quality Authority, Dublin, Ireland
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77
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Al Rajeh AM, Hurst JR. Monitoring of Physiological Parameters to Predict Exacerbations of Chronic Obstructive Pulmonary Disease (COPD): A Systematic Review. J Clin Med 2016; 5:jcm5120108. [PMID: 27897995 PMCID: PMC5184781 DOI: 10.3390/jcm5120108] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/14/2016] [Accepted: 11/19/2016] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The value of monitoring physiological parameters to predict chronic obstructive pulmonary disease (COPD) exacerbations is controversial. A few studies have suggested benefit from domiciliary monitoring of vital signs, and/or lung function but there is no existing systematic review. OBJECTIVES To conduct a systematic review of the effectiveness of monitoring physiological parameters to predict COPD exacerbation. METHODS An electronic systematic search compliant with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted. The search was updated to April 6, 2016. Five databases were examined: Medical Literature Analysis and Retrieval System Online, or MEDLARS Online (Medline), Excerpta Medica dataBASE (Embase), Allied and Complementary Medicine Database (AMED), Cumulative Index of Nursing and Allied Health Literature (CINAHL) and the Cochrane clinical trials database. RESULTS Sixteen articles met the pre-specified inclusion criteria. Fifteen of these articules reported positive results in predicting COPD exacerbation via monitoring of physiological parameters. Nine studies showed a reduction in peripheral oxygen saturation (SpO₂%) prior to exacerbation onset. Three studies for peak flow, and two studies for respiratory rate reported a significant variation prior to or at exacerbation onset. A particular challenge is accounting for baseline heterogeneity in parameters between patients. CONCLUSION There is currently insufficient information on how physiological parameters vary prior to exacerbation to support routine domiciliary monitoring for the prediction of exacerbations in COPD. However, the method remains promising.
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Affiliation(s)
- Ahmed M Al Rajeh
- UCL Respiratory, Royal Free Campus, University College London, London NW3 2PF, UK.
| | - John R Hurst
- UCL Respiratory, Royal Free Campus, University College London, London NW3 2PF, UK.
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Kayyali R, Odeh B, Frerichs I, Davies N, Perantoni E, D’arcy S, Vaes AW, Chang J, Spruit MA, Deering B, Philip N, Siva R, Kaimakamis E, Chouvarda I, Pierscionek B, Weiler N, Wouters EFM, Raptopoulos A, Nabhani-Gebara S. COPD care delivery pathways in five European Union countries: mapping and health care professionals' perceptions. Int J Chron Obstruct Pulmon Dis 2016; 11:2831-2838. [PMID: 27881915 PMCID: PMC5115685 DOI: 10.2147/copd.s104136] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND COPD is among the leading causes of chronic morbidity and mortality in the European Union with an estimated annual economic burden of €25.1 billion. Various care pathways for COPD exist across Europe leading to different responses to similar problems. Determining these differences and the similarities may improve health and the functioning of health services. OBJECTIVE The aim of this study was to compare COPD patients' care pathway in five European Union countries including England, Ireland, the Netherlands, Greece, and Germany and to explore health care professionals' (HCPs) perceptions about the current pathways. METHODS HCPs were interviewed in two stages using a qualitative, semistructured email interview and a face-to-face semistructured interview. RESULTS Lack of communication among different health care providers managing COPD and comorbidities was a common feature of the studied care pathways. General practitioners/family doctors are responsible for liaising between different teams/services, except in Greece where this is done through pulmonologists. Ireland and the UK are the only countries with services for patients at home to shorten unnecessary hospital stay. HCPs emphasized lack of communication, limited resources, and poor patient engagement as issues in the current pathways. Furthermore, no specified role exists for pharmacists and informal carers. CONCLUSION Service and professional integration between care settings using a unified system targeting COPD and comorbidities is a priority. Better communication between health care providers, establishing a clear role for informal carers, and enhancing patients' engagement could optimize current care pathways resulting in a better integrated system.
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Affiliation(s)
- Reem Kayyali
- Faculty of Science, Engineering and Computing, Kingston University, Kingston-Upon-Thames, UK
| | - Bassel Odeh
- Faculty of Science, Engineering and Computing, Kingston University, Kingston-Upon-Thames, UK
| | - Inéz Frerichs
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | - Nikki Davies
- Chest Clinic and Research and Development, Croydon University Hospital, Croydon, UK
| | - Eleni Perantoni
- Pulmonary Clinic, AHEPA University Hospital, Thessaloniki, Greece
| | - Shona D’arcy
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Anouk W Vaes
- Research and Education, CIRO – Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands
| | - John Chang
- Chest Clinic and Research and Development, Croydon University Hospital, Croydon, UK
| | - Martijn A Spruit
- Research and Education, CIRO – Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands
| | | | - Nada Philip
- Faculty of Science, Engineering and Computing, Kingston University, Kingston-Upon-Thames, UK
| | - Roshan Siva
- Chest Clinic and Research and Development, Croydon University Hospital, Croydon, UK
| | | | | | - Barbara Pierscionek
- Faculty of Science, Engineering and Computing, Kingston University, Kingston-Upon-Thames, UK
| | - Norbert Weiler
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | - Emiel FM Wouters
- Research and Education, CIRO – Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands
| | | | - Shereen Nabhani-Gebara
- Faculty of Science, Engineering and Computing, Kingston University, Kingston-Upon-Thames, UK
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79
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Sanchez-Morillo D, Fernandez-Granero MA, Leon-Jimenez A. Use of predictive algorithms in-home monitoring of chronic obstructive pulmonary disease and asthma: A systematic review. Chron Respir Dis 2016; 13:264-83. [PMID: 27097638 PMCID: PMC5720188 DOI: 10.1177/1479972316642365] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Major reported factors associated with the limited effectiveness of home telemonitoring interventions in chronic respiratory conditions include the lack of useful early predictors, poor patient compliance and the poor performance of conventional algorithms for detecting deteriorations. This article provides a systematic review of existing algorithms and the factors associated with their performance in detecting exacerbations and supporting clinical decisions in patients with chronic obstructive pulmonary disease (COPD) or asthma. An electronic literature search in Medline, Scopus, Web of Science and Cochrane library was conducted to identify relevant articles published between 2005 and July 2015. A total of 20 studies (16 COPD, 4 asthma) that included research about the use of algorithms in telemonitoring interventions in asthma and COPD were selected. Differences on the applied definition of exacerbation, telemonitoring duration, acquired physiological signals and symptoms, type of technology deployed and algorithms used were found. Predictive models with good clinically reliability have yet to be defined, and are an important goal for the future development of telehealth in chronic respiratory conditions. New predictive models incorporating both symptoms and physiological signals are being tested in telemonitoring interventions with positive outcomes. However, the underpinning algorithms behind these models need be validated in larger samples of patients, for longer periods of time and with well-established protocols. In addition, further research is needed to identify novel predictors that enable the early detection of deteriorations, especially in COPD. Only then will telemonitoring achieve the aim of preventing hospital admissions, contributing to the reduction of health resource utilization and improving the quality of life of patients.
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Affiliation(s)
- Daniel Sanchez-Morillo
- Biomedical Engineering and Telemedicine Research Group, University of Cádiz, Puerto Real, Cádiz, Spain
| | | | - Antonio Leon-Jimenez
- Pulmonology, Allergy and Thoracic Surgery Unit, Puerta del Mar University Hospital, Cádiz, Spain
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80
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Cottrell MA, Galea OA, O'Leary SP, Hill AJ, Russell TG. Real-time telerehabilitation for the treatment of musculoskeletal conditions is effective and comparable to standard practice: a systematic review and meta-analysis. Clin Rehabil 2016; 31:625-638. [PMID: 27141087 DOI: 10.1177/0269215516645148] [Citation(s) in RCA: 325] [Impact Index Per Article: 40.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of treatment delivered via real-time telerehabilitation for the management of musculoskeletal conditions, and to determine if real-time telerehabilitation is comparable to conventional methods of delivery within this population. DATA SOURCES Six databases (Medline, Embase, Cochrane CENTRAL, PEDro, psycINFO, CINAHL) were searched from inception to November 2015 for literature which reported on the outcomes of real-time telerehabilitation for musculoskeletal conditions. REVIEW METHODS Two reviewers screened 5913 abstracts where 13 studies ( n = 1520) met the eligibility criteria. Methodological quality was assessed using the Downs & Black 'Checklist for Measuring Quality' tool. Results were pooled for meta-analysis based upon primary outcome measures and reported as standardised mean differences and 95% confidence intervals (CI). RESULTS Aggregate results suggest that telerehabilitation is effective in the improvement of physical function (SMD 1.63, 95%CI 0.92-2.33, I2=93%), whilst being slightly more favourable (SMD 0.44, 95%CI 0.19-0.69, I2=58%) than the control cohort following intervention. Sub-group analyses reveals that telerehabilitation in addition to usual care is more favourable (SMD 0.64, 95%CI 0.43-0.85, I2=10%) than usual care alone, whilst treatment delivered solely via telerehabilitation is equivalent to face-to-face intervention (SMD MD 0.14, 95% CI -0.10-0.37, I2 = 0%) for the improvement of physical function. The improvement of pain was also seen to be comparable between cohorts (SMD 0.66, 95%CI -0.27-1.60, I2=96%) following intervention. CONCLUSIONS Real-time telerehabilitation appears to be effective and comparable to conventional methods of healthcare delivery for the improvement of physical function and pain in a variety of musculoskeletal conditions.
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Affiliation(s)
- Michelle A Cottrell
- 1 School of Health and Rehabilitation Science, University of Queensland, Australia.,2 Centre for Research Excellence in Telehealth, University of Queensland, Australia
| | - Olivia A Galea
- 1 School of Health and Rehabilitation Science, University of Queensland, Australia
| | - Shaun P O'Leary
- 1 School of Health and Rehabilitation Science, University of Queensland, Australia.,3 Physiotherapy Department, Royal Brisbane and Women's Hospital, Australia
| | - Anne J Hill
- 1 School of Health and Rehabilitation Science, University of Queensland, Australia.,2 Centre for Research Excellence in Telehealth, University of Queensland, Australia
| | - Trevor G Russell
- 1 School of Health and Rehabilitation Science, University of Queensland, Australia.,2 Centre for Research Excellence in Telehealth, University of Queensland, Australia
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81
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Gregersen TL, Green A, Frausing E, Ringbæk T, Brøndum E, Suppli Ulrik C. Do telemedical interventions improve quality of life in patients with COPD? A systematic review. Int J Chron Obstruct Pulmon Dis 2016; 11:809-22. [PMID: 27143872 PMCID: PMC4846042 DOI: 10.2147/copd.s96079] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objective Telehealth is an approach to disease management, which may hold the potential of improving some of the features associated with COPD, including positive impact on disease progression, and thus possibly limiting further reduction in quality of life (QoL). Our objective was, therefore, to summarize studies addressing the impact of telehealth on QoL in patients with COPD. Design Systematic review. Methods A series of systematic searches were carried out using the following databases: PubMed, EMBASE, Cochrane Controlled Trials Register, and ClinicalTrials.gov (last updated November 2015). A predefined search algorithm was utilized with the intention to capture all results related to COPD, QoL, and telehealth published since year 2000. Outcome measures Primary outcome was QoL, assessed by validated measures. Results Out of the 18 studies fulfilling the criteria for inclusion in this review, three studies found statistically significant improvements in QoL for patients allocated to telemedical interventions. However, all of the other included studies found no statistically significant differences between control and telemedical intervention groups in terms of QoL. Conclusion Telehealth does not make a strong case for itself when exclusively looking at QoL as an outcome, since statistically significant improvements relative to control groups have been observed only in few of the available studies. Nonetheless, this does not only rule out the possibility that telehealth is superior to standard care with regard to other outcomes but also seems to call for more research, not least in large-scale controlled trials.
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Affiliation(s)
| | - Allan Green
- Department of Pulmonary Medicine, Hvidovre Hospital, Hvidovre, Denmark
| | - Ejvind Frausing
- Department of Pulmonary Medicine, Hvidovre Hospital, Hvidovre, Denmark
| | - Thomas Ringbæk
- Department of Pulmonary Medicine, Hvidovre Hospital, Hvidovre, Denmark; Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Eva Brøndum
- Department of Pulmonary Medicine, Hvidovre Hospital, Hvidovre, Denmark
| | - Charlotte Suppli Ulrik
- Department of Pulmonary Medicine, Hvidovre Hospital, Hvidovre, Denmark; Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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82
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Ho TW, Huang CT, Chiu HC, Ruan SY, Tsai YJ, Yu CJ, Lai F. Effectiveness of Telemonitoring in Patients with Chronic Obstructive Pulmonary Disease in Taiwan-A Randomized Controlled Trial. Sci Rep 2016; 6:23797. [PMID: 27029815 PMCID: PMC4814821 DOI: 10.1038/srep23797] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 03/14/2016] [Indexed: 11/23/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is the leading cause of death worldwide, and poses a substantial economic and social burden. Telemonitoring has been proposed as a solution to this growing problem, but its impact on patient outcome is equivocal. This randomized controlled trial aimed to investigate effectiveness of telemonitoring in improving COPD patient outcome. In total, 106 subjects were randomly assigned to the telemonitoring (n = 53) or usual care (n = 53) group. During the two months following discharge, telemonitoring group patients had to report their symptoms daily using an electronic diary. The primary outcome measure was time to first re-admission for COPD exacerbation within six months of discharge. During the follow-up period, time to first re-admission for COPD exacerbation was significantly increased in the telemonitoring group than in the usual care group (p = 0.026). Telemonitoring was also associated with a reduced number of all-cause re-admissions (0.23 vs. 0.68/patient; p = 0.002) and emergency room visits (0.36 vs. 0.91/patient; p = 0.006). In conclusion, telemonitoring intervention was associated with improved outcomes among COPD patients admitted for exacerbation in a country characterized by a small territory and high accessibility to medical services. The findings are encouraging and add further support to implementation of telemonitoring as part of COPD care.
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Affiliation(s)
- Te-Wei Ho
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Chun-Ta Huang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan
| | - Herng-Chia Chiu
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan.,Research Education and Epidemiology Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Sheng-Yuan Ruan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Ju Tsai
- School of Medicine, College of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan
| | - Chong-Jen Yu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Feipei Lai
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan.,Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan.,Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan
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Greenhalgh T, Shaw S, Wherton J, Hughes G, Lynch J, A'Court C, Hinder S, Fahy N, Byrne E, Finlayson A, Sorell T, Procter R, Stones R. SCALS: a fourth-generation study of assisted living technologies in their organisational, social, political and policy context. BMJ Open 2016; 6:e010208. [PMID: 26880671 PMCID: PMC4762149 DOI: 10.1136/bmjopen-2015-010208] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Research to date into assisted living technologies broadly consists of 3 generations: technical design, experimental trials and qualitative studies of the patient experience. We describe a fourth-generation paradigm: studies of assisted living technologies in their organisational, social, political and policy context. Fourth-generation studies are necessarily organic and emergent; they view technology as part of a dynamic, networked and potentially unstable system. They use co-design methods to generate and stabilise local solutions, taking account of context. METHODS AND ANALYSIS SCALS (Studies in Co-creating Assisted Living Solutions) consists (currently) of 5 organisational case studies, each an English health or social care organisation striving to introduce technology-supported services to support independent living in people with health and/or social care needs. Treating these cases as complex systems, we seek to explore interdependencies, emergence and conflict. We employ a co-design approach informed by the principles of action research to help participating organisations establish, refine and evaluate their service. To that end, we are conducting in-depth ethnographic studies of people's experience of assisted living technologies (micro level), embedded in evolving organisational case studies that use interviews, ethnography and document analysis (meso level), and exploring the wider national and international context for assisted living technologies and policy (macro level). Data will be analysed using a sociotechnical framework developed from structuration theory. ETHICS AND DISSEMINATION Research ethics approval for the first 4 case studies has been granted. An important outcome will be lessons learned from individual co-design case studies. We will document the studies' credibility and rigour, and assess the transferability of findings to other settings while also recognising unique aspects of the contexts in which they were generated. Academic outputs will include a cross-case analysis and progress in theory and method of fourth-generation assisted living technology research. We will produce practical guidance for organisations, policymakers, designers and service users.
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Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sara Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Joe Wherton
- Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK
| | - Gemma Hughes
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jenni Lynch
- Department of Politics and International Studies, University of Warwick, Warwick, UK
| | - Christine A'Court
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sue Hinder
- Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK
| | - Nick Fahy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Emma Byrne
- Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK
| | - Alexander Finlayson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Tom Sorell
- Department of Politics and International Studies, University of Warwick, Warwick, UK
| | - Rob Procter
- Department of Computer Science, University of Warwick, Warwick, UK
| | - Rob Stones
- Sociology and Criminology Department, University of Western Sydney, Sydney, Australia
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84
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Kasteleyn MJ, Bonten TN, Taube C, Chavannes NH. Coordination of care for patients with COPD: Clinical points of interest. INTERNATIONAL JOURNAL OF CARE COORDINATION 2015. [DOI: 10.1177/2053434515620223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The management of care of chronic obstructive pulmonary disease improved over the last years but is still very complex. Both over- and underdiagnosis are often reported and misclassification of disease severity is common. Differentiating between chronic obstructive pulmonary disease, asthma and asthma-chronic obstructive pulmonary disease overlap syndrome remains difficult. Much is known about the effectiveness of treatment approaches in chronic obstructive pulmonary disease, but patients are often not treated according to the guidelines, and we need more evidence on effectiveness in phenotypes of chronic obstructive pulmonary disease. Care coordination is of great importance and can help to further improve care for chronic obstructive pulmonary disease patients. Pulmonary rehabilitation and self-management are considered important aspects of chronic obstructive pulmonary disease care. In our opinion, there is a major role for eHealth to improve coordination of care of chronic obstructive pulmonary disease.
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85
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Lettieri E, Fumagalli LP, Radaelli G, Bertele' P, Vogt J, Hammerschmidt R, Lara JL, Carriazo A, Masella C. Empowering patients through eHealth: a case report of a pan-European project. BMC Health Serv Res 2015; 15:309. [PMID: 26242863 PMCID: PMC4526304 DOI: 10.1186/s12913-015-0983-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 07/30/2015] [Indexed: 11/10/2022] Open
Abstract
Background This paper crystallises the experience developed by the pan-European PALANTE Consortium in dealing with the generation of relevant evidence from heterogeneous eHealth services for patient empowerment in nine European Regions. The European Commission (EC) recently funded a number of pan-European eHealth projects aimed at empowering European patients/citizens thus transforming the traditional patient/citizen role in the management of their health (e.g., PALANTE, SUSTAIN, CARRE, HeartCycle, Empower). However, the heterogeneity of the healthcare systems, of the implemented services and of the target patients, the use of ad-hoc definitions of the salient concepts and the development of small-size experiences have prevented the dissemination of “global” results and the development of cumulative knowledge. The main challenge has been the generation of large-scale evidence from heterogeneous small-size experiences. Discussion Three lessons have been collectively learnt during the development of the PALANTE project, which involves 9 sites that have implemented different eHealth services for empowering different typologies of patients. These lessons have been refined progressively through project meetings, reviews with the EC Project Officer and Reviewers. The paper illustrates the ten steps followed to develop the three lessons. The first lesson learnt is about how EC-funded projects should develop cumulative knowledge by avoiding self-crafted measures of outcome and by adopting literature-grounded definitions and scales. The second lesson learnt is about how EC-funded projects should identify ambitious, cross-pilot policy and research questions that allow pooling of data from across heterogeneous experiences even if a multi-centre study design was not agreed before. The third lesson learnt is about how EC-funded projects should open their collections of data and make them freely-accessible to the scientific community shortly after the conclusion of the project in order to guarantee the replicability of results and conclusions. Summary The three lessons might provide original elements for fuelling the ongoing debate about the capability of the EC to develop evidence-based policies by pooling evidence from heterogeneous, local experiences.
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Affiliation(s)
- Emanuele Lettieri
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, 4/B Lambruschini Street, Milan, 20156, Italy.
| | - Lia P Fumagalli
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, 4/B Lambruschini Street, Milan, 20156, Italy.
| | | | - Paolo Bertele'
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, 4/B Lambruschini Street, Milan, 20156, Italy.
| | - Jess Vogt
- Empirica Gesellschaft für Kommunikations- und Technologieforschung mbH, 2 Oxfordstr, Bonn, D-53111, Germany.
| | - Reinhard Hammerschmidt
- Empirica Gesellschaft für Kommunikations- und Technologieforschung mbH, 2 Oxfordstr, Bonn, D-53111, Germany.
| | - Juan L Lara
- Fundación Pública Andaluza Progreso y Salud (FPS), 13 Avda. Américo Vespucio, Sevilla, 41071, Spain.
| | - Ana Carriazo
- Andalusian Health Service/Regional Ministry of Equality, Health and Social Policies of Andalusia, 14 Av. Hytasa, Sevilla, 41071, Spain.
| | - Cristina Masella
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, 4/B Lambruschini Street, Milan, 20156, Italy.
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86
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Odeh B, Kayyali R, Nabhani-Gebara S, Philip N, Robinson P, Wallace CR. Evaluation of a Telehealth Service for COPD and HF patients: Clinical outcome and patients' perceptions. J Telemed Telecare 2015; 21:292-7. [PMID: 25766852 DOI: 10.1177/1357633x15574807] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2015] [Indexed: 11/16/2022]
Abstract
NHS Croydon Health Services and NHS Croydon Clinical Commissioning Group have been providing telehealth services for the past 36 months. The aim of this study was to measure the impact of telehealth when implemented as a service within a standard patient care pathway. To measure the clinical outcomes, the number of A&E visits and hospital admissions, recorded on the NHS Secondary Uses Service database, were compared before and after the implementation of the telehealth service. The number of all events despite its cause and the number of events related to the patients' diagnosed condition were collected. To elicit patients' perceptions about the telehealth service, a cross sectional survey of patients registered on the triage manager database was used to explore their perceptions, concerns and general satisfaction with the telehealth service via a 4 point likert scale questionnaire. The data of 48 patients were collected and telehealth reduced the number of both A&E and hospital admission due to all causes by 13% (P = 0.42) and 22% (P = 0.048), respectively. When only the events directly related to the patient's diagnosed condition were considered, a reduction by 36% (P = 0.03) and 28% (P = 0.02) was recorded for A&E visits and hospital admission respectively. 27 patients consented to participate in the survey. Overall, patients were very satisfied with telehealth services. Patients agreed that telehealth had improved their health, it was a convenient form of health care delivery for them and they were more involved in the decisions about their care or treatment. In addition, since being on telehealth, patients' confidence in managing their health increased from somewhat confident to confident. Telehealth, when provided as a service within a standard care pathway, seems to decrease hospital admissions and A&E visits. Good patient satisfaction suggests that the current service is accepted and it could be further expanded to include a larger number of patients.
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Affiliation(s)
- Bassel Odeh
- School of Pharmacy and Chemistry, Kingston University, UK
| | - Reem Kayyali
- School of Pharmacy and Chemistry, Kingston University, UK
| | | | - Nada Philip
- School of Computing and Information Systems, Kingston University, UK
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Kaptein AA, Fischer MJ, Scharloo M. Self-management in patients with COPD: theoretical context, content, outcomes, and integration into clinical care. Int J Chron Obstruct Pulmon Dis 2014; 9:907-17. [PMID: 25214777 PMCID: PMC4159069 DOI: 10.2147/copd.s49622] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In this narrative review, we put self-management in the context of a 50-year history of research about how patients with COPD respond to their illness. We review a definition of self-management, and emphasize that self-management should be combined with disease management and the chronic care model in order to be effective. Reviewing the empirical status of self-management in COPD, we conclude that self-management is part and parcel of modern, patient-oriented biopsychosocial care. In pulmonary rehabilitation programs, self-management is instrumental in improving patients' functional status and quality of life. We conclude by emphasizing how studying the way persons with COPD make sense of their illness helps in refining self-management, and thereby patient-reported outcomes in COPD.
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MESH Headings
- Adaptation, Psychological
- Delivery of Health Care, Integrated
- Health Behavior
- Health Knowledge, Attitudes, Practice
- History, 20th Century
- History, 21st Century
- Humans
- Lung/physiopathology
- Patients/psychology
- Pulmonary Disease, Chronic Obstructive/diagnosis
- Pulmonary Disease, Chronic Obstructive/history
- Pulmonary Disease, Chronic Obstructive/physiopathology
- Pulmonary Disease, Chronic Obstructive/psychology
- Pulmonary Disease, Chronic Obstructive/therapy
- Quality of Life
- Self Care/history
- Treatment Outcome
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Affiliation(s)
- Ad A Kaptein
- Medical Psychology Section, Leiden University Medical Centre (LUMC), Leiden, the Netherlands
| | - Maarten J Fischer
- Medical Psychology Section, Leiden University Medical Centre (LUMC), Leiden, the Netherlands
| | - Margreet Scharloo
- Medical Psychology Section, Leiden University Medical Centre (LUMC), Leiden, the Netherlands
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