Segrelles Calvo G, Gómez-Suárez C, Soriano J B, Zamora E, Gónzalez-Gamarra A, González-Béjar M, Jordán A, Tadeo E, Sebastián A, Fernández G, Ancochea J
Pneumology Service, La Princesa Institute for Health Research (IP), Hospital Universitario de la Princesa, Madrid, Spain.
Linde Healthcare, The Linde Group, Spain.
Respir Med. 2014 Mar;108(3):453-62. doi: 10.1016/j.rmed.2013.12.003. Epub 2013 Dec 16.
Acute exacerbations of chronic obstructive pulmonary disease (AECOP) are key events in the natural history of the disease. Patients with more AECOPD have worse prognosis. There is a need of innovative models of care for patients with severe COPD and frequent AECOPD, and Telehealth (TH) is part of these programs.
In a cluster assignment, controlled trial study design, we recruited 60 patients, 30 in home telehealth (HT) and 30 in conventional care (CC). All participants had a prior diagnosis of COPD with a post-bronchodilator forced expiratory volume (FEV1)% predicted <50%, age ≥ 50 years, were on long-term home oxygen therapy, and non-smokers. Patients in the HT group measured their vital signs on a daily bases, and data were transmitted automatically to a Clinical Monitoring Center for followed-up, and who escalated clinical alerts to a Pneumologist.
After 7-month of monitoring and follow-up, there was a significant reduction in ER visits (20 in HT vs. 57 in CC), hospitalizations (12 vs. 33), length of hospital stay in (105 vs. 276 days), and even need for non-invasive mechanical ventilation (0 vs. 8), all p < 0.05. Time to the first severe AECOPD increased from 77 days in CC to 141 days in HT (K-M p < 0.05). There was no study withdrawals associated with technology. All patients showed a high level of satisfaction with the HT program.
We conclude that HT in elderly, severe COPD patients with multiple comorbidities is safe and efficacious in reducing healthcare resources utilization.
慢性阻塞性肺疾病急性加重（AECOP）是该疾病自然史中的关键事件。AECOPD发作次数较多的患者预后较差。对于重度慢性阻塞性肺疾病（COPD）且频繁发生AECOPD的患者，需要创新的护理模式，远程医疗（TH）是这些项目的一部分。
在一项整群分配的对照试验研究设计中，我们招募了60名患者，30名接受家庭远程医疗（HT），30名接受常规护理（CC）。所有参与者先前均被诊断为COPD，支气管扩张剂后用力呼气量（FEV1）%预计值<50%，年龄≥50岁，接受长期家庭氧疗，且为非吸烟者。HT组患者每天测量生命体征，并将数据自动传输至临床监测中心进行随访，该中心会将临床警报升级至肺科医生。
经过7个月的监测和随访，HT组的急诊就诊次数（20次 vs. CC组的57次）、住院次数（12次 vs. 33次）、住院时长（105天 vs. 276天）以及无创机械通气需求（0次 vs. 8次）均显著减少，所有p<0.05。首次严重AECOPD的时间从CC组的77天增加至HT组的141天（K-M检验p<0.05）。没有与技术相关的研究退出情况。所有患者对HT项目均表现出高度满意度。
我们得出结论，对于患有多种合并症的老年重度COPD患者，HT在减少医疗资源利用方面是安全有效的。
