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Ramachandran HJ, Oh JL, Cheong YK, Jiang Y, Teo JYC, Seah CWA, Yu M, Wang W. Barriers and facilitators to the adoption of digital health interventions for COPD management: A scoping review. Heart Lung 2023; 59:117-127. [PMID: 36801546 DOI: 10.1016/j.hrtlng.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/01/2023] [Accepted: 02/05/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Knowledge of the barriers and facilitators in the adoption of digital health interventions (DHI) is sparse yet crucial to facilitate chronic obstructive pulmonary disease (COPD) management. OBJECTIVES This scoping review aimed to summarize patient- and healthcare provider-level barriers and facilitators in the adoption of DHIs for COPD management. METHODS Nine electronic databases were searched from inception up till October 2022 for English language evidence. Inductive content analysis was used. RESULTS This review included 27 papers. Frequent patient-level barriers were poor digital literacy (n = 6), impersonal care delivery (n = 4), and fear of being controlled by telemonitoring data (n = 4). Frequent patient-level facilitators were improved disease understanding and management (n = 17), bi-directional communication and contact with healthcare providers (n = 15), and remote monitoring and feedback (n = 14). Frequent healthcare provider-level barriers were increased workload (n = 5), lack of technology interoperability with existing health systems (n = 4), lack of funding (n = 4), and lack of dedicated and trained manpower (n = 4). Frequent healthcare provider-level facilitators were improved efficiency of care delivery (n = 6) and DHI training programmes (n = 5). CONCLUSION DHIs have the potential to facilitate COPD self-management and improve efficiency of care delivery. However, several barriers challenge its successful adoption. Attaining organizational support in developing user centric DHIs that can be integrated and are interoperable with existing health systems is crucial if we are to witness tangible return on investments at the patient-, healthcare provider- and healthcare system-level.
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Affiliation(s)
- Hadassah Joann Ramachandran
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Block MD 11, 10 Medical Drive 117597, Singapore.
| | - Joo Lin Oh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Block MD 11, 10 Medical Drive 117597, Singapore
| | - Yue Krystal Cheong
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Block MD 11, 10 Medical Drive 117597, Singapore
| | - Ying Jiang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Block MD 11, 10 Medical Drive 117597, Singapore
| | - Jun Yi Claire Teo
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Block MD 11, 10 Medical Drive 117597, Singapore
| | - Chuen Wei Alvin Seah
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Block MD 11, 10 Medical Drive 117597, Singapore
| | - Mingming Yu
- School of Nursing, Peking University, Beijing, China
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Block MD 11, 10 Medical Drive 117597, Singapore
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2
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Peters GM, Doggen CJM, van Harten WH. Budget impact analysis of providing hospital inpatient care at home virtually, starting with two specific surgical patient groups. BMJ Open 2022; 12:e051833. [PMID: 35914920 PMCID: PMC9345035 DOI: 10.1136/bmjopen-2021-051833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To determine the budget impact of virtual care. METHODS We conducted a budget impact analysis of virtual care from the perspective of a large teaching hospital in the Netherlands. Virtual care included remote monitoring of vital signs and three daily remote contacts. Net budget impact over 5 years and net costs per patient per day (costs/patient/day) were calculated for different scenarios: implementation in one ward, in two different wards, in the entire hospital, and in multiple hospitals. Sensitivity analyses included best-case and worst-case scenarios, and reducing the frequency of daily remote contacts. RESULTS Net budget impact over 5 years was €2 090 000 for implementation in one ward, €410 000 for two wards and €-6 206 000 for the entire hospital. Costs/patient/day in the first year were €303 for implementation in one ward, €94 for two wards and €11 for the entire hospital, decreasing in subsequent years to a mean of €259 (SD=€72), €17 (SD=€10) and €-55 (SD=€44), respectively. Projecting implementation in every Dutch hospital resulted in a net budget impact over 5 years of €-445 698 500. For this scenario, costs/patient/day decreased to €-37 in the first year, and to €54 in subsequent years in the base case. CONCLUSIONS With present cost levels, virtual care only saves money if it is deployed at sufficient scale or if it can be designed such that the active involvement of health professionals is minimised. Taking a greenfield approach, involving larger numbers of hospitals, further decreases costs compared with implementing virtual care in one hospital alone.
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Affiliation(s)
- Guido M Peters
- Rijnstate Research Center, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Health Technology and Services Research, Faculty of Behavioural, Management & Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Carine J M Doggen
- Rijnstate Research Center, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Health Technology and Services Research, Faculty of Behavioural, Management & Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Wim H van Harten
- Department of Health Technology and Services Research, Faculty of Behavioural, Management & Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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Telemedicine as a Means to an End, Not an End in Itself. Life (Basel) 2022; 12:life12010122. [PMID: 35054515 PMCID: PMC8777880 DOI: 10.3390/life12010122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/10/2022] [Accepted: 01/13/2022] [Indexed: 11/16/2022] Open
Abstract
Telemedicine (TM)—the management of disease at a distance—has potential usefulness for patients with advanced respiratory disease. Underscoring this potential is the dramatic expansion of its applications in clinical medicine. However, since clinical studies testing this intervention often provide heterogeneous results, its role in the medical management of respiratory disorders remains inconclusive. A major problem in establishing TM’s effectiveness is that it is not a single intervention; rather, it includes a number of divergent diagnostic and therapeutic modalities—and each must be tested separately. Reflecting the discord between the need for further documentation of its approaches and effectiveness and its rapid utilization without this needed information, a major challenge is the lack of international guidelines for its integration, regulation, operational plans, and guidance for professionals. Tailored TM, with increased flexibility to address differing healthcare contexts, has the potential to improve access to and quality of services while reducing costs and direct input by health professionals. We should view TM as a tool to aid healthcare professionals in managing their patients with respiratory diseases rather than as a stand-alone substitute to traditional medical care. As such, TM is a means rather than an end.
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Shah NM, Kaltsakas G. Telemedicine in the management of patients with chronic respiratory failure. Breathe (Sheff) 2021; 17:210008. [PMID: 34295411 PMCID: PMC8291909 DOI: 10.1183/20734735.0008-2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/12/2021] [Indexed: 12/20/2022] Open
Abstract
Patients with chronic respiratory failure are often required to attend multiple hospital appointments, which may be difficult due to their physical disabilities and the amount of equipment they are required to bring. Their caregivers often struggle with the lack of immediate care available when the patient suffers difficulties at home. Telemedicine is an opportunity to bridge the gap between home and healthcare professionals by allowing the healthcare team to reach into patients' homes to provide more frequent support. The evidence for the use of telemedicine in patients with chronic respiratory failure remains equivocal. Although the uptake of telemedicine has been slow, the SARS-CoV-2 pandemic has resulted in the rapid dissemination of telemedicine to allow the delivery of care to vulnerable patients while reducing the need for their attendance in hospital. Logistical and legal challenges to the delivery of telemedicine remain, but the pandemic may serve as a driver to ameliorate these challenges and facilitate wider use of this technology to improve the experience of patients with chronic respiratory failure. Educational aims To provide an overview of the rationale for delivering care via telemedicine for patients with chronic respiratory failure.To provide the evidence base for establishing a telemedicine service.To highlight the potential opportunities and challenges in delivering a telemedicine service for patients with chronic respiratory failure.
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Affiliation(s)
- Neeraj M Shah
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
| | - Georgios Kaltsakas
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
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5
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Majorski DS, Duiverman ML, Windisch W, Schwarz SB. Long-term noninvasive ventilation in COPD: current evidence and future directions. Expert Rev Respir Med 2021; 15:89-101. [PMID: 33245003 DOI: 10.1080/17476348.2021.1851601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction: Long-term noninvasive ventilation (NIV) is an established treatment for end-stage COPD patients suffering from chronic hypercapnic respiratory failure. This is reflected by its prominent position in national and international medical guidelines. Areas covered: In recent years, novel developments in technology such as auto-titrating machines and hybrid modes have emerged, and when combined with advances in information and communication technologies, these developments have served to improve the level of NIV-based care. Such progress has largely been instigated by the fact that healthcare systems are now confronted with an increase in the number of patients, which has led to the need for a change in current infrastructures. This article discusses the current practices and recent trends, and offers a glimpse into the future possibilities and requirements associated with this form of ventilation therapy. Expert opinion: Noninvasive ventilation is an established and increasingly used treatment option for patients with chronic hypercapnic COPD and those with persistent hypercapnia following acute hypercapnic lung failure. The main target is to augment alveolar hypoventilation by reducing PaCO2 to relieve symptoms. Nevertheless, when dealing with severely impaired patients, it appears necessary to switch the focus to patient-related outcomes such as health-related quality of life.
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Affiliation(s)
- Daniel S Majorski
- Department of Pneumology, Cologne Merheim Hospital , Cologne, Germany.,Faculty of Health/School of Medicine, Witten/Herdecke University , Witten, Germany
| | - Marieke L Duiverman
- Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
| | - Wolfram Windisch
- Department of Pneumology, Cologne Merheim Hospital , Cologne, Germany.,Faculty of Health/School of Medicine, Witten/Herdecke University , Witten, Germany
| | - Sarah B Schwarz
- Department of Pneumology, Cologne Merheim Hospital , Cologne, Germany.,Faculty of Health/School of Medicine, Witten/Herdecke University , Witten, Germany
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6
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Crimi C, Pierucci P, Carlucci A, Cortegiani A, Gregoretti C. Long-Term Ventilation in Neuromuscular Patients: Review of Concerns, Beliefs, and Ethical Dilemmas. Respiration 2019; 97:185-196. [PMID: 30677752 DOI: 10.1159/000495941] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 12/03/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Noninvasive mechanical ventilation (NIV) is an effective treatment in patients with neuromuscular diseases (NMD) to improve symptoms, quality of life, and survival. SUMMARY NIV should be used early in the course of respiratory muscle involvement in NMD patients and its requirements may increase over time. Therefore, training on technical equipment at home and advice on problem solving are warranted. Remote monitoring of ventilator parameters using built-in ventilator software is recommended. Telemedicine may be helpful in reducing hospital admissions. Anticipatory planning and palliative care should be carried out to lessen the burden of care, to maintain or withdraw from NIV, and to guarantee the most respectful management in the last days of NMD patients' life. Key Message: Long-term NIV is effective but challenging in NMD patients. Efforts should be made by health care providers in arranging a planned transition to home and end-of-life discussions for ventilator-assisted individuals and their families.
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Affiliation(s)
- Claudia Crimi
- Respiratory Medicine Unit, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Paola Pierucci
- Cardiothoracic Department, Respiratory and Sleep Medicine Unit, Policlinico University Hospital, Bari, Italy
| | - Annalisa Carlucci
- Respiratory Intensive Care Unit, Pulmonary Rehabilitation Unit, IRCCS Fondazione S. Maugeri, Pavia, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy,
| | - Cesare Gregoretti
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy
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7
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Vitacca M, Montini A, Comini L. How will telemedicine change clinical practice in chronic obstructive pulmonary disease? Ther Adv Respir Dis 2019; 12:1753465818754778. [PMID: 29411700 PMCID: PMC5937158 DOI: 10.1177/1753465818754778] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Within telehealth there are a number of domains relevant to pulmonary care: telemonitoring, teleassistance, telerehabilitation, teleconsultation and second opinion calls. In the last decade, several studies focusing on the effects of various telemanagement programs for patients with chronic obstructive pulmonary disease (COPD) have been published but with contradictory findings. From the literature, the best telemonitoring outcomes come from programs dedicated to aged and very sick patients, frequent exacerbators with multimorbidity and limited community support; programs using third-generation telemonitoring systems providing constant analytical and decisionmaking support (24 h/day, 7 days/week); countries where strong community links are not available; and zones where telemonitoring and rehabilitation can be delivered directly to the patient's location. In the near future, it is expected that telemedicine will produce changes in work practices, cultural attitudes and organization, which will affect all professional figures involved in the provision of care. The key to optimizing the use of telemonitoring is to correctly identify who the ideal candidates are, at what time they need it, and for how long. The time course of disease progression varies from patient to patient; hence identifying for each patient a 'correct window' for initiating telemonitoring could be the correct solution. In conclusion, as clinicians, we need to identify the specific challenges we face in delivering care, and implement flexible systems that can be customized to individual patients' requirements and adapted to our diverse healthcare contexts.
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Affiliation(s)
- Michele Vitacca
- Istituti Clinici Scientifici Maugeri, IRCCS Lumezzane, Respiratory Rehabilitation Division, Via G Mazzini 129, Lumezzane (BS) 25065, Italy
| | - Alessandra Montini
- Respiratory Rehabilitation Division, Istituti Clinici Scientifici Maugeri IRCCS Lumezzane (Brescia), Italy
| | - Laura Comini
- Health Directorate, Istituti Clinici Scientifici Maugeri IRCCS Lumezzane (Brescia), Italy
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8
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Lee JH, Park YR, Kweon S, Kim S, Ji W, Choi CM. A Cardiopulmonary Monitoring System for Patient Transport Within Hospitals Using Mobile Internet of Things Technology: Observational Validation Study. JMIR Mhealth Uhealth 2018; 6:e12048. [PMID: 30429115 PMCID: PMC6262206 DOI: 10.2196/12048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/19/2018] [Accepted: 10/19/2018] [Indexed: 11/13/2022] Open
Abstract
Background During intrahospital transport, adverse events are inevitable. Real-time monitoring can
be helpful for preventing these events during intrahospital transport. Objective We attempted to determine the viability of risk signal detection using wearable devices
and mobile apps during intrahospital transport. An alarm was sent to clinicians in the
event of oxygen saturation below 90%, heart rate above 140 or below 60 beats per minute
(bpm), and network errors. We validated the reliability of the risk signal transmitted
over the network. Methods We used two wearable devices to monitor oxygen saturation and heart rate for 23
patients during intrahospital transport for diagnostic workup or rehabilitation. To
determine the agreement between the devices, records collected every 4 seconds were
matched and imputation was performed if no records were collected at the same time by
both devices. We used intraclass correlation coefficients (ICC) to evaluate the
relationships between the two devices. Results Data for 21 patients were delivered to the cloud over LTE, and data for two patients
were delivered over Wi-Fi. Monitoring devices were used for 20 patients during
intrahospital transport for diagnostic work up and for three patients during
rehabilitation. Three patients using supplemental oxygen before the study were included.
In our study, the ICC for the heart rate between the two devices was 0.940 (95% CI
0.939-0.942) and that of oxygen saturation was 0.719 (95% CI 0.711-0.727). Systemic
error analyzed with Bland-Altman analysis was 0.428 for heart rate and –1.404 for oxygen
saturation. During the study, 14 patients had 20 risk signals: nine signals for eight
patients with less than 90% oxygen saturation, four for four patients with a heart rate
of 60 bpm or less, and seven for five patients due to network error. Conclusions We developed a system that notifies the health care provider of the risk level of a
patient during transportation using a wearable device and a mobile app. Although there
were some problems such as missing values and network errors, this paper is meaningful
in that the previously mentioned risk detection system was validated with actual
patients.
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Affiliation(s)
- Jang Ho Lee
- Department of Pulmonology and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yu Rang Park
- Department of Biomedical System Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Solbi Kweon
- Department of Biomedical System Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seulgi Kim
- Department of Pulmonology and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Wonjun Ji
- Department of Pulmonology and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chang-Min Choi
- Department of Pulmonology and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.,Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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9
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Donner CF, Raskin J, ZuWallack R, Nici L, Ambrosino N, Balbi B, Blackstock F, Casaburi R, Dreher M, Effing T, Goldstein R, Krishnan J, Lareau SC, Make BJ, Maltais F, Meek P, Morgan M, Pépin JL, Rabbito C, Rochester CL, Silverman AR, Singh S, Spruit MA, Vitacca M, Williams L. Incorporating telemedicine into the integrated care of the COPD patient a summary of an interdisciplinary workshop held in Stresa, Italy, 7-8 September 2017. Respir Med 2018; 143:91-102. [PMID: 30261999 DOI: 10.1016/j.rmed.2018.09.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 09/03/2018] [Indexed: 10/28/2022]
Abstract
This report is a summary of a workshop focusing on using telemedicine to facilitate the integrated care of chronic obstructive pulmonary disease (COPD). Twenty-five invited participants from 8 countries met for one and one-half days in Stresa, Italy on 7-8 September 2017, to discuss this topic. Participants included physiotherapists, nurses, a nurse practitioner, and physicians. While evidence-based data are always at the center of sound inference and recommendations, at this point in time the science behind telemedicine in COPD remains under-developed; therefore, this document reflects expert opinion and consensus. While telemedicine has great potential to expand and improve the care of our COPD patients, its application is still in its infancy. While studies have demonstrated its effectiveness in some patient-centered outcomes, the results are by no means consistently positive. Whereas this tool may potentially reduce health care costs by moving some medical interventions from centralized locations in to patient's home, its cost-effectiveness has had mixed results and telemonitoring has yet to prove its worth in the COPD population. These discordant results should not be unexpected in view of patient complexity and the heterogeneity of telemedicine. This is reflected in the very limited support offered by the National Health Services to a wider application of telemedicine in the integrated care of COPD patients. However, this situation should challenge us to develop the necessary science to clarify the role of telemedicine in the medical management of our patients, providing a better and definitive scientific basis to this approach.
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Affiliation(s)
- Claudio F Donner
- Fondazione Mondo Respiro ONLUS, Via Monsignor Cavigioli, 10, 28021, Borgomanero, NO, Italy.
| | - Jonathan Raskin
- Pulmonary and Internal Medicine, 1000 Park Ave, New York, NY, 10028, USA.
| | - Richard ZuWallack
- University of CT, Pulmonary and Critical Care, St Francis Hospital and Medical Center, Hartford, CT, 06015, USA.
| | | | | | - Bruno Balbi
- ICS Maugeri, I.R.C.C.S. Institute of Veruno (Novara), Italy.
| | - Felicity Blackstock
- School of Science and Health, Western Sydney University, Sydney, New South Wales, Australia.
| | - Richard Casaburi
- UCLA School of Medicine, Rehabilitation Clinical Trial Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center Torrance, California, 90502, USA.
| | - Michael Dreher
- Division of Pneumology, University Hospital RWTH Aachen, Germany.
| | - Tanja Effing
- College of Medicine & Public Health, Flinders University, Adelaide, Australia, Department of Respiratory Medicine, Southern Adelaide Local Health Network, Adelaide, Australia.
| | - Roger Goldstein
- University of Toronto, NSA Chair in Respiratory Rehabilitation Research, USA.
| | | | - Suzanne C Lareau
- College of Nursing, Univ. of Colorado Denver, Anschutz Medical Campus, C288-04, ED 2 North, Rm 4327, 13120 East 19th Ave, Aurora, CO, 80045, USA.
| | - Barry J Make
- Department of Medicine, University of Colorado, USA.
| | - Francois Maltais
- Institut Universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Canada.
| | - Paula Meek
- College of Nursing, Anschutz Medical Campus, University of Colorado, USA.
| | - Michael Morgan
- University of Leicester, Chair NHS England Respiratory Clinical Reference Group, National Clinical Director Respiratory NHS, UK.
| | - Jean-Louis Pépin
- Sleep and Exercise Department, Scientific Director of Clinical Research Administration, Research Division at Grenoble University Hospital, Grenoble, FR, France.
| | - Chiara Rabbito
- Rabbito Law Firm, Via Piave 44, San Lazzaro, 40068, BO, Italy.
| | - Carolyn L Rochester
- Yale University School of Medicine, Pulmonary Rehabilitation Program, VA Connecticut Healthcare System, USA.
| | - Adam R Silverman
- Quinnipiac University School of Medicine, 95 Woodland St, 4th Floor, Hartford, CT, 06105, USA.
| | - Sally Singh
- University Hospitals of Leicester Leicester, UK.
| | - Martijn A Spruit
- Department of Research and Education, Ciro, Horn, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands; REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium.
| | - Michele Vitacca
- Respiratory Department ICS S. Maugeri IRCCS Lumezzane (Bs) Italy, Respiratory Department, Via Mazzini 129, Lumezzane, 25066, Bs, Italy.
| | - Loreen Williams
- Management Program, Pulmonary and Critical Care, St Francis Hospital & Med Ctr, Hartford, CT, 06105, USA.
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10
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Granger CL, Wijayarathna R, Suh ES, Arbane G, Denehy L, Murphy P, Hart N. Uptake of telehealth implementation for COPD patients in a high-poverty, inner-city environment: A survey. Chron Respir Dis 2017; 15:81-84. [PMID: 28513197 PMCID: PMC5802654 DOI: 10.1177/1479972317707653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study aimed to investigate computer and internet access and education attained in patients with chronic obstructive pulmonary disease (COPD) as potential barriers to implementation of telemedicine. We prospectively assessed 98 patients admitted with an acute exacerbation of COPD (mean age: 70.5 ± 9.3 years; force expired volume in the first second: 0.75 ± 0.39 L; 59% male) recording educational level attained and home computer and internet access. Hospital readmission surveillance occurred up to 2.7 (2.6-2.8) years following the index hospital admission. Only 16% of patients had a computer and only 14% had internet access; this group were younger and more educated than those without a computer. There was no difference in hospital readmissions over 2 years between those with and without access to a computer or internet. Only 12% of the whole cohort were educated to a school leaving age of 16 years and this group were more likely to be still working. School leaving age was directly associated with fewer hospital readmissions ( r = 0.251, p = 0.031). In conclusion, these data highlight the current challenges to the widespread implementation of telehealth in COPD patients as there is limited availability of computer and internet access with such patients demonstrating a lower level of education achievement.
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Affiliation(s)
- Catherine L Granger
- 1 Department of Physiotherapy, The University of Melbourne, Melbourne, Australia.,2 Department of Physiotherapy, Royal Melbourne Hospital, Melbourne, Australia.,3 Lane Fox Respiratory Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Rachel Wijayarathna
- 3 Lane Fox Respiratory Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Eui-Sik Suh
- 3 Lane Fox Respiratory Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK.,4 Division of Asthma, Allergy and Lung Biology, King's College London, London, UK
| | - Gill Arbane
- 3 Lane Fox Respiratory Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Linda Denehy
- 1 Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - Patrick Murphy
- 3 Lane Fox Respiratory Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK.,4 Division of Asthma, Allergy and Lung Biology, King's College London, London, UK
| | - Nicholas Hart
- 3 Lane Fox Respiratory Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK.,4 Division of Asthma, Allergy and Lung Biology, King's College London, London, UK
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