Background: Recent reviews suggest that telemedicine solutions for patients with chronic obstructive pulmonary\r\ndisease (COPD) may prevent hospital readmissions and emergency room visits and improve health-related quality\r\nof life. However, the studies are few and only involve COPD patients who are in a stable phase or in-patients who\r\nare ready for discharge. COPD patients hospitalized with an acute exacerbation may also benefit from telemedicine\r\nsolutions. The overall aim is to investigate a telemedicine-based treatment solution for patients with acute\r\nexacerbation of COPD at home as compared to conventional hospital treatment measured according to first\r\ntreatment failure, which is defined as readmission due to COPD within 30 days after discharge.\r\nMethods: COPD patients with acute exacerbation who fulfilled the eligibility criteria and were from two university\r\nhospitals in Denmark were randomized (1:1) by computer-generated tables that allocated treatments in blocks of\r\nfour to receive either standard treatment at the hospital or the same standard treatment at home using\r\ntelemedicine technology (that is, a video conference system with a touch screen and webcam and monitoring\r\nequipment (spirometer, thermometer, and pulse oximeter)). Patients treated in the telemedicine group were backed\r\nup by an organizational setting securing 24/7/365 online access to the hospital, as well as access to oxygen,\r\nnebulizer therapy, oral medical therapy and surveillance of vital parameters from home monitoring devices. Patients\r\nin both groups were discharged when clinically stable and when fulfilling five pre-specified discharge criteria.\r\nFollow-up was performed at 1, 3 and 6 months after discharge.\r\nThe primary outcome was treatment failure defined as readmission due to exacerbation in COPD within 30 days.\r\nSecondary outcomes were death from any cause, prescription of additional antibiotics or steroids, need of\r\nintubation or non-invasive ventilation, emergency room visits, visits to the general practitioner, lung function, bed\r\ndays, health-related quality of life, healthcare costs and user satisfaction.\r\nResults: Enrollment of patients started in June 2010 and ended in December 2011. Follow-up ended in May 2012.\r\nResults were analyzed in 2013.\r\nConclusions: The results may have implications on future hospital treatment modalities for patients with severe\r\nexacerbations in COPD where telemedicine may be used as an alternative to conventional admission.
Loading....