Innovating the treatment of COPD exacerbations: a phone interactive telesystem to increase COPD Action Plan adherence.

Introduction: Self-management interventions with Written Action Plans and case management support have been shown to improve outcomes in patients with chronic obstructive pulmonary disease (COPD). Novel telehealth technologies may improve self-management interventions. The objectives of this study were to determine whether the use of an interactive phone telesystem increases Action Plan adherence, improves exacerbation recovery and reduces healthcare use in a real-life practice of a COPD clinic. Methods: Initially, 40 patients were followed by a COPD telesystem for 1 year. Detailed data from patients' behaviours during exacerbations was recorded. The telesystem use was then extended to 256 patients from a real-life COPD clinic. Healthcare utilisation for the year before and after telesystem enrolment was then assessed through hospital administrative databases. Results: Thirty-three of the 40 patients completed the initial 1-year study. Eighty-one exacerbations were reported in the 1-year follow-up. Action Plan adherence was observed for 72% of the exacerbations and those who were adherent had a significantly faster exacerbation recovery time. The large-scale implementation of the telesystem resulted in a significant decrease in the proportion of patients with ≥1 respiratory-related emergency room (ER) visits (120 before vs 110 after enrolment, p<0.001) and with ≥1 COPD-related hospitalisations (75 before vs 65 after enrolment, p<0.001). Discussion: COPD Written Action Plan adherence was further enhanced with the use of telehealth technologies in a specialised clinic with experience in COPD self-management. Patients followed by the telesystem recovered faster from exacerbations and had a further decrease in COPD-related ER visits and hospitalisations. Trial registration number: NCT02275078.

Making collaborative self-management successful in COPD patients with high disease burden.

BACKGROUND: Exacerbations in severe COPD patients lead to challenges in terms of self-management. This study is a "real-life" situation aiming to assess whether or not it is possible for COPD patients with high burden of disease to self-manage acute exacerbations and to reduce hospital use. METHODS: 100 randomly selected charts of patients followed in a specialised COPD clinic in 2006 and 2009 (patients with higher burden of disease) were reviewed. Data on patients' characteristics, COPD severity and exacerbation management were extracted. RESULTS: Compared to the 2006 cohort, patients from the 2009 cohort had lower (0.85 L), but not statistically significant different FEV1 (L) than the 2006 cohort (0.98 L) and more exacerbations (2.6 exacerbations/pt vs 3. 6 exacerbations/pt, p = 0.03). Despite having a higher burden of disease, patients in the 2009 cohort as compared to 2006 had more appropriate self-management behaviours in the event of an exacerbation (60% vs 42%, p = 0.05) and fewer emergency room visits and/or hospital admissions (39% vs 57%, p = 0.02). There were more phone calls to the case managers (590 vs 382, p < 0.001) and fewer physician office visits (167 vs 179, p = 0.024). CONCLUSIONS: This study of a real life situation adds to the current body of literature that a more severe COPD patient population can be taught self-management skills in the event of exacerbations, leading to fewer health care visits and hospital admissions.