Hospital-admitted COPD patients treated at home using telemedicine technology in The Virtual Hospital Trial: methods of a randomized effectiveness trial

Trials

Klaus V Phanareth⁴  Susan Rydahl-Hansen³  Birte Østergaard²  Lars C Laursen¹  Anna Svarre Jakobsen³ 

[1]Medical Department O, Herlev University Hospital, Herlev Ringvej 75, DK 2730, Herlev, Denmark

[2]Research Unit of Nursing, Institute of Clinical Research, University of Southern Denmark, Campusvej 55, DK 5230, Odense M, Denmark

[3]Research Unit of Clinical Nursing, Bispebjerg & Frederiksberg University Hospital, Bispebjerg Bakke 23a, DK 2400, Copenhagen, NV, Denmark

[4]Medical Department M, Frederiksberg University Hospital, Nordre Fasanvej 57, DK 2000, Frederiksberg, Denmark

关键词: Telehealth;    Hospital admission;    Readmissions;    COPD;    Telemedicine technology;    Acute exacerbation;   

Others  :  1093115
DOI  :  10.1186/1745-6215-14-280

 received in 2013-04-24, accepted in 2013-08-27,  发布年份 2013

【 摘 要 】

Background

Recent reviews suggest that telemedicine solutions for patients with chronic obstructive pulmonary disease (COPD) may prevent hospital readmissions and emergency room visits and improve health-related quality of life. However, the studies are few and only involve COPD patients who are in a stable phase or in-patients who are ready for discharge. COPD patients hospitalized with an acute exacerbation may also benefit from telemedicine solutions. The overall aim is to investigate a telemedicine-based treatment solution for patients with acute exacerbation of COPD at home as compared to conventional hospital treatment measured according to first treatment failure, which is defined as readmission due to COPD within 30 days after discharge.

Methods

COPD patients with acute exacerbation who fulfilled the eligibility criteria and were from two university hospitals in Denmark were randomized (1:1) by computer-generated tables that allocated treatments in blocks of four to receive either standard treatment at the hospital or the same standard treatment at home using telemedicine technology (that is, a video conference system with a touch screen and webcam and monitoring equipment (spirometer, thermometer, and pulse oximeter)). Patients treated in the telemedicine group were backed up by an organizational setting securing 24/7/365 online access to the hospital, as well as access to oxygen, nebulizer therapy, oral medical therapy and surveillance of vital parameters from home monitoring devices. Patients in both groups were discharged when clinically stable and when fulfilling five pre-specified discharge criteria. Follow-up was performed at 1, 3 and 6 months after discharge.

The primary outcome was treatment failure defined as readmission due to exacerbation in COPD within 30 days. Secondary outcomes were death from any cause, prescription of additional antibiotics or steroids, need of intubation or non-invasive ventilation, emergency room visits, visits to the general practitioner, lung function, bed days, health-related quality of life, healthcare costs and user satisfaction.

Results

Enrollment of patients started in June 2010 and ended in December 2011. Follow-up ended in May 2012. Results were analyzed in 2013.

Conclusions

The results may have implications on future hospital treatment modalities for patients with severe exacerbations in COPD where telemedicine may be used as an alternative to conventional admission.

Trial registration

Clinical Trials NCT01155856

【 授权许可】

   
2013 Jakobsen et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]World Health Organization: Burden of COPD. http://www.who.int/respiratory/copd/burden/en/index.html webcite
• [2]Hansen JG, Pedersen L, Overvad K, Omland Ø, Jensen HK, Sørensen HT: The prevalence of chronic obstructive pulmonary disease among Danes aged 45–84: population based study. COPD 2008, 5:347-352.
• [3]Sundhedsstyrelsen: KOL: Kronisk Obstruktiv Lungesygdom, anbefalinger for tidlig opsporing, opfølgning, behandling og rehabilitering. http://www.sst.dk/publ/Publ2007/CFF/KOL/KOLanbefalinger.pdf webcite
• [4]Teknologirådet: Sundhedsydelser med IT - Pervasive HealthCare i den danske sundhedssektor. Vurderinger og anbefalinger fra en arbejdsgruppe under Teknologirådet. http://www.tekno.dk/pdf/projekter/p06_pervasive-healthcare.pdf webcite
• [5]Smith SM, Elkin SL, Partrigde MR: Technology and its role in respiratory care. Prim Care Resp J 2009, 18:159-164.
• [6]Steventon A, Bardsley M, Billings J, Dixon J, Doll H, Hirani S, Cartwright M, Rixon L, Knapp M, Henderson C, Rogers A, Fitzpatrick R, Hendy J, Newman S, Whole System Demonstrator Evaluation Team: Effect of telehealth on use of secondary care and mortality: findings from the Whole System Demonstrator cluster randomized trial. BMJ 2012, 344:e3874.
• [7]Bolton CE, Waters CS, Peirce S, Elwyn G, EPSRC and MRC Grand Challenge Team: Insufficient evidence of a benefit: a systematic review of home telemonitoring in COPD. J Eval Clin Pract 2011, 17:1216-1222.
• [8]Jakobsen AS, Laursen LC, Schou L, Emme C, Phanareth KV: Varying effect of telemedicine in the treatment of chronic obstructive pulmonary disease – a systematic review. Ugeskr Laeger 2012, 174:936-942.
• [9]Mclean S, Nurmatov U, Liu JL, Pagliari C, Car J, Sheikh A: Telehealthcare for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2011, 7:CD007718.
• [10]Polisena J, Tran K, Cimon K, Hutton B, Mcgill S, Palmer K, Scott RE: Home telehealth for chronic obstructive pulmonary disease: a systematic review and meta-analysis. J Telemed Telecare 2010, 16:120-127.
• [11]Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD). 2011. http://www.goldcopd.org/ webcite
• [12]Anthonisen NR, Manfreda J, Warren CP, Hershfield ES, Harding GK, Nelson NA: Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med 1987, 106:196-204.
• [13]Niewoehner DE, Erbland ML, Deupree RH, Collins D, Gross NJ, Light RW, Anderson P, Morgan NA, Department of Veterans Affairs Cooperative Study Group: Effect of systemic glucocorticoids on exacerbations of chronic obstructive pulmonary disease. N Engl J Med 1999, 340:1941-1947.
• [14]Erbland ML, Deupree RH, Niewoehner DE: Systemic corticosteroids in chronic obstructive pulmonary disease exacerbations (SCCOPE): rationale and design of an equivalence trial. Control Clin Trials 1998, 19:404-417.
• [15]The CONSORT statement website. http://www.consort-statement.org/ webcite
• [16]Emme C, Mortensen EL, Rydahl-Hansen S, Østergaard B, Phanareth K: Danish version of “The COPD self-efficacy scale”; translation and psychometric properties. Scand J Caring Sci 2012, 26:615-623.
• [17]Schafer JL, Graham JW: Missing data: our view of the state of the art. Psychol Methods 2002, 7:147-77.
• [18]Genindlæggelser af ældre i Danmark: Genindlæggelser af ældre i Danmark. 2008. http://www.sst.dk/publ/Publ2009/DOKU/nye_tal/Genindlaeggelser2008_final_uden_bilag.pdf webcite