November 12, 2009 (San Diego, California) — A notable reduction in unscheduled healthcare utilization was documented at one institution in patients with chronic obstructive pulmonary disease (COPD) enrolled in an automated telemedicine program. A new study found that proactive monitored self-management resulted in the early detection and treatment of COPD exacerbations and cut patient visits to the hospital in half, according to results released here at CHEST 2009: American College of Chest Physicians Annual Meeting.
The retrospective analysis was conducted by Toby R. Smith, MD, from Pulmonary and Critical Care, Willis Knighton Medical Center, and Louisiana State University Health Science Center in Shreveport, and colleagues. It that looked at 100 patients with advanced COPD and a history of frequent exacerbations at the Overton Brooks Veterans Affairs (VA) Medical Center in Shreveport.
Patients were given the iCare Health Buddy telemedicine intervention system — a small, wireless, electronic device that costs about $50 per month. The device asks health status questions to which the patients respond and allows patients to measure their temperature, pulse oximetry, heart rate, breathing rate, and vital signs. There are some 25 outcomes measures for COPD and miscellaneous other health assessment measures, Dr. Smith told Medscape Pulmonary Medicine.
Some of the health status questions are:
How's your breathing today?
Did you use your inhaler?
Have you taken all your COPD medicines as your doctor ordered them?
Do you feel rested this morning?
Do you have more shortness of breath than usual today?
In the past 48 hours, have you been wheezing more than usual?
Are you having trouble doing your usual routine activities today?
Data are transmitted daily to a monitoring center where a registered nurse reviews responses, symptoms, vital signs, and medications.
In this study, interventions based on an indication of decompensation were made at the discretion of practitioners. If there is an intervention, notes are entered into the patient's chart.
"If the patient's heart rate is elevated, they are informed that the "increased heart rate, along with increases in other symptoms, can be caused by a worsening of your COPD," Dr. Smith explained.
"I think telemedicine in COPD educates patients and gives them better access to healthcare through this self-management program, especially with the nurse right there monitoring them for a better outcome," said Dr. Smith.
"It helps in smoking cessation, for instance, and all responses go to the nurse assigned to COPD patients, who are categorized as low, medium, or high risk," Dr. Smith described.
The researchers found that fewer of the COPD patients were getting to the point of an exacerbation during the monitoring period than in the previous year. The mean reduction was 0.14 visits per year, with a relative reduction of 14.6% (P = .18).
Unscheduled hospital visits for COPD exacerbations were nearly cut in half from the pre-enrollment year's visits (3.59 visits/year prior to monitoring, compared with 1.95 visits/year with the monitoring device; 46% relative reduction; P = .003).
"Right now, we're setting up data from all the VA hospitals throughout the region. We have about 1200 enrolled in the telehealth program. We're looking at [these patients] retrospectively to see how the program has benefited them," said Dr. Smith. "We're also looking at healthcare utilization to see if it has decreased, which reduces the costs of this disease to the patient and to the treating institution. The preliminary data, based on our smaller study, show that it may reduce this utilization."
Commenting on the study for Medscape Pulmonary Medicine was Mark J. Rosen, MD, chief, Division of Pulmonary and Critical Care and Sleep Medicine at North Shore University Hospital Long Island Jewish Medical Center in New Hyde Park, New York. "Anything you do to improve communication with patients will probably have a positive impact," he said. "To the extent that telecommunications makes things easier for both practitioners and patients, it will probably lead to improved outcomes. Telemedicine in COPD patients makes perfect sense."
The study did not receive commercial support. Dr. Smith and Dr. Rosen have disclosed no relevant financial relationships.
CHEST 2009: American College of Chest Physicians Annual Meeting: Poster 8918. Presented November 4, 2009.
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Cite this: Telemedicine Increases Compliance, Reduces Costs in Patients With COPD - Medscape - Nov 12, 2009.
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