Outcomes of a telemonitoring-based program (telEPOC) in frequently hospitalized COPD patients
Authors Esteban C, Moraza J, Iriberri M, Aguirre U, Goiria B, Quintana JM, Aburto M, Capelastegui A
Received 20 June 2016
Accepted for publication 20 September 2016
Published 24 November 2016 Volume 2016:11(1) Pages 2919—2930
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Amy Norman
Peer reviewer comments 4
Editor who approved publication: Dr Richard Russell
Cristóbal Esteban,1,2 Javier Moraza,1 Milagros Iriberri,3 Urko Aguirre,2,4 Begoña Goiria,5 José M Quintana,2,4 Myriam Aburto,1 Alberto Capelastegui1
1Pneumology Department, Galdakao-Usansolo Hospital, Galdakao, 2Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Bilbao, 3Pneumology Department, Cruces Hospital, Barakaldo, 4Research Unit, Galdakao-Usansolo Hospital, Galdakao, 5Primary Care Unit, Barrualde Integrated Healthcare Organisation (OSI-Barrualde), Spain
Background: The increasing prevalence of chronic diseases requires changes in health care delivery. In COPD, telemedicine appears to be a useful tool. Our objective was to evaluate the efficacy (in improving health care-resource use and clinical outcomes) of a telemonitoring-based program (telEPOC) in COPD patients with frequent hospitalizations.
Materials and methods: We conducted a nonrandomized observational study in an intervention cohort of 119 patients (Galdakao-Usansolo Hospital) and a control cohort of 78 patients (Cruces Hospital), followed up for 2 years (ClinicalTrials.gov identifier: NCT02528370). The inclusion criteria were two or more hospital admissions in the previous year or three or more admissions in the previous 2 years. The intervention group received telemonitoring plus education and controls usual care.
Results: Most participants were men (13% women), and the sample had a mean age of 70 years, forced expiratory volume in 1 second of 45%, Charlson comorbidity index score of 3.5, and BODE (body mass index, airflow obstruction, dyspnea, and exercise capacity) index score of 4.1. In multivariate analysis, the intervention was independently related to lower rates of hospital admission (odds ratio [OR] 0.38, 95% confidence interval [CI] 0.27–0.54; P<0.0001), emergency department attendance (OR 0.56, 95% CI 0.35–0.92; P<0.02), and 30-day readmission (OR 0.46, 95% CI 0.29–0.74; P<0.001), as well as cumulative length of stay (OR 0.58, 95% CI 0.46–0.73; P<0.0001). The intervention was independently related to changes in several clinical variables during the 2-year follow-up.
Conclusion: An intervention including telemonitoring and education was able to reduce the health care-resource use and stabilize the clinical condition of frequently admitted COPD patients.
Keywords: COPD, hospitalizations, telemonitoring program
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