Ove Grann

Using preventive home monitoring to reduce hospital admission rates and reduce costs: a case study of telehealth among chronic obstructive pulmonary disease patients

We studied whether preventive home monitoring of patients with chronic obstructive pulmonary disease (COPD) could reduce the frequency of hospital admissions and lower the cost of hospitalization. Patients were recruited from a health centre, general practitioner (GP) or the pulmonary hospital ward. They were randomized to usual care or tele-rehabilitation with a telehealth monitoring device installed in their home for four months. A total of 111 patients were suitable for inclusion and consented to be randomized: 60 patients were allocated to intervention and three were lost to follow-up. In the control group 51 patients were allocated to usual care and three patients were lost to follow-up. In the tele-rehabilitation group, the mean hospital admission rate was 0.49 per patient per 10 months compared to the control group rate of 1.17; this difference was significant (P = 0.041). The mean cost of admissions was €3461 per patient in the intervention group and €4576 in the control group; this difference was not significant. The Kaplan-Meier estimates for time to hospital admission were longer for the intervention group than the controls, but the difference was not significant. Future work requires large-scale studies of prolonged home monitoring with more extended follow-up.

Cost-Utility Analysis of a Telerehabilitation Program: A Case Study of COPD Patients

OBJECTIVE The present study seeks to conduct cost-utility analysis (CUA) of the Danish TELEKAT (Telehomecare, Chronic Patients and the Integrated Healthcare System) project. The TELEKAT project seeks to test and develop a preventive home monitoring concept across sectors for chronic obstructive pulmonary disease (COPD) patients. The concept of the TELEKAT project is to reduce admissions by enabling the COPD patients to conduct self-monitoring and maintain rehabilitation activities in their own home. COPD patients with severe and very severe COPD were included in the study. SUBJECTS AND METHODS This economic evaluation follows international guidelines for the conduction of a CUA alongside a clinical randomized controlled trial. The analysis is based on a health sector perspective. RESULTS The mean incremental cost efficiency ratio, located in the southeast quadrant, shows that telerehabilitation is less costly and more effective than the rehabilitation given to the control group. The telerehabilitation program produces more value for money and generates savings on healthcare budgets. CONCLUSIONS The telerehabilitation program appears to be more cost-effective than the conventional rehabilitation program for COPD patients. Further studies of cost-effectiveness with a focus on large-scale studies are needed.

Clinical Impact of Home Telemonitoring on Patients with Chronic Obstructive Pulmonary Disease

BACKGROUND Chronic obstructive pulmonary disease (COPD) affects millions of people worldwide. A complication of COPD is exacerbations that result in increased utilization of healthcare services, readmissions to the hospital, and a decline in health-related quality of life. Home telehealth has been shown both to improve health-related quality of life and to reduce admission rates. Using clinical data from a home telemonitoring group, this study sought to investigate the clinical impact of telemonitoring. SUBJECTS AND METHODS Fifty-seven subjects with COPD were included in a 4-month telemonitoring project. Differences between the clinical parameters during the first and last months of participation in the project were tested for significance, and the levels for the first month versus the difference were tested for correlation. RESULTS Significant declines were observed in prescriptions for antibiotics and steroids (p=0.03), clinical consultations (p=0.05), mean systolic blood pressure (p<0.001), standard deviation of systolic blood pressure (p=0.03), and mean diastolic blood pressure (p=0.02). No significant differences were observed for mean of oxygen saturation (p=0.77), standard deviation of oxygen saturation (p=0.36), mean of forced expiratory volume in 1 s (p=0.17), mean of forced vital capacity (p=0.29), mean of pulse rate (p=0.78), standard deviation of pulse rate (p=0.57), and standard deviation of diastolic blood pressure (p=0.27). CONCLUSIONS The results suggest that telemonitoring improves the condition of the patient by lowering the blood pressure, the number of prescribed antibiotics and steroids, and the number of clinical consultations.

Telerehabilitation across sectors: The experiences of chronic obstructive pulmonary disease (COPD) patients and healthcare professionals

The purpose of this paper is to describe the qualitative perspectives of telerehabilitation as concerns the interaction between COPD patients and healthcare professionals. The case study approach is chosen as the overall research strategy for this study. A randomised study (n=111) has also been conducted. The paper conclude that telerehabilitation process becomes a learning process which is more than an individual cognitive process, since learning takes place in interaction with healthcare professionals, the family and network of the COPD patients.

Chronic obstructive pulmonary disease (COPD) rehabilitation at primary health‐care centres – the KOALA project

Background:  Implementation of pulmonary rehabilitation in primary health care in Denmark is a new challenge in the management of patients with chronic obstructive pulmonary disease (COPD).