Effectiveness of Telemonitoring in Patients with Chronic Obstructive Pulmonary Disease in Taiwan-A Randomized Controlled Trial Home telemonitoring and quality of life in stable, optimised chronic obstructive pulmonary disease Exploring telemonitoring and self-management by patients with chronic obstructive pulmonary disease: a qualitative study embedded in a randomized controlled trial. Effects of home telemonitoring to support improved care for chronic obstructive pulmonary diseases. Continuity, but at what cost? The impact of telemonitoring COPD on continuities of care: a qualitative study. Does Home Telemonitoring after Pulmonary Rehabilitation Reduce Healthcare Use in Optimized COPD?? A Pilot Randomized Trial Telemonitoring in Chronic Obstructive Pulmonary Disease (CHROMED). A Randomized Clinical Trial Telemonitoring for chronic obstructive pulmonary disease: a cost and cost-utility analysis of a randomised controlled trial A randomised clinical trial of the effectiveness of home-based health care with telemonitoring in patients with COPD Telemedicine Experience for Chronic Care in COPD Efficacy of multiparametric telemonitoring on respiratory outcomes in elderly people with COPD: a randomized controlled trial Effectiveness of telemonitoring integrated into existing clinical services on hospital admission for exacerbation of chronic obstructive pulmonary disease: researcher blind, multicentre, randomised controlled trial Home telemonitoring for patients with acute exacerbation of chronic obstructive pulmonary disease: a randomized controlled trial The E-coach transition support computer telephony implementation study: protocol of a randomized trial. Effects of telemonitoring in patients with chronic obstructive pulmonary disease. Assessment of a primary care-based telemonitoring intervention for home care patients with heart failure and chronic lung disease. The TELBIL study Effectiveness of chronic obstructive pulmonary disease self-management interventions in primary care settings: a systematic review. Randomised crossover trial of telemonitoring in chronic respiratory patients (TeleCRAFT trial) Telemonitoring and Protocolized Case Management for Hypertensive Community-Dwelling Seniors With Diabetes: Protocol of the TECHNOMED Randomized Controlled Trial A Randomized Trial of Telemonitoring Heart Failure Patients A randomized controlled trial of telemonitoring in older adults with multiple chronic conditions: the Tele-ERA study Development and Implementation of the Home Asthma Telemonitoring (HAT) System to Facilitate Asthma Self-Care Long-term integrated telerehabilitation of COPD Patients: a multicentre randomised controlled trial (iTrain)
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 r and omized controlled trial aim ed to investigate effectiveness of telemonitoring in improving COPD patient outcome . In total , 106 subjects were r and omly 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 We conducted a six-month r and omised controlled trial of home telemonitoring for patients with chronic obstructive pulmonary disease ( COPD ) . A total of 40 stable patients with moderate to severe COPD who had completed pulmonary rehabilitation took part . They were r and omised to receive st and ard care ( controls ) or st and ard care plus home telemonitoring ( intervention ) . During the monitoring period , patients in the telemonitoring group recorded their symptoms and physical observations twice daily . The data were transmitted automatically at night via the home telephone line . Nurses could access the data through a website and receive alerting email messages if certain conditions were detected . The patients completed the St George 's Respiratory Question naire , Hospital Anxiety and Depression and the EuroQoL EQ-5D quality of life scores before and after pulmonary rehabilitation , and then periodically during the trial . There were significant and clinical ly important improvements in the scores immediately following pulmonary rehabilitation , but thereafter there were no differences in quality of life scores between the groups at any time , or consistently within either group over time . The study showed that telemonitoring was safe but , despite being well used , it was not associated with changes in quality of life in patients who had stable COPD OBJECTIVE To explore patient and professional views on self-management in the context of telemonitoring in chronic obstructive pulmonary disease ( COPD ) . METHODS Semi-structured interviews with patients with COPD and healthcare professionals participating in a r and omized controlled trial of telemonitoring in Lothian , Scotl and , explored experiences of using telemonitoring , and dynamics in patient-practitioner relationships . Transcribed data were analyzed using the Framework approach . RESULTS 38 patients ( mean age 67.5 years ) and 32 professionals provided 70 interviews . Patients considered that telemonitoring empowered self-management by enhancing their underst and ing of COPD and providing additional justification for their decisions to adjust treatment or seek professional advice . Professionals discussed telemonitoring as promoting compliance with medical advice and encouraged patients to exercise personal responsibility within clinical parameters , but expressed concerns about promoting the sick role and creating dependence on telemonitoring . CONCLUSION Telemonitoring assisted many patients to embrace greater responsibility for their health but the model of service provision remained clinician-centered . A medical model of ' compliant self-management ' may paradoxically have promoted dependence on professionals . PRACTICE IMPLICATION S Patients and professionals shared responsibility for meeting the central objective of prompt management of exacerbations of COPD . Care is needed , however , to minimize the risk in some patients , of telemonitoring increasing dependence on practitioner support OBJECTIVE To assess the impact of a home telemonitoring technology on patients with chronic obstructive pulmonary disease in terms of care satisfaction , patient empowerment , improved quality of life , and utilization of hospital and home care . DESIGN A quasi-experimental retrospective and prospect i ve design was developed with a matched control group to compare the effects of telemonitoring  ( the experimental group , n = 23 ) with the traditional homecare offering  ( the control group , n = 23 ) . MEASUREMENTS Satisfaction , patient empowerment , and quality of life were measured using vali date d Likert scales , whereas the data on care utilization were collected from the participating patients ' medical record . RESULTS Mixed results were observed . The clinical effects of home telemonitoring were very positive in terms of patients ' satisfaction and empowerment . The perceptions of care providers as well as those of patients were congruent in this respect . Also , the study suggests that telemonitoring may have a positive effect on quality of life for patients with chronic obstructive pulmonary diseases . In contrast , the results were disappointing in terms of re source savings for the use of both homecare and hospital care . CONCLUSION Capturing the full potential of these new technologies will require a much more fundamental reorganization of work than just a simple deployment of the technology BACKGROUND Continuity of care is widely regarded as an important marker of quality in the management of patients with long-term conditions . New services that integrate telemonitoring into care pathways have potential to change aspects of continuity in both positive and negative ways . AIMS A telemonitoring service for patients with chronic obstructive pulmonary disease ( COPD ) was introduced in Lothian , Scotl and , in 2009 . A qualitative study , nested within the TELESCOT COPD r and omised control trial , was undertaken to explore the views of patients and professionals on  telemonitoring . The perceived impact of telemonitoring on continuity of care was investigated as part of the research . METHODS Semi-structured interviews were undertaken with 38 patients ( 47 % male , mean age 67.5 years ) . A maximum variation sample in relation to age , sex , socio-economic background , disease severity , and compliance with telemonitoring was recruited . Thirty-two stakeholders ( healthcare professionals and managers ) were interviewed . Transcribed coded data were analysed thematically using the framework approach . Interpretation was supported by multidisciplinary discussion . RESULTS Patients and healthcare professionals considered that relationship-based continuity of care was important in the delivery of telemonitoring services . Managers placed emphasis on improved continuity of clinical management as a means of reducing healthcare costs . However , professionals described many operational challenges arising from the ' bolting-on ' of telemonitoring provision to existing usual care provision which , they considered , result ed in the proliferation of additional managerial discontinuities . CONCLUSIONS Managers and healthcare professionals face major challenges in meeting dem and s for both relationship continuity and continuity of clinical management in the development of telemonitoring services ABSTRACT Aim . To see if home telemonitors reduce healthcare use in those with optimized chronic obstructive pulmonary disease ( COPD ) . Methods . We r and omized 40 stable patients with moderate to severe COPD , who had completed at least 12 sessions of outpatient pulmonary rehabilitation ( PR ) , to receive st and ard care ( Controls ) for 52 weeks or st and ard care plus Docobo HealthHUB monitors at home for 26 weeks followed by 26 weeks st and ard care ( Tm Group ) . During the monitoring period , the Tm Group completed  symptoms and physical observations  twice daily which were stored and then uploaded at 2 am through a freephone l and line . Nurses could access the data through a secure web site and received alerting e-mails if certain combinations of data occurred . Results . There were fewer primary care contacts for chest problems ( p < 0.03 ) in the Tm group , but no differences between the groups in emergency room visits , hospital admissions , days in hospital or contacts to the specialist COPD community nurse team , during the monitoring period . After the monitors were removed , there were no differences between the groups for any of the health care contacts ( p > 0.20 throughout ) . Conclusion . In stable , optimized COPD patients who have already completed PR , telemonitoring in addition to best care , reduces primary care chest contacts but not hospital or specialist team utilization Rationale : Early detection of chronic obstructive pulmonary disease ( COPD ) exacerbations using telemonitoring of physiological variables might reduce the frequency of hospitalization . Objectives : To evaluate the efficacy of home monitoring of lung mechanics by the forced oscillation technique and cardiac parameters in older patients with COPD and comorbidities . Methods : This multicenter , r and omized clinical trial recruited 312 patients with Global Initiative for Chronic Obstructive Lung Disease grade s II to IV COPD ( median age , 71 yr [ interquartile range , 66‐76 yr ] ; 49.6 % grade II , 50.4 % grade s III‐IV ) , with a history of exacerbation in the previous year and at least one nonpulmonary comorbidity . Patients were r and omized to usual care ( n = 158 ) or telemonitoring ( n = 154 ) and followed for 9 months . All telemonitoring patients self‐assessed lung mechanics daily , and in a subgroup with congestive heart failure ( n = 37 ) cardiac parameters were also monitored . An algorithm identified deterioration , triggering a telephone contact to determine appropriate interventions . Measurements and Main Results : Primary outcomes were time to first hospitalization ( TTFH ) and change in the EuroQoL EQ‐5D utility index score . Secondary outcomes included : rate of antibiotic/corticosteroid prescription ; hospitalization ; the COPD Assessment Tool , Patient Health Question naire‐9 , and Minnesota Living with Heart Failure question naire scores ; quality ‐adjusted life years ; and healthcare costs . Telemonitoring did not affect TTFH , EQ‐5D utility index score , antibiotic prescriptions , hospitalization rate , or question naire scores . In an exploratory analysis , telemedicine was associated with fewer repeat hospitalizations ( −54 % ; P = 0.017 ) . Conclusions : In older patients with COPD and comorbidities , remote monitoring of lung function by forced oscillation technique and cardiac parameters did not change TTFH and EQ‐5D . Clinical trial registered with www . clinical trials.gov ( NCT 01960907 ) We compared the costs and cost-effectiveness of telemonitoring vs usual care for patients with chronic obstructive pulmonary disease ( COPD ) . A total of 256 patients were r and omised to either telemonitoring or usual care . In the telemonitoring arm , the touch-screen telemonitoring equipment transmitted data to clinical teams monitoring the patients . Total healthcare costs were estimated over a 12-month period from a National Health Service perspective and quality adjusted life year ( QALYs ) were estimated by the EQ-5D tool . Telemonitoring was not significantly more costly than usual care ( mean difference per patient £ 2065.90 ( P < 0.18 ) . The increased costs were predominantly due to telemonitoring service costs and non-significantly higher secondary care costs . Telemonitoring for COPD was not cost-effective at a base case of £ 137,277 per QALY with only 15 % probability of being cost-effective at the usual threshold of £ 30,000 per QALY . Although there was some statistical and method ological uncertainty in the measures used , telemonitoring was not cost-effective in the sensitivity analyses performed . It seems unlikely that a telemonitoring service of the kind that was trialled would be cost-effective in providing care for people with COPD We studied the effect of telemonitoring in addition to usual care compared to usual care alone in patients with chronic obstructive pulmonary disease ( COPD ) . A total of 110 patients with moderate to severe COPD were recruited from a specialist respiratory service in Northern Irel and . Patients had at least two of : emergency department admissions , hospital admissions or emergency general practitioner ( GP ) contacts in the 12 months before the study . Exclusion criteria were patients who had any respiratory disorder other than COPD , or were cognitively unable to learn the process of monitoring . Patients were r and omised to receive six months of home telemonitoring with usual care , or six months of usual care . The primary outcome measure was disease-specific quality of life , as measured by the St George ’s Respiratory Question naire for COPD patients ( SGRQ-C ) . Of 100 patients completing the study , 48 patients were r and omised to telemonitoring and 52 patients were r and omised to the control group . The SGRQ-C scores improved significantly in the intervention group compared to usual care ( P = 0.001 ) . The HADS anxiety score was significantly higher in the telehealth group compared to the usual care group ( P = 0.01 ) . There were significantly more contacts with the Community Respiratory Team in the telemonitoring group compared to the control group ( P = 0.029 ) . There were no significant between group differences in EQ-5D scores , HADS depression scores , GP activity , emergency department visits , hospital admissions or exacerbations . The total cost to the health service of the intervention over the 6-month study period was £ 2039 , giving an estimated ICER of £ 203,900 . In selected patients with COPD , telemonitoring was effective in improving health-related quality of life and anxiety , but was not a cost-effective intervention Information and telecommunication technologies are called to play a major role in the changes that healthcare systems have to face to cope with chronic disease . This paper reports a telemedicine experience for the home care of chronic patients suffering from chronic obstructive pulmonary disease ( COPD ) and an integrated system design ed to carry out this experience . To determine the impact on health , the chronic care telemedicine system was used during one year ( 2002 ) with 157 COPD patients in a clinical experiment ; endpoints were readmissions and mortality . Patients in the intervention group were followed up at their homes and could contact the care team at any time through the call center . The care team shared a unique electronic chronic patient record ( ECPR ) accessible through the web-based patient management module or the home visit units . Results suggest that integrated home telemedicine services can support health professionals caring for patients with chronic disease , and improve their health . We have found that simple telemedicine services ( ubiquitous access to ECPR , ECPR shared by care team , accessibility to case manager , problem reporting integrated in ECPR ) can increase the number of patients that were not readmitted ( 51 % intervention , 33 % control ) , are acceptable to professionals , and involve low installation and exploitation costs . Further research is needed to determine the role of telemonitoring and televisit services for this kind of Background Chronic obstructive pulmonary disease ( COPD ) is a highly prevalent condition associated with a high health care re source consumption and health care expenditures , driven mainly by exacerbations-related hospitalizations . Telemedicine has been proposed as a mean for timely detection of exacerbation , but the available evidence is inadequate to provide conclusive information on its efficacy . The aim of this study is to evaluate the efficacy of a telemonitoring system in reducing COPD -related hospitalizations in an elderly population with COPD . Methods This is a parallel arms , r and omized trial including patients aged 65 or older with COPD in GOLD stages II and III enrolled in a Pulmonary Medicine outpatient facility . Patients were r and omly assigned to receive a non-invasive system able to telemonitor vital signs ( oxygen saturation , heart rate , near-body temperature , overall physical activity ) or st and ard care , and were followed up for 9 months . The outcome measures were the number of exacerbations and exacerbation-related hospitalization . Results Fifty patients were included in the telemonitoring group and 49 in the control group . The incidence rate of respiratory events was 28/100 person/years in the telemonitoring group vs. 42/100 person/years in the control group ( incidence rate ratio : 0.67 , 95 % CI : 0.32 – 1.36 ) . The corresponding figures for hospital admissions where 13/100 person/years and 20/100 person/years , respectively ( IRR : 0.66 , 95 % CI : 0.21 – 1.86 ) . Conclusions In our study , COPD patients followed up with the aid of a multiparametric remote monitoring system experienced a lower rate of exacerbations and COPD -related hospitalizations compared to patients followed up using the st and ard model of care . These results need to be replicated in larger studies before they can be applied to the general COPD population . Trial registration number : NCT01481506 ( clinical trials.gov ) . Funding : co-financed by Lazio Region and Intersistemi Objective To test the effectiveness of telemonitoring integrated into existing clinical services such that intervention and control groups have access to the same clinical care . Design Research er blind , multicentre , r and omised controlled trial . Setting UK primary care ( Lothian , Scotl and ) . Participants Adults with at least one admission for chronic obstructive pulmonary disease ( COPD ) in the year before r and omisation . We excluded people who had other significant lung disease , who were unable to provide informed consent or complete the study , or who had other significant social or clinical problems . Interventions Participants were recruited between 21 May 2009 and 28 March 2011 , and central ly r and omised to receive telemonitoring or conventional self monitoring . Using a touch screen , telemonitoring participants recorded a daily question naire about symptoms and treatment use , and monitored oxygen saturation using linked instruments . Algorithms , based on the symptom score , generated alerts if readings were omitted or breached thresholds . Both groups received similar care from existing clinical services . Main outcome measures The primary outcome was time to hospital admission due to COPD exacerbation up to one year after r and omisation . Other outcomes included number and duration of admissions , and vali date d question naire assessment s of health related quality of life ( using St George ’s respiratory question naire ( SGRQ ) ) , anxiety or depression ( or both ) , self efficacy , knowledge , and adherence to treatment . Analysis was intention to treat . Results Of 256 patients completing the study , 128 patients were r and omised to telemonitoring and 128 to usual care ;  baseline characteristics of each group were similar . The number of days to admission did not differ significantly between groups ( adjusted hazard ratio 0.98 , 95 % confidence interval 0.66 to 1.44 ) . Over one year , the mean number of COPD admissions was similar in both groups ( telemonitoring 1.2 admissions per person ( st and ard deviation 1.9 ) v control 1.1 ( 1.6 ) ; P=0.59 ) . Mean duration of COPD admissions over one year was also similar between groups ( 9.5 days per person ( st and ard deviation 19.1 ) v 8.8 days ( 15.9 ) ; P=0.88 ) . The intervention had no significant effect on SGRQ scores between groups ( 68.2 ( st and ard deviation 16.3 ) v 67.3 ( 17.3 ) ; adjusted mean difference 1.39 ( 95 % confidence interval −1.57 to 4.35 ) ) , or on other question naire outcomes . Conclusions In participants with a history of admission for exacerbations of COPD , telemonitoring was not effective in postponing admissions and did not improve quality of life . The positive effect of telemonitoring seen in previous trials could be due to enhancement of the underpinning clinical service rather than the telemonitoring communication . Trial registration IS RCT N96634935 . Funding : The trial was funded by an NHS applied research programme grant from the Chief Scientist Office of the Scottish government ( ARPG/07/03 ) . The funder had no role in study design and the collection , analysis , and interpretation of data and the writing of the article and the decision to su bmi t it for publication . NHS Lothian supported the telemonitoring service and the clinical services Background Although a number of studies have suggested that the use of Telemonitoring ( TM ) in patients with Chronic Obstructive Pulmonary Disease ( COPD ) can be useful and efficacious , its real utility in detecting Acute Exacerbation ( AE ) signaling the need for prompt treatment is not entirely clear . The current study aim ed to investigate the benefits of a TM system in managing AE in advanced-stage COPD patients to improve their Health-Related Quality of Life ( HRQL ) and to reduce utilization of healthcare services . Methods A 12-month R and omised Controlled Trial ( RCT ) was conducted in the Veneto region ( Italy ) . Adult patients diagnosed with Class III-IV COPD in accordance with the Global Initiative for Chronic Obstructive Lung Disease ( GOLD ) classification were recruited and provided a TM system to alert the clinical staff via a trained operator whenever variations in respiratory parameters fell beyond the individual ’s normal range . The study ’s primary endpoint was HRQL , measured by the Italian version of the two Short Form 36-item Health Survey ( SF36v2 ) . Its secondary endpoints were : scores on the Hospital Anxiety and Depression Scale ( HADS ) ; the number and duration of hospitalizations ; the number of readmissions ; the number of appointments with a pulmonary specialist ; the number of visits to the emergency department ; and the number of deaths . Results Three hundred thirty-four patients were enrolled and r and omized into two groups for a 1 year period . At its conclusion , changes in the SF36 Physical and Mental Component Summary scores did not significantly differ between the TM and control groups [ ( -2.07 ( 8.98 ) vs -1.91 ( 7.75 ) ; p = 0.889 and -1.08 ( 11.30 ) vs -1.92 ( 10.92 ) ; p = 0.5754 , respectively ] . Variations in HADS were not significantly different between the two groups [ 0.85 ( 3.68 ) vs 0.62 ( 3.6 ) ; p = 0.65 and 0.50 ( 4.3 ) vs 0.72 ( 4.5 ) ; p = 0.71 ] . The hospitalization rate for AE COPD and /or for any cause was not significantly different in the two groups [ IRR = 0.89 ( 95 % CI 0.79–1,04 ) ; p = 0.16 and IRR = 0.91 ( 95 % CI 0,75 – 1.04 ) ; p = 0.16 , respectively ] . The readmission rate for AE COPD and /or any cause was , however , significantly lower in the TM group with respect to the control one [ IRR = 0.43 ( 95 % CI 0.19–0.98 ) ; p = 0.01 and 0.46 ( 95 % CI 0.24–0.89 ) ; p = 0.01 , respectively ] . ConclusionS tudy results showed that in areas where medical services are well established , TM does not significantly improve HRQL  in patients with COPD who develop AE . Although not effective in reducing hospitalizations , TM can nevertheless facilitate continuity of care during hospital-to-home transition by reducing the need for early readmission . Trial registration Retrospectively registered on January 2012 , Clinical Trials.gov Identifier : NCT01513980 BACKGROUND Patients requiring complex care are at high risk during the transition from one setting of care to another . Effective interventions to support care transitions have been design ed but are very re source intensive . Telemonitoring has been considered as an approach to enhance care transition support , but many telemonitoring systems require special equipment or web-based interfaces to interact with patients and caregivers . METHODS / DESIGN In this paper we report our protocol for developing and testing E-Coach , an interactive voice response (IVR)-enhanced care transition intervention that monitors patients at home using their personal phone . The elements described include 1 ) development of an IVR  monitoring system that will be based on Coleman 's four pillars of care transition support ; 2 ) development of a web-based " dashboard " of  IVR responses that alert care transition nurses ( CTN ) of patient/caregiver concerns after discharge and allow documentation by the CTN when patients /caregivers are called ; 3 ) pilot testing of the IVR system by patients and providers with refinement of the system based on patient/provider input ; and 4 ) a pragmatic protocol for formal testing through a r and omized controlled trial ( RCT ) of the E-Coach intervention in congestive heart failure ( CHF ) and chronic obstructive pulmonary disease ( COPD ) patients admitted to a large tertiary hospital . TRIAL REGISTRATION CT.gov # : NCT01135381 The objective of this study was to determine the effects of a homebased telemonitoring device , The Health Buddy ( HB ) , on health consumption and health-related quality of life ( HRQoL ) in patients with moderate to severe chronic obstructive pulmonary disease ( COPD ) . The HB provides daily symptom-surveillance by a case manager and education to enhance disease knowledge and self-management . A nonr and omized controlled multicenter study was established comparing the effectiveness of telemonitoring as an add-on to care as usual with a follow-up of 6 months . Four hospitals took part in the experimental group and 2 hospitals formed an equivalent control group with 59 and 56 patients , respectively .  HRQoL was measured by the Clinical COPD Question naire . Healthcare consumption was assessed using medical records in the 6 months preceding study entry and during the study . Compared with the control group , the HB group showed a significant decrease in hospital admission rates ( HB -0.11 + /- 1.16 vs. control + 0.27 + /- 1.0 , p = 0.02 ) and in the total number of exacerbations ( HB -0.35 + /- 1.4 vs. control + 0.32 + /- 1.2 , p = 0.004 ) . There was a tendency toward decreased hospital days and outpatient visits . No significant changes in HRQoL were observed at follow-up between both study groups . Despite inherent limitations of the study , these findings suggest that adopting telemonitoring in everyday clinical practice is feasible and can substantially improve care and decrease healthcare utilization of patients with moderate to severe COPD Background Telemonitoring technology offers one of the most promising alternatives for the provision of health care services at the patient 's home . The primary aim of this study is to evaluate the impact of a primary care-based telemonitoring intervention on the frequency of hospital admissions . Methods / design A primary care-based r and omised controlled trial will be carried out to assess the impact of a telemonitoring intervention aim ed at home care patients with heart failure ( HF ) and /or chronic lung disease ( CLD ) . The results will be compared with those obtained with st and ard health care practice . The duration of the study will be of one year . Sixty patients will be recruited for the study . In-home patients , diagnosed with HF and /or CLD , aged 14 or above and with two or more hospital admissions in the previous year will be eligible . For the intervention group , telemonitoring will consist of daily patient self- measurements of respiratory-rate , heart-rate , blood pressure , oxygen saturation , weight and body temperature . Additionally , the patients will complete a qualitative symptom question naire daily using the telemonitoring system . Routine telephone contacts will be conducted every fortnight and additional telephone contacts will be carried out if the data received at the primary care centre are out of the established limits . The control group will receive usual care . The primary outcome measure is the number of hospital admissions due to any cause that occurred in a period of 12 months post-r and omisation . The secondary outcome measures are : duration of hospital stay , hospital admissions due to HF or CLD , mortality rate , use of health care re sources , quality of life , cost-effectiveness , compliance and patient and health care professional satisfaction with the new technology . Discussion The results of this study will shed some light on the effects of telemonitoring for the follow-up and management of chronic patients from a primary care setting . The study may contribute to enhance the underst and ing of alternative modes of health care provision for medically unstable elderly patients , who bear a high degree of physical and functional deterioration . Trial Registration IS RCT N : IS RCT Chronic obstructive pulmonary disease ( COPD ) is one of the more disabling diseases and the third cause of mortality worldwide . Self-management is considered an effective strategy for controlling and managing COPD . This review aims to summarise the available evidence on the effectiveness of COPD self-management in primary care setting s. Social Sciences , Citation Index , MEDLINE , CINAHL , Academic Search Complete and Scopus were search ed for r and omised controlled trials of COPD self-management in general practice between 2001 and 2018 . Ten r and omised controlled trials of COPD self-management trials conducted in primary care setting s were included in this review . The identified trials have recruited stable patients ; a majority having mild to moderate COPD . The trials implemented different types of interventions and measured improvements in knowledge , skills and behaviours of self-management , mental health , self-efficacy and endpoint outcomes such as hospitalisation and quality of life . The findings showed that COPD self-management trials had positive effects on COPD knowledge and improved self-management behaviours such as adherence to medication , physical activities and smoking cessation in some cases ; however , the effect of trials on hospitalisation rate , quality of life and healthcare utilisation were not conclusive . There was also not enough evidence to suggest that the trials were efficient in improving self-efficacy , a major driver of self-management behaviours . Primary care COPD self-management trials are efficient in improving surrogate outcomes such as knowledge of and adherence to self-management behaviours ; however , such improvements are less likely to be sustainable in the absence of self-efficacy . Future studies should also focus on improving endpoint self-management outcomes like hospitalisation rate and quality of life to benefit both patient and healthcare system Objective To assess the impact of home telemonitoring on health service use and quality of life in patients with severe chronic lung disease . Design R and omised crossover trial with 6 months of st and ard best practice clinical care ( control group ) and 6 months with the addition of telemonitoring . Participants 68 patients with chronic lung disease ( 38 with COPD ; 30 with chronic respiratory failure due to other causes ) , who had a hospital admission for an exacerbation within 6 months of r and omisation and either used long-term oxygen therapy or had an arterial oxygen saturation ( SpO2 ) of < 90 % on air during the previous admission . Individuals received telemonitoring ( second-generation system ) via broadb and link to a hospital-based care team . Outcome measures Primary outcome measure was time to first hospital admission for an acute exacerbation . Secondary outcome measures were hospital admissions , general practitioner ( GP ) consultations and home visits by nurses , quality of life measured by EuroQol-5D and hospital anxiety and depression ( HAD ) scale , and self-efficacy score ( Stanford ) . Results Median ( IQR ) number of days to first admission showed no difference between the two groups—77 ( 114 ) telemonitoring , 77.5 ( 61 ) control ( p=0.189 ) . Hospital admission rate at 6 months increased ( 0.63 telemonitoring vs 0.32 control p=0.026 ) . Home visits increased during telemonitoring ; GP consultations were unchanged . Self-efficacy fell , while HAD depression score improved marginally during telemonitoring . Conclusions Telemonitoring added to st and ard care did not alter time to next acute hospital admission , increased hospital admissions and home visits overall , and did not improve quality of life in chronic respiratory patients . Trial registration number NCT02180919 ( Clinical Trials.gov ) Background Diabetes and hypertension are devastating , deadly , and costly conditions that are very common in seniors . Controlling hypertension in seniors with diabetes dramatically reduces hypertension-related complications . However , blood pressure ( BP ) must be lowered carefully because seniors are also susceptible to low BP and attendant harms . Achieving “ optimal BP control ” ( ie , avoiding both undertreatment and overtreatment ) is the ultimate therapeutic goal in such patients . Regular BP monitoring is required to achieve this goal . BP monitoring at home is cheap , convenient , widely used , and guideline endorsed . However , major barriers prevent proper use . These may be overcome through use of BP telemonitoring — the secure teletransmission of BP readings to a health portal , where BP data are summarized for provider and patient use , with or without protocol ized case management . Objective To examine the incremental effectiveness , safety , cost-effectiveness , usability , and acceptability of home BP telemonitoring , used with or without protocol ized case management , compared with “ enhanced usual care ” in community-dwelling seniors with diabetes and hypertension . Methods A 300-patient , 3-arm , pragmatic r and omized controlled trial with blinded outcome ascertainment will be performed in seniors with diabetes and hypertension living independently in seniors ’ residences in greater Edmonton . Consenting patients will be r and omized to usual care , home BP telemonitoring alone , or home BP telemonitoring plus protocol ized pharmacist case management . Usual care subjects will receive a home BP monitor but neither they nor their providers will have access to teletransmitted data . In both telemonitored arms , providers will receive telemonitored BP data summaries . In the case management arm , pharmacist case managers will be responsible for review ing teletransmitted data and initiating guideline -concordant and protocol ized changes in BP management . Results Outcomes will be ascertained at 6 and 12 months . Within- study -arm change scores will be calculated and compared between study arms . These include : ( 1 ) clinical outcomes : proportion of subjects with a mean 24-hour ambulatory systolic BP in the optimal range ( 110 - 129 mmHg in patients 65 - 79 years and 110 - 139 mmHg in those ≥80 years : primary outcome ) ; additional ambulatory and home BP outcomes ; A1c and lipid profile ; medications , cognition , health care use , cardiovascular events , and mortality . ( 2 ) Safety outcomes : number of serious episodes of hypotension , syncope , falls , and electrolyte disturbances ( requiring third party assistance or medical attention ) . ( 3 ) Humanistic outcomes : quality of life , satisfaction , and medication adherence . ( 4 ) Economic outcomes : incremental costs , incremental cost-utility , and cost per mmHg change in BP of telemonitoring ± case management compared with usual care ( health payor and societal perspectives ) . ( 5 ) Intervention usability and acceptability to patients and providers . Conclusion The potential benefits of telemonitoring remain largely unstudied and unproven in seniors . This trial will comprehensively assess the impact of home BP telemonitoring across a range of outcomes . Results will inform the value of implementing home-based telemonitoring within supportive living residences in Canada . Trial Registration Clinical trials.gov NCT02721667 ; https:// clinical trials.gov/ct2/show/NCT02721667 ( Archived by Webcite at http://www.webcitation.org/6i8tB20Mc EXECUTIVE SUMMARY The purpose of this study was to measure the ability of telemonitoring to reduce hospital days and total costs for Medicare managed care enrollees diagnosed with heart failure . Patients were recruited and r and omly assigned for six months to either  telemonitoring or st and ard care . Telemonitoring transmitted vital signs and clinical alerts daily to a central nursing station . Utilization of covered services was analyzed for the six‐month telemonitoring period to test for hypothesized reductions in hospital days and changes in utilization of the emergency department ( ED ) , urgent care , and primary care . Negative binomial regressions adjusted for gender , age , co‐occurring diabetes , co‐occurring chronic obstructive pulmonary disease , and residence neighborhood were used to analyze units of service , and two‐part ( hurdle ) multivariable models were used for expenditures . The main finding was a tendency for lower total number of hospital days for patients assigned to telemonitoring . Results for other covered services were generally consistent with hypothesized direction and magnitude ; however , statistical power was reduced because of lowerthan‐expected recruitment rates into the study . Within a managed‐care environment , telemonitoring appears to facilitate better ambulatory management of heart failure patients  , including fewer ED visits , which were offset by more frequent primary care and urgent care visits Background Older adults with multiple chronic illnesses are at risk for worsening functional and medical status and hospitalization . Home telemonitoring may help slow this decline . This protocol of a r and omized controlled trial was design ed to help determine the impact of home telemonitoring on hospitalization . The specific aim of the study reads as follows : to determine the effectiveness of home telemonitoring compared with usual care in reducing the combined outcomes of hospitalization and emergency department visits in an at-risk population 60 years of age or older . Methods / Design Two-hundred patients with the highest 10 % Mayo Clinic Elder Risk Assessment scores will be r and omly assigned to one of two interventions . Home telemonitoring involves the use of a computer device , the Intel Health Guide , which records biometric and symptom data from patients in their homes . This information is monitored by midlevel providers associated with a primary care medical practice . Under the usual care scenario , patients make appointments with their providers as problems arise and use ongoing support such as a 24-hour nurse line . Patients will have initial evaluations of gait and quality of life using instruments such as the SF-12 Health Survey , the Kokmen Short Test of Mental Status , and the PHQ-9 health question naire . Patients will be followed for 1 year for primary outcomes of hospitalizations and emergency department visits . Secondary analysis will include quality of life , compliance with the device , and attitudes about telemonitoring . Sample size is based on an 80 % power to detect a 36 % difference between the two groups . The primary analysis will involve Cox proportional time-to-event analysis . Secondary analysis will use t-test comparisons for continuous variables and the chi square test for proportional analysis . Discussion Patients r and omized to home telemonitoring will have daily assessment s of their health status using the device . Registered nurse monitoring will assess any change in status followed by videoconferencing by a mid-level provider . We obtained trial registration and Institutional Review Board approval . Trial registration Trial registration number through http://www . clinical trials.gov:%20NCT01056640 National Asthma Education and Prevention Program ( NAEPP ) suggests using asthma action plans for patient self-care . Recent studies reported that many asthma patients had difficulties in following action plans on a daily basis and had low compliance to medication regimens . The goal of our study was to design and evaluate the Home Asthma Telemonitoring ( HAT ) system aim ed to help asthma patients to follow their self-care plans according to the NAEPP recommendations . Our study result ed in the development of the system which provided patients with continuous individualized help in the daily routine of asthma self-care and notified heath care providers if certain clinical conditions occurred . This allowed early recognition of potentially dangerous situations and timely intervention . The evaluation of the HAT system underwent several stages . First we showed , that the HAT system provides reliable reciprocal exchange of all relevant information between a physician and asthma patient in home setting s. Further evaluation demonstrated that lung function test results collected during home asthma telemonitoring are comparable to those collected under the supervision of trained professionals , and Internet-based home asthma telemonitoring can be successfully implemented in a group of patients without previous computer experience . Preliminary results of an on-going HAT evaluation showed higher patient compliance to asthma action plans in comparison to the compliance reported for patients in st and ard care . The clinical impact of HAT on asthma outcomes is being currently evaluated in a r and omized clinical trial funded by NIH . HAT has a potential for improving clinical outcomes and quality of life in the studied patient population and may be a model for monitoring and self-management of patients with other chronic health conditions Background Pulmonary rehabilitation ( PR ) is an effective intervention for the management of people with chronic obstructive pulmonary disease ( COPD ) . However , available re sources are often limited , and many patients bear with poor availability of programmes . Sustaining PR benefits and regular exercise over the long term is difficult without any exercise maintenance strategy . In contrast to traditional centre-based PR programmes , telerehabilitation may promote more effective integration of exercise routines into daily life over the longer term and broaden its applicability and availability . A few studies showed promising results for telerehabilitation , but mostly with short-term interventions . The aim of this study is to compare long-term telerehabilitation with unsupervised exercise training at home and with st and ard care . Methods / Design An international multicentre r and omised controlled trial conducted across sites in three countries will recruit 120 patients with COPD . Participants will be r and omly assigned to telerehabilitation , treadmill and control , and followed up for 2 years . The telerehabilitation intervention consists of individualised exercise training at home on a treadmill , telemonitoring by a physiotherapist via videoconferencing using a tablet computer , and self-management via a customised website . Patients in the  treadmill  arm are provided with a treadmill only to perform unsupervised exercise training at home . Patients in the control arm are offered st and ard care . The primary outcome is the combined number of hospitalisations and emergency department presentations . Secondary outcomes include changes in health status , quality of life , anxiety and depression , self-efficacy , subjective impression of change , physical performance , level of physical activity , and personal experiences in telerehabilitation . Discussion This trial will provide evidence on whether long-term telerehabilitation represents a cost-effective strategy for the follow-up of patients with COPD . The delivery of telerehabilitation services will also broaden the availability of PR and maintenance strategies , especially to those living in remote areas and with no access to centre-based exercise programmes . Trial registration Clinical Trials.gov : NCT02258646
Patients were generally satisfied and found the systems useful to help them manage their disease and improve healthcare provision .
Nevertheless , they reported some difficulties in their use , which in some studies were related to lower compliance rates .
AIM This systematic review aim ed to provide a comprehensive description of the method ologies used in home telemonitoring interventions for Chronic Obstructive Pulmonary Disease ( COPD ) and to explore patients ' adherence and satisfaction with the use of telemonitoring systems .