Telemedicine in COPD
2014; Elsevier BV; Volume: 145; Issue: 5 Linguagem: Inglês
10.1378/chest.13-1656
ISSN1931-3543
AutoresRoger Goldstein, Sachi O’Hoski,
Tópico(s)Lung Cancer Diagnosis and Treatment
ResumoThere is increasing interest in the use of telemedicine to assist in the management of chronic diseases. Telemedicine possibilities for patients with COPD include medical consultations, in-home patient monitoring, and remote rehabilitation. Teleconsultations have been used successfully, saving time and travel costs for patients with only a few subsequently requiring face-to-face visits. Despite many reports, the impact of telemonitoring on the detection of exacerbations, reductions in health-care utilization, and cost savings is equivocal. Given the health-care costs and commitment involved in telemonitoring, well-designed longer-term multicenter studies with appropriate follow-up are required prior to its more widespread application. Emerging evidence from preliminary trials of telerehabilitation for the pulmonary patient is encouraging. It may represent a useful tool for increasing access and building capacity, especially in remote areas. There is increasing interest in the use of telemedicine to assist in the management of chronic diseases. Telemedicine possibilities for patients with COPD include medical consultations, in-home patient monitoring, and remote rehabilitation. Teleconsultations have been used successfully, saving time and travel costs for patients with only a few subsequently requiring face-to-face visits. Despite many reports, the impact of telemonitoring on the detection of exacerbations, reductions in health-care utilization, and cost savings is equivocal. Given the health-care costs and commitment involved in telemonitoring, well-designed longer-term multicenter studies with appropriate follow-up are required prior to its more widespread application. Emerging evidence from preliminary trials of telerehabilitation for the pulmonary patient is encouraging. It may represent a useful tool for increasing access and building capacity, especially in remote areas. Over the last decade there has been increasing interest in the use of telemedicine to assist in the management of chronic diseases.1Botsis T Hartvigsen G Current status and future perspectives in telecare for elderly people suffering from chronic diseases.J Telemed Telecare. 2008; 14: 195-203Crossref PubMed Scopus (127) Google Scholar, 2Wootton R Twenty years of telemedicine in chronic disease management—an evidence synthesis.J Telemed Telecare. 2012; 18: 211-220Crossref PubMed Scopus (333) Google Scholar Telemedicine technology and devices have been used for care of patients with COPD to provide medical consultations, in-home patient monitoring, and remote pulmonary rehabilitation. Telemedicine consultations, in which the physician and patient are connected via a video conference device rather than meeting in person, have been shown, in preliminary communications, to be feasible and acceptable for the management of patients with a variety of pulmonary conditions, including COPD.3Raza T Joshi M Schapira RM Agha Z Pulmonary telemedicine—a model to access the subspecialist services in underserved rural areas.Int J Med Inform. 2009; 78: 53-59Crossref PubMed Scopus (54) Google Scholar If a health-care professional, such as a nurse or respiratory therapist, is present at the satellite site, then he or she can provide clinical information such as vital signs, chest auscultation, or pulse oximetry. Raza and colleagues3Raza T Joshi M Schapira RM Agha Z Pulmonary telemedicine—a model to access the subspecialist services in underserved rural areas.Int J Med Inform. 2009; 78: 53-59Crossref PubMed Scopus (54) Google Scholar found that the technology was reliable, wait times for appointments were similar to in-person wait times, and, over a 7-year period in which 314 patients had 684 videoconference clinical encounters, only 8% of patients required a subsequent in-person visit. Most referrals were for abnormal radiology (38%) or for COPD (26%). The most frequent postconsultation diagnosis was COPD (29%) followed by benign pulmonary nodule (11%). Over the study period, patients were saved 473,340 km (294,120 miles) of travel and 748 work days, with 94% of patients receiving medical subspecialty care close to home.3Raza T Joshi M Schapira RM Agha Z Pulmonary telemedicine—a model to access the subspecialist services in underserved rural areas.Int J Med Inform. 2009; 78: 53-59Crossref PubMed Scopus (54) Google Scholar This has exciting implications for patients in terms of time and cost savings as well as for the environment and the health-care system, as a result of which some clinicians now include telemedicine consultation within their scope of practice. Telemonitoring (TM) involves the use of equipment, sensors, and questionnaires by patients in their homes, followed by transmission of the data to a health-care professional (HCP) or team at a central location,4Gaikwad R Warren J The role of home-based information and communications technology interventions in chronic disease management: a systematic literature review.Health Informatics J. 2009; 15: 122-146Crossref PubMed Scopus (75) Google Scholar, 5Polisena J Tran K Cimon K et al.Home telehealth for chronic obstructive pulmonary disease: a systematic review and meta-analysis.J Telemed Telecare. 2010; 16: 120-127Crossref PubMed Scopus (234) Google Scholar, 6McLean S Nurmatov U Liu JL Pagliari C Car J Sheikh A Telehealthcare for chronic obstructive pulmonary disease.Cochrane Database Syst Rev. 2011; 7: CD007718Google Scholar either in real time or in a record-and-store fashion.2Wootton R Twenty years of telemedicine in chronic disease management—an evidence synthesis.J Telemed Telecare. 2012; 18: 211-220Crossref PubMed Scopus (333) Google Scholar There may be a range of predetermined baseline acceptable values set for each piece of information collected, causing an alert to be sent to an HCP when the data submitted by the patient falls outside of these values.6McLean S Nurmatov U Liu JL Pagliari C Car J Sheikh A Telehealthcare for chronic obstructive pulmonary disease.Cochrane Database Syst Rev. 2011; 7: CD007718Google Scholar The patient is then contacted by the central site and provided with health-care assistance. TM has recently been introduced to assist with the management of patients with COPD. Given the progressive nature of the condition, the dominant symptoms of dyspnea, and the clinical course punctuated by acute exacerbations of COPD (AECOPDs), it has been suggested that daily TM of patients' signs and symptoms will detect changes in their clinical status sufficiently early to improve care and decrease health-care resource utilization by decreasing unscheduled visits to the family physician or specialist, home visits, ED visits, and hospitalizations.7Crist TM Kaufman SB Crampton KR Home telemedicine: a home health care agency strategy for maximizing resources.Home Health Care Manage Pract. 1996; 8: 1-9Crossref Google Scholar, 8European Commission. Commission Communication COM/2008/0689 final. Communication from the Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee of the Regions (COM/2008/0689 final) on telemedicine for the benefit of patients, healthcare systems and society. European Commission websitehttp://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=CELEX:52008DC0689:EN:NOTGoogle Scholar Despite plentiful communications on this topic, the benefits of TM in regard to its impact on clinical outcomes and cost-effectiveness remain to be clearly demonstrated. COPD is one of the most expensive chronic diseases in the developed world, mainly due to its increasing prevalence, with attendant exacerbation rates and hospitalizations as the condition progresses. In the United States in 2006, there were > 1.25 million hospitalizations due to AECOPD, with an average length of hospital stay of 5.9 (± 6.1) days resulting in a total inpatient cost of $11.98 billion US dollars.9Perera PN Armstrong EP Sherrill DL Skrepnek GH Acute exacerbations of COPD in the United States: inpatient burden and predictors of costs and mortality.COPD. 2012; 9: 131-141Crossref PubMed Scopus (149) Google Scholar Regardless of the reason for hospitalization, the prevalence of COPD even as a comorbidity increases the incidence of in-hospital mortality.10Holguin F Folch E Redd SC Mannino DM Comorbidity and mortality in COPD-related hospitalizations in the United States, 1979 to 2001.Chest. 2005; 128: 2005-2011Abstract Full Text Full Text PDF PubMed Scopus (314) Google Scholar Patient and HCP satisfaction with TM is generally positive.1Botsis T Hartvigsen G Current status and future perspectives in telecare for elderly people suffering from chronic diseases.J Telemed Telecare. 2008; 14: 195-203Crossref PubMed Scopus (127) Google Scholar, 11Smith SM Elkin SL Partridge MR Technology and its role in respiratory care.Prim Care Respir J. 2009; 18: 159-164Crossref PubMed Scopus (47) Google Scholar, 12Bernocchi P Scalvini S Tridico C et al.Healthcare continuity from hospital to territory in Lombardy: TELEMACO project.Am J Manag Care. 2012; 18: e101-e108PubMed Google Scholar, 13Ure J Pinnock H Hanley J et al.Piloting tele-monitoring in COPD: a mixed methods exploration of issues in design and implementation.Prim Care Respir J. 2012; 21: 57-64Crossref PubMed Scopus (82) Google Scholar, 14Paré G Jaana M Sicotte C Systematic review of home telemonitoring for chronic diseases: the evidence base.J Am Med Inform Assoc. 2007; 14: 269-277Crossref PubMed Scopus (559) Google Scholar Patients report that the equipment is easy to use,1Botsis T Hartvigsen G Current status and future perspectives in telecare for elderly people suffering from chronic diseases.J Telemed Telecare. 2008; 14: 195-203Crossref PubMed Scopus (127) Google Scholar, 12Bernocchi P Scalvini S Tridico C et al.Healthcare continuity from hospital to territory in Lombardy: TELEMACO project.Am J Manag Care. 2012; 18: e101-e108PubMed Google Scholar, 15Rogers A Kirk S Gately C May CR Finch T Established users and the making of telecare work in long term condition management: implications for health policy.Soc Sci Med. 2011; 72: 1077-1084Crossref PubMed Scopus (45) Google Scholar, 16Antoniades NC Rochford PD Pretto JJ et al.Pilot study of remote telemonitoring in COPD.Telemed J E Health. 2012; 18: 634-640Crossref PubMed Scopus (65) Google Scholar, 17Roberts A Garrett L Godden DJ Can telehealth deliver for rural Scotland? Lessons from the Argyll & Bute Telehealth Programme.Scott Med J. 2012; 57: 33-37Crossref PubMed Scopus (19) Google Scholar, 18De San Miguel K Smith J Lewin G Telehealth remote monitoring for community-dwelling older adults with chronic obstructive pulmonary disease.Telemed J E Health. 2013; 19: 652-657Crossref PubMed Scopus (53) Google Scholar despite the fact that the majority of the patients are > 65 years of age and may have limited exposure to technology. This is likely due to the training they receive when the equipment is installed. They also report that they feel safe knowing they are being monitored regularly13Ure J Pinnock H Hanley J et al.Piloting tele-monitoring in COPD: a mixed methods exploration of issues in design and implementation.Prim Care Respir J. 2012; 21: 57-64Crossref PubMed Scopus (82) Google Scholar, 15Rogers A Kirk S Gately C May CR Finch T Established users and the making of telecare work in long term condition management: implications for health policy.Soc Sci Med. 2011; 72: 1077-1084Crossref PubMed Scopus (45) Google Scholar, 17Roberts A Garrett L Godden DJ Can telehealth deliver for rural Scotland? Lessons from the Argyll & Bute Telehealth Programme.Scott Med J. 2012; 57: 33-37Crossref PubMed Scopus (19) Google Scholar, 18De San Miguel K Smith J Lewin G Telehealth remote monitoring for community-dwelling older adults with chronic obstructive pulmonary disease.Telemed J E Health. 2013; 19: 652-657Crossref PubMed Scopus (53) Google Scholar and that home monitoring is convenient13Ure J Pinnock H Hanley J et al.Piloting tele-monitoring in COPD: a mixed methods exploration of issues in design and implementation.Prim Care Respir J. 2012; 21: 57-64Crossref PubMed Scopus (82) Google Scholar and makes medical care more accessible.19Fairbrother P Pinnock H Hanley J et al.Continuity, but at what cost? The impact of telemonitoring COPD on continuities of care: a qualitative study.Prim Care Respir J. 2012; 21 (TELESCOT Programme Team): 322-328Crossref PubMed Scopus (57) Google Scholar They report satisfaction and empowerment from being involved in self-managing their condition.20Dinesen B Haesum LKE Soerensen N et al.Using preventive home monitoring to reduce hospital admission rates and reduce costs: a case study of telehealth among chronic obstructive pulmonary disease patients.J Telemed Telecare. 2012; 18: 221-225Crossref PubMed Scopus (73) Google Scholar However, some patients are equally satisfied when their care includes regular home visits and telephone calls. Only a few studies have suggested added benefit to quality of life when home monitoring is compared with home care21Sicotte C Paré G Morin S Potvin J Moreault MP Effects of home telemonitoring to support improved care for chronic obstructive pulmonary diseases.Telemed J E Health. 2011; 17: 95-103Crossref PubMed Scopus (47) Google Scholar or usual care.22Gellis ZD Kenaley B McGinty J Bardelli E Davitt J Ten Have T Outcomes of a telehealth intervention for homebound older adults with heart or chronic respiratory failure: a randomized controlled trial.Gerontologist. 2012; 52: 541-552Crossref PubMed Scopus (106) Google Scholar, 23Haesum LK Soerensen N Dinesen B et al.Cost-utility analysis of a telerehabilitation program: a case study of COPD patients.Telemed J E Health. 2012; 18: 688-692Crossref PubMed Scopus (37) Google Scholar Not only have studies shown no between-group differences resulting from the addition of TM,18De San Miguel K Smith J Lewin G Telehealth remote monitoring for community-dwelling older adults with chronic obstructive pulmonary disease.Telemed J E Health. 2013; 19: 652-657Crossref PubMed Scopus (53) Google Scholar, 24Lewis KE Annandale JA Warm DL Hurlin C Lewis MJ Lewis L Home telemonitoring and quality of life in stable, optimised chronic obstructive pulmonary disease.J Telemed Telecare. 2010; 16: 253-259Crossref PubMed Scopus (48) Google Scholar, 25Trappenburg JCA Niesink A de Weert-van Oene GH et al.Effects of telemonitoring in patients with chronic obstructive pulmonary disease.Telemed J E Health. 2008; 14: 138-146Crossref PubMed Scopus (110) Google Scholar some HCPs have expressed concern that, in addition to increasing their workload,13Ure J Pinnock H Hanley J et al.Piloting tele-monitoring in COPD: a mixed methods exploration of issues in design and implementation.Prim Care Respir J. 2012; 21: 57-64Crossref PubMed Scopus (82) Google Scholar, 17Roberts A Garrett L Godden DJ Can telehealth deliver for rural Scotland? Lessons from the Argyll & Bute Telehealth Programme.Scott Med J. 2012; 57: 33-37Crossref PubMed Scopus (19) Google Scholar, 19Fairbrother P Pinnock H Hanley J et al.Continuity, but at what cost? The impact of telemonitoring COPD on continuities of care: a qualitative study.Prim Care Respir J. 2012; 21 (TELESCOT Programme Team): 322-328Crossref PubMed Scopus (57) Google Scholar it creates the potential for overtreatment13Ure J Pinnock H Hanley J et al.Piloting tele-monitoring in COPD: a mixed methods exploration of issues in design and implementation.Prim Care Respir J. 2012; 21: 57-64Crossref PubMed Scopus (82) Google Scholar and increased dependency on technology,21Sicotte C Paré G Morin S Potvin J Moreault MP Effects of home telemonitoring to support improved care for chronic obstructive pulmonary diseases.Telemed J E Health. 2011; 17: 95-103Crossref PubMed Scopus (47) Google Scholar which varies in accuracy and reliability. To interpret the symptoms and signs in context, it is preferable for the same HCP to be monitoring the same patients on an ongoing basis. Patients have indicated that this consistency adds to their comfort level with TM.13Ure J Pinnock H Hanley J et al.Piloting tele-monitoring in COPD: a mixed methods exploration of issues in design and implementation.Prim Care Respir J. 2012; 21: 57-64Crossref PubMed Scopus (82) Google Scholar, 15Rogers A Kirk S Gately C May CR Finch T Established users and the making of telecare work in long term condition management: implications for health policy.Soc Sci Med. 2011; 72: 1077-1084Crossref PubMed Scopus (45) Google Scholar, 19Fairbrother P Pinnock H Hanley J et al.Continuity, but at what cost? The impact of telemonitoring COPD on continuities of care: a qualitative study.Prim Care Respir J. 2012; 21 (TELESCOT Programme Team): 322-328Crossref PubMed Scopus (57) Google Scholar Given the cost of TM in human resources, equipment, and patients' time, firm evidence of cost-effectiveness is required, especially regarding the impact of earlier detection of AECOPD. Both randomized and nonrandomized trials have reported fewer exacerbations in the TM intervention group compared with control participants,25Trappenburg JCA Niesink A de Weert-van Oene GH et al.Effects of telemonitoring in patients with chronic obstructive pulmonary disease.Telemed J E Health. 2008; 14: 138-146Crossref PubMed Scopus (110) Google Scholar, 26Vitacca M Bianchi L Guerra A et al.Tele-assistance in chronic respiratory failure patients: a randomised clinical trial.Eur Respir J. 2009; 33: 411-418Crossref PubMed Scopus (211) Google Scholar with one study noting that regular monitoring of oxygen saturation, heart rate, and symptoms resulted in exacerbation prediction by an HCP 73% of the time.27Sund ZM Powell T Greenwood R Jarad NA Remote daily real-time monitoring in patients with COPD—a feasibility study using a novel device.Respir Med. 2009; 103: 1320-1328Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar Although one randomized trial concluded that TM decreased ED visits compared with a control group receiving home care22Gellis ZD Kenaley B McGinty J Bardelli E Davitt J Ten Have T Outcomes of a telehealth intervention for homebound older adults with heart or chronic respiratory failure: a randomized controlled trial.Gerontologist. 2012; 52: 541-552Crossref PubMed Scopus (106) Google Scholar and two other studies reported a decrease in visits within the intervention group,17Roberts A Garrett L Godden DJ Can telehealth deliver for rural Scotland? Lessons from the Argyll & Bute Telehealth Programme.Scott Med J. 2012; 57: 33-37Crossref PubMed Scopus (19) Google Scholar, 28Vontetsianos Th Giovas P Katsaras Th et al.Telemedicine-assisted home support for patients with advanced chronic obstructive pulmonary disease: preliminary results after nine-month follow-up.J Telemed Telecare. 2005; 11: 86-88Crossref PubMed Scopus (60) Google Scholar one study observed a small increase in ED visits in the intervention group25Trappenburg JCA Niesink A de Weert-van Oene GH et al.Effects of telemonitoring in patients with chronic obstructive pulmonary disease.Telemed J E Health. 2008; 14: 138-146Crossref PubMed Scopus (110) Google Scholar and another reported no between-group differences.21Sicotte C Paré G Morin S Potvin J Moreault MP Effects of home telemonitoring to support improved care for chronic obstructive pulmonary diseases.Telemed J E Health. 2011; 17: 95-103Crossref PubMed Scopus (47) Google Scholar Hospital admissions have been reported to decrease when a period of TM was compared with the time prior to the intervention,17Roberts A Garrett L Godden DJ Can telehealth deliver for rural Scotland? Lessons from the Argyll & Bute Telehealth Programme.Scott Med J. 2012; 57: 33-37Crossref PubMed Scopus (19) Google Scholar, 27Sund ZM Powell T Greenwood R Jarad NA Remote daily real-time monitoring in patients with COPD—a feasibility study using a novel device.Respir Med. 2009; 103: 1320-1328Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar, 28Vontetsianos Th Giovas P Katsaras Th et al.Telemedicine-assisted home support for patients with advanced chronic obstructive pulmonary disease: preliminary results after nine-month follow-up.J Telemed Telecare. 2005; 11: 86-88Crossref PubMed Scopus (60) Google Scholar, 29Davey J How collaborative care is becoming a reality in COPD management.Prim Health Care. 2007; 17: 36-39Crossref Google Scholar, 30Jarad NA Sund ZM Telemonitoring in chronic obstructive airway disease and adult patients with cystic fibrosis.J Telemed Telecare. 2011; 17: 127-132Crossref PubMed Scopus (22) Google Scholar or when patients receiving TM were compared with those receiving usual care18De San Miguel K Smith J Lewin G Telehealth remote monitoring for community-dwelling older adults with chronic obstructive pulmonary disease.Telemed J E Health. 2013; 19: 652-657Crossref PubMed Scopus (53) Google Scholar, 20Dinesen B Haesum LKE Soerensen N et al.Using preventive home monitoring to reduce hospital admission rates and reduce costs: a case study of telehealth among chronic obstructive pulmonary disease patients.J Telemed Telecare. 2012; 18: 221-225Crossref PubMed Scopus (73) Google Scholar, 25Trappenburg JCA Niesink A de Weert-van Oene GH et al.Effects of telemonitoring in patients with chronic obstructive pulmonary disease.Telemed J E Health. 2008; 14: 138-146Crossref PubMed Scopus (110) Google Scholar, 26Vitacca M Bianchi L Guerra A et al.Tele-assistance in chronic respiratory failure patients: a randomised clinical trial.Eur Respir J. 2009; 33: 411-418Crossref PubMed Scopus (211) Google Scholar or home care.21Sicotte C Paré G Morin S Potvin J Moreault MP Effects of home telemonitoring to support improved care for chronic obstructive pulmonary diseases.Telemed J E Health. 2011; 17: 95-103Crossref PubMed Scopus (47) Google Scholar, 31Paré G Sicotte C St-Jules D Gauthier R Cost-minimization analysis of a telehomecare program for patients with chronic obstructive pulmonary disease.Telemed J E Health. 2006; 12: 114-121Crossref PubMed Scopus (95) Google Scholar However, other randomized controlled trials have concluded that there were no between-group differences in hospital admissions,16Antoniades NC Rochford PD Pretto JJ et al.Pilot study of remote telemonitoring in COPD.Telemed J E Health. 2012; 18: 634-640Crossref PubMed Scopus (65) Google Scholar, 24Lewis KE Annandale JA Warm DL Hurlin C Lewis MJ Lewis L Home telemonitoring and quality of life in stable, optimised chronic obstructive pulmonary disease.J Telemed Telecare. 2010; 16: 253-259Crossref PubMed Scopus (48) Google Scholar and, in one pre-to-post study, admissions increased in the 6 months following the intervention.32Dang S Ma F Nedd N Aguilar EJ Roos BA Differential resource utilization benefits with Internet-based care coordination in elderly veterans with chronic diseases associated with high resource utilization.Telemed J E Health. 2006; 12: 14-23Crossref PubMed Scopus (43) Google Scholar The impact of TM on the length of hospital stay is also inconclusive with reports of a decrease,18De San Miguel K Smith J Lewin G Telehealth remote monitoring for community-dwelling older adults with chronic obstructive pulmonary disease.Telemed J E Health. 2013; 19: 652-657Crossref PubMed Scopus (53) Google Scholar, 29Davey J How collaborative care is becoming a reality in COPD management.Prim Health Care. 2007; 17: 36-39Crossref Google Scholar, 32Dang S Ma F Nedd N Aguilar EJ Roos BA Differential resource utilization benefits with Internet-based care coordination in elderly veterans with chronic diseases associated with high resource utilization.Telemed J E Health. 2006; 12: 14-23Crossref PubMed Scopus (43) Google Scholar no within-group change or between-group difference,16Antoniades NC Rochford PD Pretto JJ et al.Pilot study of remote telemonitoring in COPD.Telemed J E Health. 2012; 18: 634-640Crossref PubMed Scopus (65) Google Scholar, 21Sicotte C Paré G Morin S Potvin J Moreault MP Effects of home telemonitoring to support improved care for chronic obstructive pulmonary diseases.Telemed J E Health. 2011; 17: 95-103Crossref PubMed Scopus (47) Google Scholar, 24Lewis KE Annandale JA Warm DL Hurlin C Lewis MJ Lewis L Home telemonitoring and quality of life in stable, optimised chronic obstructive pulmonary disease.J Telemed Telecare. 2010; 16: 253-259Crossref PubMed Scopus (48) Google Scholar and an increase in the TM group.31Paré G Sicotte C St-Jules D Gauthier R Cost-minimization analysis of a telehomecare program for patients with chronic obstructive pulmonary disease.Telemed J E Health. 2006; 12: 114-121Crossref PubMed Scopus (95) Google Scholar The impact of TM on home-care visits and visits to primary care is also inconsistent with reports of decreased contact,17Roberts A Garrett L Godden DJ Can telehealth deliver for rural Scotland? Lessons from the Argyll & Bute Telehealth Programme.Scott Med J. 2012; 57: 33-37Crossref PubMed Scopus (19) Google Scholar, 28Vontetsianos Th Giovas P Katsaras Th et al.Telemedicine-assisted home support for patients with advanced chronic obstructive pulmonary disease: preliminary results after nine-month follow-up.J Telemed Telecare. 2005; 11: 86-88Crossref PubMed Scopus (60) Google Scholar, 31Paré G Sicotte C St-Jules D Gauthier R Cost-minimization analysis of a telehomecare program for patients with chronic obstructive pulmonary disease.Telemed J E Health. 2006; 12: 114-121Crossref PubMed Scopus (95) Google Scholar no between-group differences,22Gellis ZD Kenaley B McGinty J Bardelli E Davitt J Ten Have T Outcomes of a telehealth intervention for homebound older adults with heart or chronic respiratory failure: a randomized controlled trial.Gerontologist. 2012; 52: 541-552Crossref PubMed Scopus (106) Google Scholar, 24Lewis KE Annandale JA Warm DL Hurlin C Lewis MJ Lewis L Home telemonitoring and quality of life in stable, optimised chronic obstructive pulmonary disease.J Telemed Telecare. 2010; 16: 253-259Crossref PubMed Scopus (48) Google Scholar and increased visits in the TM group.18De San Miguel K Smith J Lewin G Telehealth remote monitoring for community-dwelling older adults with chronic obstructive pulmonary disease.Telemed J E Health. 2013; 19: 652-657Crossref PubMed Scopus (53) Google Scholar, 21Sicotte C Paré G Morin S Potvin J Moreault MP Effects of home telemonitoring to support improved care for chronic obstructive pulmonary diseases.Telemed J E Health. 2011; 17: 95-103Crossref PubMed Scopus (47) Google Scholar This outcome is of concern if, instead of fostering self-management and independence,33Pauwels RA Buist AS Calverley PM Jenkins CR Hurd SS Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary.Am J Respir Crit Care Med. 2001; 163 (GOLD Scientific Committee): 1256-1276Crossref PubMed Scopus (4282) Google Scholar intensive monitoring of symptoms and vital signs encourages requests for clarification of symptoms or increased care for comorbidities as well as dependence on repeated coaching from a case manager. Of the few studies evaluating the cost-effectiveness of adding TM to care of patients with COPD, both no cost benefit20Dinesen B Haesum LKE Soerensen N et al.Using preventive home monitoring to reduce hospital admission rates and reduce costs: a case study of telehealth among chronic obstructive pulmonary disease patients.J Telemed Telecare. 2012; 18: 221-225Crossref PubMed Scopus (73) Google Scholar and reduced costs among the intervention group have been reported.18De San Miguel K Smith J Lewin G Telehealth remote monitoring for community-dwelling older adults with chronic obstructive pulmonary disease.Telemed J E Health. 2013; 19: 652-657Crossref PubMed Scopus (53) Google Scholar, 23Haesum LK Soerensen N Dinesen B et al.Cost-utility analysis of a telerehabilitation program: a case study of COPD patients.Telemed J E Health. 2012; 18: 688-692Crossref PubMed Scopus (37) Google Scholar, 26Vitacca M Bianchi L Guerra A et al.Tele-assistance in chronic respiratory failure patients: a randomised clinical trial.Eur Respir J. 2009; 33: 411-418Crossref PubMed Scopus (211) Google Scholar, 31Paré G Sicotte C St-Jules D Gauthier R Cost-minimization analysis of a telehomecare program for patients with chronic obstructive pulmonary disease.Telemed J E Health. 2006; 12: 114-121Crossref PubMed Scopus (95) Google Scholar Crist and colleagues,7Crist TM Kaufman SB Crampton KR Home telemedicine: a home health care agency strategy for maximizing resources.Home Health Care Manage Pract. 1996; 8: 1-9Crossref Google Scholar in a retrospective chart review following a home health-care strategy for patients with a variety of chronic conditions, estimated a projected savings of $216 to $681 per patient per week in home-care costs. These savings were among patients with wounds, IV therapies, diabetes, and stroke, rather than for those with a respiratory diagnosis. Details of adherence to TM in COPD are lacking. However, as in most chronic disease management programs, patient adherence to TM has been shown to be > 77% in the medium-term,16Antoniades NC Rochford PD Pretto JJ et al.Pilot study of remote telemonitoring in COPD.Telemed J E Health. 2012; 18: 634-640Crossref PubMed Scopus (65) Google Scholar, 17Roberts A Garrett L Godden DJ Can telehealth deliver for rural Scotland? Lessons from the Argyll & Bute Telehealth Programme.Scott Med J. 2012; 57: 33-37Crossref PubMed Scopus (19) Google Scholar, 27Sund ZM Powell T Greenwood R Jarad NA Remote daily real-time monitoring in patients with COPD—a feasibility study using a novel device.Respir Med. 2009; 103: 1320-1328Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar but markedly decreases over time.14Paré G Jaana M Sicotte C Systematic review of home telemonitoring for chronic diseases: the evidence base.J Am Med Inform Assoc. 2
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