COPD Telemonitoring

Evaluation of the effectiveness of telemonitorization in CHUC

COPD

Chronic Obstructive Pulmonary Disease

(COPD) is a respiratory condition,

characterized by the progressive obstruction

of the air flux, due to the chronic

inflammation of the respiratory tract.

Inhalation of harmful air particles or noxious

gases and smoke, and specifically those

originated by tobacco smoke are often

associated with the development of COPD.

COPD is currently one of the main causes of

chronic morbidity, physical incapacity and

increased mortality. In Portugal COPD is

currently the 5th major cause of death,

causing 2,4% of death

The prognosis and evolution of COPD are well

determined by exacerbations, which tend to

become more frequent and severe with time,

causing very frequent visits to the Emergency

Room and internments.

With this in mind, the present study focuses

on the case of a home telemonitoring pilot

study, directed towards a group of COPD

patients.

The aim of the project was to increase the

support and medical care provided to these

CASE STUDY

COPD Telemonitoring

OMS estimates that Chronic

Obstructive Pulmonary (COPD)

affects an estimated 210

million people worldwide.

COPD Telemonitoring

patients, as well as the reduction of the number

of hospital commitments and emergency visits,

by attempting to act in a preventive manner

towards the typical COPD acutizations

Methods

15 patients were selected among the population

of COPD patients followed in the Pulmonology

Departments A (Coimbra’s University Hospital)

and B (HG), from CHUC (Coimbra’s University).

One of the most important criteria used in this

study consisted on choosing patients with the

highest internment and emergency visit rates.

Other factors considered was the willingness of

the patients to participate and other social and

family related factors, in order to assure they had

a strong support network, who could help

provide assistance and motivation to adhere to

the program.

While the initial number of patients was 15, only

12 patients were considered for this study, as

there were substitutions due to dropouts. The 12

patients. Thus, the 12 patients considered are

those who remained in the pilot for the full

course of the project.

Each patient received a telemonitoring kit,

consisting of a Tablet and a set of medical

equipment (oximeter, thermometer, pedometer

(physical activity monitor, sphygmomanometer,

and blood pressure monitor)

Initial training and teaching was provided, to help

patient make their daily measurements, 1 or 2

times a day of each parameter.

Measurements were analysed by a Medical

Screening Centre, who verified the patient’s data

and implemented an action protocol, written by

CHUC physicians. This protocol screened each

patient for exacerbation symptoms and watched

the symptoms evolution, providing situation

appropriate medical advice.

Medical professionals of CHUC’s Pulmonology

Department had access to all data recovered

during the project. However, most of their

interventions occurred when patient’s

parameters were abnormal, or reflected some

health decrease. (As shown in the model

presented in the model in Figure 1).

Figure 1- Structure of the telemonitorization model used in this project

The ages of the participants

varied between 50 and 84

years old.

The great majority of the

subjects in this study were

male (83%), with only 17%

female participants.

COPD Telemonitoring

Results

Despite the fact that this project has been in

course for over 3 years, we chose to focus the

analysis of results focused on the comparison

between the first two years following the

implementation of the telemonitoring system

(2015 and 2016) with the two years previous to

the start of the project (2012 and 2013), in terms

of the number of commitments and emergency

episodes, for each of the 12 participants.

The data recovered shown a 50% reduction in

hospital commitments and 30% in emergency

room and medical services visits, in the two

latter years, when telemonitoring was

implemented, when compared to the two years

before the start of the study (Figure 2).

Each patient case was further analysed; to search

for other useful information, as patients

presented various disease stages.

The application of a satisfaction survey to

patients and/or their carers(Figure 5)

demonstrated a high level o0f satisfaction with

the service and that most patients shared the

belief that this was an effective and useful

service, which had improved their quality of life

in a significant manner.

Figure 2 – Comparison of the number of hospital commitments (“Internamentos”) and emergency visits (“Urgências”) Before (2012/2013) and After the Implementation of Telemonitoring (2015/2016)

Figure 3 – Percentages of patients who had more hospital commitments (“Aumento”), who had the same number (“Manutenção”) and decreased (“Diminuição”) in the number of hospital commitments (“internamentos”) between the two time periods.

Figure 4- Percentages of patients who had more hospital commitments (“Aumento”), who had the same number (“Manutenção”) and decreased (“Diminuição”) in the number of emergency medical visits (“Urgências”) between the two time periods.

50%

Reduction in the

number of hospital

commitments

30%

Reduction in the

number of

emergency visits to

medical services

Telemonitorização em DPOC

Figure 5 – Responses to the survey, delivered during October 2015.The topics are, from left to right: “Quality of the service”, “Your opinion on the services provided by the company”, “Your opinion on the quality of the services provided by the Medical team” and “Would you recommend this service to a family member or friend?”; the possible answers are in each “Bad” (“Má”), “Good/Satisfactory”(“Satisfatória/Boa) and “Very Good/Ecxelent” (“Muito Boa/Excelente”); for the last question the possible answers are “Yes/”No”(“Sim/Não”)

Conclusions

Home telemonitoring had a positive effect and was able to

reduce the number of exacerbations in COPD patients, with a

reduction of the number of medical interventions involving

visits top medical centres.

Actions should be taken in order to study and implement this

system for other chronic conditions, such as diabetes, renal

insufficiency and cardiovascular conditions.

It is also of great importance to study the scalability of

telemonitoring services,

References

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Direcção Geral de Saúde. Doenças Respiratórias em

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Castelo-Branco, M., Gomes da Costa, F. Ribeiro, C.,

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Implementing Telemonitoring in the Portuguese

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