Elderly patients with COPD require more health care than elderly heart failure patients do in a hospital-based home care setting
Received 5 March 2019
Accepted for publication 14 June 2019
Published 16 July 2019 Volume 2019:14 Pages 1569—1581
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Cristina Weinberg
Peer reviewer comments 2
Editor who approved publication: Dr Richard Russell
Hans Lennart Persson,1 Johan Lyth,2 Ann-Britt Wiréhn,2 Leili Lind3,4
1Respiratory Medicine, Department of Medical and Health Sciences (IMH), Linköping University, Linköping, Sweden; 2Research and Development Unit in Region Östergötland and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; 3Department of Biomedical Engineering/Health Informatics, Linköping University, Linköping, Sweden; 4Rise Research Institutes of Sweden Ab/Division Ict Sics East, Linköping University, Linköping, Sweden
Background: Elderly patients with advanced stages of COPD or chronic heart failure (CHF) often require hospitalization due to exacerbations. We hypothesized that telemonitoring supported by hospital-based home care (HBHC) would detect exacerbations early, thus, reducing the number of hospitalization. We also speculated that patients with advanced COPD or CHF would present differences regarding exacerbation frequency and the need of HBHC.
Methods: The Health Diary system, based on digital pen technology, was employed. Patients aged ≥65 years with ≥2 hospitalizations the previous year were included. Exacerbations were categorized and treated as either COPD or CHF exacerbation by an experienced physician. All HBHC contacts (home visits or telephone consultations) were registered.
Results: Ninety-four patients with advanced diseases were enrolled (36 COPD and 58 CHF subjects) of which 53 subjects (19 COPD and 34 CHF subjects) completed the 1-year study period. Death was the major reason for not finalizing the study. Compared to the 1-year prior inclusion, the intervention significantly reduced hospitalization. Although COPD subjects were younger with less comorbidity, exacerbations and HBHC contacts were significantly greater in this group.
Conclusions: COPD subjects exhibit exacerbations more frequently, mainly due to disease characteristics, thus, demanding much more HBHC.
Keywords: home care services, hospital-based, telemedicine, digital pen, exacerbation, hospitalization
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