Last reviewed 5 November 2013
A study has reported that the use of telemonitoring to remotely support patients with managing chronic obstructive pulmonary disease (COPD) did not reduce their risk of being admitted to hospital with an acute exacerbation.
Effectiveness of Telemonitoring Integrated into Existing Clinical Services on Hospital Admission for Exacerbation of Chronic Obstructive Pulmonary Disease found that, for patients with a history of admission for exacerbations of COPD, “telemonitoring was not effective in postponing admissions and did not improve quality of life”.
The one-year randomised controlled trial, the results of which were published in the British Medical Journal (BMJ), included 256 patients registered with practices in Lothian, all of whom had a recent history of being admitted to hospital for an acute exacerbation of COPD.
In the trial, telemonitoring was integrated into existing clinical services so that intervention and control groups had access to the same clinical care. The telemonitoring participants used a touchscreen to complete a daily questionnaire about symptoms and treatment use, and monitor oxygen saturation using linked instruments. Algorithms, based on the symptom score, generated alerts if readings were left out or breached thresholds.
Concerns among GPs about the costs of setting up for the new directed enhanced service (DES) for remote telemonitoring, together with renewed doubts over the benefits of this approach for people with long-term conditions, appear to be increasing.
Findings from a government-backed Whole System Demonstrator cluster randomised trial showed that for people with long-term conditions, telehealth could reduce mortality and help avoid emergency hospital care but the cost of the technology needed to be set against any estimated hospital cost savings. An editorial that accompanied this study in the BMJ added that the results did not convincingly support the Department of Health’s “3millionlives” scheme to bring telehealth and telecare to three million people with long-term conditions and complex care needs.
The more recent study on managing COPD concluded that the integration of telemonitoring into existing clinical services had no effect on delaying time to a hospital admission, and had a substantial impact on workload. It stated: “The positive effect of telemonitoring seen in previous trials could thus be due to enhancement of the underpinning clinical service rather than the telemonitoring communication.
“Specific developments that could improve the performance of telemonitoring in COPD in the future include the validation of measures and algorithms that can predict potentially serious exacerbations more reliably, and an understanding of clinical contexts in which telemonitoring is most effective. In the meantime, long-term telemonitoring of people with COPD is unlikely to reduce admissions unless it is a means of enhancing clinical services.”