ABSTRACT
BACKGROUND: Evidence is needed to determine the role of telehealth (TH) in COPD management. METHODS: PROMETE II was a multicentre, randomized, 12-month trial. Severe COPD patients in stable condition were randomized to a specific monitoring protocol with TH or routine clinical practice (RCP). The primary objective was to reduce the number of COPD exacerbations leading to ER visits/hospital admissions between groups. RESULTS: Overall, 237 COPD patients were screened, and 229 (96.6%) were randomized to TH (nâ¯=â¯115) or RCP (nâ¯=â¯114), with age of 71⯱â¯8 years and 80% were men. Overall, 169 completed the full follow-up period. There were no statistical differences at one year between groups in the proportion of participants who had a COPD exacerbation (60% in TH vs. 53.5% in RCP; pâ¯=â¯0.321). There was, however, a marked but non-significant trend towards a shorter duration of hospitalization and days in ICU in the TH group (18.9⯱â¯16.0 and 6.0⯱â¯4.6 days) compared to the RCP group (22.4⯱â¯19.5 and 13.3⯱â¯11.1 days). The number of all-cause deaths was comparable between groups (12 in TH vs. 13 in RCP) as was total resource utilization cost (7912 in TH vs. 8918 in RCP). Telehealth was evaluated highly positively by patients and doctors. CONCLUSIONS: Remote patient management did not reduce COPD-related ER visits or hospital admissions compared to RCP within 12 months.
Subject(s)
Pulmonary Disease, Chronic Obstructive/therapy , Telemedicine , Aged , Aged, 80 and over , Ambulatory Care/statistics & numerical data , Cause of Death , Disease Progression , Emergency Service, Hospital/statistics & numerical data , Female , Follow-Up Studies , Health Care Costs , Health Resources/economics , Health Resources/statistics & numerical data , Humans , Length of Stay/statistics & numerical data , Male , Middle Aged , Patient Acceptance of Health Care , Pulmonary Disease, Chronic Obstructive/economics , Pulmonary Disease, Chronic Obstructive/mortality , Severity of Illness Index , Telemedicine/economics , Telemedicine/statistics & numerical data , Time FactorsABSTRACT
BACKGROUND: Portable oxygen devices simplify and facilitate patient therapy. This study was designed to compare S(pO2) and patient satisfaction with a portable oxygen concentrator or a combined system consisting of a fixed device with continuous-flow oxygen dispensation and a portable device with pulse dispensation for ambulation. METHODS: This crossover trial assessed 25 subjects with COPD (92% men, mean age of 72.2 ± 7.4 y, mean FEV1 of 34.14 ± 12.51% of predicted) at 4 hospitals in Madrid. All subjects had previously used the combined system, consisting of a fixed oxygenation system and a portable system for ambulation, with 16 (64%) using stationary and portable concentrators and 9 (36%) using a stationary reservoir and portable liquid oxygen bag. Oxygenation settings at rest and while walking were determined at baseline. Subjects were maintained on the previous combined system for 1 week and then switched to the portable oxygen concentrator for 1 week. Mean S(pO2) over 24 h was calculated using the software in the oximeter, and compliance was monitored (Visionox). RESULTS: Low S(pO2) (< 90%) was significantly more frequent during use of the portable concentrator alone than with the combined system (37.1% vs 18.4%, P < .05). The portable system alone was preferred by 43% of subjects, and the combined system was preferred by 36%, whereas 21% were not sure. CONCLUSIONS: Subjects preferred using a single portable oxygenation system both at home and during ambulation. Portable systems alone, however, did not supply the same levels of oxygenation as the combination of fixed and portable systems. Before the widespread adoption of portable systems as a single device, additional studies are needed to determine best-practice protocols for adjustment of daytime and nighttime oxygenation settings. (ClinicalTrials.gov registration NCT02079753).
