Please select the eligibility criteria that correspond to the clinical trial below.
Title: Effectiveness and Cost-effectiveness of Telemedicine for Chronic Obstructive Pulmonary Disease: The Danish "TeleCare North" Pragmatic Cluster-randomized Trial.
Brief Summary: There are two main aims in this study. The first objective is to evaluate whether a particular telehealth solution, in addition to standard treatment and care, lead to a significant decrease in the mortality and an increase in health related quality of life for patients suffering from COPD that may benefit from telehealth compared with only standard treatment and care. The second objective is to examine the additional costs of the telehealth solution and assess whether this solution is a cost-effective way to care for patients with COPD across patients and municipality districts.

It is hypothesized that telehealth care will increase patients quality adjusted life years at both the cluster and individual level compared to usual practice, since no difference in mortality and a higher health related quality of life is expected. Furthermore, it is hoped that there will be a 30% reduction in the number of admissions and readmissions to hospitals and a 30% reduction in the number of outpatient visits resulting in fewer costs for hospitals. However, it is uncertain as to whether these savings are offset by other costs such as more visits to general practitioners, community care or the implementation costs.


Options:
A: Inclusion Criteria:

* Clinically diagnosed chronic obstructive pulmonary disease (COPD), confirmed by post-bronchodilator spirometry and defined as a ratio of Forced Expiratory VolumeFEV1 to Forced Vital Capacity \<0.7 and \<lower limit of normal for age post bronchodilator use
* ≥2 Acute Exacerbations of COPD (AECOPD) in the previous 12 months according to the patient and/or ≥1 hospital admission for AECOPD
* Exacerbation free for at least 6 weeks
* An age of at least 18 years
* Willing and able to comply with the data collection process out to 12 months from randomisation
* Ability to consent
* Ability to use intervention as judged by the investigator at screening, upon demonstration of the system to the patient

Exclusion Criteria:

* Life expectancy \< 12 months
* Patients with active infection, unstable co-morbidities at enrolment or very severe comorbidities such as grade IV heart failure, renal failure on haemodialysis or active neoplasia or significant cognitive impairment;
B: Inclusion Criteria:

* Appropriately signed and dated informed consent has been obtained;
* ED patients presenting with an acute exacerbation of COPD requiring treatment in the ED;
* Previous physician-diagnosis of COPD (e.g., emphysema, chronic bronchitis or COPD) either previously or within the ED;
* Age \> 40 years of age;
* Current or former smokers of more than 10 pack years (number of packs of cigarettes {or pipe and/or cigars) smoked per day X the number of years of smoking);
* FEV1/FVC ratio \< 0.7 for age, sex and height (either known or determined within the ED);
* Patients can read and comprehend English language.

Exclusion Criteria:

* Patients presenting for prescription renewal;
* Patients who require hospitalization;
* Patients who do not have a primary care physician or patients for whom a family physician cannot be found;
* Patients who have already been enrolled in the study;
* Patients with a ED physician-diagnosis of primary asthma, pneumonia, HIV/AIDS, immuno-compromise, or life expectance of \< 90 days;
* Patients who, in the opinion of the investigator, should be excluded.
C: Inclusion Criteria:

* diagnosed COPD by spirometry
* in treatment corresponding to GOLD-guidelines
* motivated for treatment of COPD
* COPD is the primary disease
* fixed residence and be affiliated to a general practitioner in North Denmark Region
* At least one of the following criteria should also be met: MRCm (modified) ≥ 2 or MRC ≥3, CAT ≥ 10, have had at least 2 exacerbations within the last 12 months

Exclusion Criteria:

* no phone line or GSM coverage
* unable to understand Danish sufficiently to complete study questionnaires
* have a cognitive impairment
D: Inclusion Criteria:

* Who has been diagnosed with COPD for more than 6 months
* No exacerbation for at least 4 weeks, stable period
* Followed up at Akdeniz University Hospital Chest Diseases Polyclinic
* Clear conscious (evaluated by Sandartize Mini-Mental Test higher than 23 points)
* No verbal communication barriers
* Individual phone owner
* No hearing or communication problems on the phone
* 18 years and older
* Literate
* Agree to participate in the research

Exclusion Criteria:

* Not getting enough points from the Standardized Mini-Mental Test
* A diagnosis of malignancy (based on file information)

Answer: C