In response to the COVID-19 pandemic, widespread adoption of remote care delivery for COPD occurred rapidly, explains John Hurst, PhD, FRCP, FHEA.  “People with respiratory conditions like COPD were advised to be cautious about making routine office visits because of the risk of coronavirus,” Dr. Hurst says. “As a result, much more care moved to delivery by phone and video. However, an important question arose as to what aspects of care could and could not be successfully delivered remotely, both from the perspectives of clinicians and people living with COPD.”

For a paper published in BMJ Open Respiratory Research, Dr. Hurst and colleagues used an online research platform to conduct a survey and consensus-building process involving clinicians (n = 55) and patients with COPD (n = 19). The study was designed to develop consensus from both parties about which aspects of COPD care could be delivered remotely rather than face-to-face.

Patents & Clinicians Hold Different Views About Ability of Remote Care

The researchers found that most clinicians felt able to assess symptom severity (n = 52, 95%), reinforce smoking cessation (n = 46, 84%), and signpost to other healthcare resources (n = 44, 80%; Table I).  Patients reported that assessing COPD severity and starting new medications were both being addressed through remote care. A total of 43 and 31 respondents participated in the first and second consensus-building rounds, respectively. When asked to rate the appropriateness of using remote delivery for specific care activities, respondents reached consensus on five of 14 items: collecting information about COPD and overall health status (77%), providing COPD education and developing a self-management plan (74%), reinforcing smoking cessation (81%), deciding whether to seek in-person care (72%), and initiating a rescue pack (76%).

The study team discovered that patients and clinicians hold different views about what remote care can and cannot accomplish. “Generally, there was most support for assessing symptoms, assisting smoking cessation, and signposting patients to other services,” he says. “Clinicians felt able to support decisions around the time of an exacerbation, such as whether to start additional treatment and whether a face-to-face emergency assessment was needed. So, where face-to-face contact is limited, clinicians may wish to focus their time on other aspects of care that are more difficult to deliver in this way, notably pulmonary rehabilitation and conversations around advance care planning and end-of-life care.”

Addressing the Hard-to-Reach Populations

Dr. Hurst and colleagues noted that few clinicians had standard protocols and procedures to facilitate remote COPD care. “In particular, there was the problem of how to deliver care to hard-to-reach populations, such as older people, those whose first language was not English, or those who did not have access to technology like a smartphone with adequate data coverage,” he says (Table II).

The study’s findings, Dr. Hurst concludes, add evidence on the acceptability of various components of remote care delivery, from the perspective of both patients and clinicians to existing evidence of the impact of telehealth in COPD. “A good portion of routine COPD care can be successfully delivered remotely, and that may indeed be of benefit to patients,” he says. “But not everything can, and we must not inadvertently exaggerate the health disparities that are inherent in COPD by only focusing on services that can be utilized by patients able to use newer technologies. We need to think about better ways to deliver care to hard-to-reach populations and create objective approaches to audit the quality and outcomes of remote COPD care. Our patients deserve nothing less.”

References

Specialty COPD Care During COVID-19: Patient and Clinician Perspectives on Remote Delivery https://bmjopenrespres.bmj.com/content/8/1/e000817