“It is not possible to treat all patients with COPD sufficiently with in-person consultations, due to several factors, such as clinical capacities, cost, travel burden, living in remote areas, or immobility,” explains Frank Rassouli, MD. “Although telehealth care (TC) offers clinicians the ability to contact and monitor patients with COPD easily over distances at low cost, the wide variability of TC interventions—such a monitoring of physiological parameters and vital signs or self-reported symptoms—makes it unclear which modalities are best suited for improving patients’ health status or detecting exacerbations.”

For a paper published in the Journal of Internal Medicine, Dr. Rassouli and colleagues investigated the impact of TC procedures on the course of COPD and health-related quality of life (HRQOL) as assessed by the slope of individual COPD assessment test (CAT) changes during the duration of a multicenter, randomized, controlled crossover trial involving patients aged 40 or older with a COPD diagnosis at six centers in Switzerland and Germany from April 2016 to September 2018. All participants received standard care and TC in a crossover study design.

Telehealth Positively Impacts CAT Score

“We focused on the early recognition of acute exacerbations in addition to standard care,” notes Dr. Rassouli. “Patients in the TC group answered, online, six daily questions that were designed to detect exacerbations, addressing the development of cough, dyspnea, and sputum purulence as cardinal symptoms. The system then generated an alarm that was sent to treating physicians. Once the alarm signal was received, physicians contacted the patient by phone to evaluate the current situation and discuss recommended further actions.”

With this simple method, Dr. Rassouli says, the study team was able to detect more moderate acute exacerbations of COPD than with standard care alone (Table). “The outcome measure of the study was HRQOL as assessed by the CAT score,” he adds. “Our findings show that, over time, the course of the CAT score could be positively modified by using this telehealth approach.” As for total days in hospital due to COPD and total COPD-related costs (including all costs related to the TC intervention), the researchers could not find a statistically significant difference between TC and standard care, but the actual numbers suggest there might be a benefit of using TC. “We observed a trend toward fewer days in hospital and lower overall COPD-associated costs in the telehealth group,” Dr. Rassouli notes. “In addition, the method demonstrated efficiency, generating a low overall workload, with about 10 minutes of telephone contact per patient year.”

Increased Patient Satisfaction With Telehealth Care

Over time, the increase of the CAT could be halved, indicating a relevant modification of disease course, according to the study team. “We also found that patient satisfaction with care, already high before the intervention, increased further with TC,” Dr. Rassouli says. “One possible explanation is that patients appreciate closer contact with the care team and easier availability of support. The TC platform allows them to make comments and ask questions.” The higher number of detected moderate exacerbations likely indicates a higher diagnostic sensitivity than without the use of TC, he adds.

Dr. Rassouli and colleagues would like to further develop the intervention by adding elements like promotion of physical activity and smoking cessation, as well as measures to improve medication compliance and inhalation technique. “We anticipate that in the near future, physicians could implement such methods into their repertoire of treatment modalities,” says Dr. Rassouli.

The study team suggests that future research integrate and investigate other established aspects of monitoring and therapy of COPD into a platform with the goal of creating a comprehensive monitoring and treatment tool for COPD. “In addition, there are efforts to broaden this concept to other diagnoses, like asthma or chronic diseases in other fields of medicine,” Dr. Rassouli notes. “We envision an individualized modular system tailored to the specific medical condition of the single patient.”

References

Telehealth Mitigates COPD Disease Progression Compared to Standard of Care: A Randomized Controlled Crossover Trial https://onlinelibrary.wiley.com/doi/10.1111/joim.13230