COPD telemonitoring ‘costly and ineffective’

Results of a UK-based study indicate that telemonitoring adds little benefit to the self-management of chronic obstructive pulmonary disease (COPD).

Hilary Pinnock (University of Edinburgh, UK) and colleagues randomly assigned 128 primary care patients with a history of COPD admission to undergo telemonitoring, and 128 to receive usual care, including self-monitoring.

Patients in the intervention group completed a daily survey on a touch screen about their symptoms, treatment, and oxygen saturation. When patients’ scores reached a certain threshold, they were contacted by the monitoring physician who, after further clinical assessment, would decide whether further management was necessary, like commencing rescue treatment, a home visit, or admission.

In contrast to some previous studies, the trial was designed to isolate the benefits of telemonitoring from other care patients were receiving. Thus “[b]oth intervention and control groups had access to the same clinical care: the only difference between the groups was the use of telemonitoring,” the authors state.

The team found that there was no difference between the telemonitoring and control groups in time to first hospital admission for COPD exacerbation, at around 360 days in both groups, the frequency of admissions (1.2 vs 1.1 per year), or the number of days spent in hospital (9.5 vs 8.8 days).

Additionally, health-related quality of life was similar, with mean scores on the St George’s Respiratory Questionnaire of 68.2 and 67.3, respectively. And there was no improvement in anxiety or depression, self efficacy, knowledge, or adherence to treatment in the telemonitoring or control groups.

However, the team notes that the telemonitoring intervention was associated with a large increase in the number of telephone consultations (510 vs 353) and home visits (821 vs 681), and a nonsignificant increase in the number of patients taking antibiotics or steroids for self-reported exacerbations (15.0 vs 12.8 per patient), compared with usual care.

Noting that in several previous studies the telemonitoring arm was supported by enhanced care, Pinnock and colleagues say their results suggest that positive effects observed could have been “due to enhancement of the underpinning clinical service rather than the telemonitoring communication.”

They write in the BMJ that future research could help to identify contexts in which telemonitoring is most effective or how it can be used to predict exacerbations.

“In the meantime,” they conclude, “long term telemonitoring of people with COPD is unlikely to reduce admissions unless it is a means of enhancing clinical services.”

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