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Telemonitoring fails to cut COPD hospital admissions

The use of telemonitoring to remotely support patients with managing COPD did not reduce their risk of being admitted to hospital with an acute exacerbation, according to the authors of a one-year randomised study.

Patients receiving the telemonitoring intervention were just as likely to end up in hospital as a result of an exacerbation as those who were not remotely monitored, despite having many more telephone consultations and home visits and the approach is unlikely to be cost-effective, the researchers found.

The findings come as GPs face concerns over the cost of setting up the government’s new DES for remote telemonitoring and add further doubts over the benefits of the approach for people with long-term conditions such as COPD, after the government-backed Whole Systems Demonstrator (WSD) trial found telemonitoring was not cost-effective.

Moreover, the authors said their findings suggest the benefits of telemonitoring seen in WSD – in which the remote monitoring did cut admissions and mortality in people with long-term conditions – are likely down to ‘enhancement of the underpinning clinical service’ rather than telemonitoring itself.

They concluded telemonitoring ‘is unlikely to reduce admissions unless it is a means of enhancing clinical services’.

The study, published in the 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.

All participants received the usual clinical care provided in their region, including self-management advice, but the half assigned to telemonitoring also submitted daily recordings of their symptoms, treatment and oxygen saturation levels for remote monitoring by the supporting clinical team.

The median time from the beginning of the study until the first hospital admission with an exacerbation did differ between patient groups, at 362 days in those using the telemonitoring and 361 days in the control group.

The mean number of admissions was also similar, with 1.2 admissions per person in the telemonitoring arm and 1.1 in the control arm, as was the mean length of stay in hospital.

Telemonitoring failed to improve patients’ health-related quality of life, with similar changes recorded on the St George’s respiratory questionnaire in each group, and was associated with a slight, albeit non-significant, increase in self-reported exacerbations, in which patients needed to take antibiotics or steroids.

The telemonitoring group also needed significantly more home visits, including 113 as a result of telemonitoring alerts – working out at around 25 contacts per patient over the year, or one contact every two weeks – as well as another five telephone and eight home contacts per patient, compared with four telephone and seven home contacts over the year in the control group.

The authors concluded: ‘Integration of telemonitoring into existing clinical services – such that both intervention and control groups had access to the same clinical care – had no effect on delaying time to a hospital admission, and had a substantial impact on workload.

‘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 performace 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.’

BMJ 2013; online 17 October


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