Cordova Francis C, Ciccolella David, Grabianowski Carla, Gaughan John, Brennan Kathleen, Goldstein Frederick, Jacobs Michael R, Criner Gerard J
1 Department of Thoracic Medicine and Surgery, Temple University School of Medicine , Philadelphia, Pennsylvania.
2 Biostatistics Consulting Center, Temple University School of Medicine , Philadelphia, Pennsylvania.
Telemed J E Health. 2016 Feb;22(2):114-122. doi: 10.1089/tmj.2015.0035. Epub 2015 Aug 10.
Patients with chronic obstructive pulmonary disease (COPD) may not recognize worsening symptoms that require intensification of therapy. They may also be reluctant to contact a healthcare provider for minor worsening of symptoms. A telemedicine application for daily symptom reporting may reduce these barriers and improve patient outcomes.
Patients hospitalized for a COPD exacerbation within the past year or using supplemental O were approached for participation. Patients received optimal COPD care and were given a telecommunication device for symptom reporting. Initial symptom scores were obtained while patients were in their usual state of health. Patients were randomly assigned to an intervention group or a control group (usual medical care). The control group patients were instructed to seek medical care if their condition worsened. The intervention group symptom scores were assessed by a computer algorithm and compared with initial values. Scores 1 or more points above the initial score generated an "alert," and patients were reviewed by a nurse and referred to a physician who prescribed treatment.
Eighty-six patients were screened; 79 met entry criteria and were randomized (intervention group, n=39; control group, n=40). Twelve patients submitted five or fewer symptom reports (5 intervention; 7 control) and were excluded from the analysis. Daily peak flow and dyspnea scores improved only in the intervention group. There were no differences in hospitalization and mortality rates between groups. No serious adverse events were reported.
A telemedicine-based symptom reporting program facilitated early treatment of symptoms and improved lung function and functional status.
慢性阻塞性肺疾病（COPD）患者可能无法识别需要强化治疗的症状加重情况。他们也可能因症状轻微加重而不愿联系医疗服务提供者。一种用于日常症状报告的远程医疗应用程序可能会减少这些障碍并改善患者预后。
研究人员邀请了在过去一年因COPD加重住院或使用补充氧气的患者参与研究。患者接受了最佳的COPD护理，并获得了用于症状报告的远程通信设备。在患者处于其通常健康状态时获取初始症状评分。患者被随机分配到干预组或对照组（常规医疗护理）。对照组患者被指示如果病情恶化要寻求医疗护理。干预组的症状评分由计算机算法评估，并与初始值进行比较。比初始评分高1分或更多分产生一个“警报”，患者由护士进行复查，并转诊给开治疗处方的医生。
筛查了86名患者；79名符合入选标准并被随机分组（干预组，n = 39；对照组，n = 40）。12名患者提交了5份或更少的症状报告（5名干预组；7名对照组），并被排除在分析之外。仅干预组的每日峰值流量和呼吸困难评分有所改善。两组之间的住院率和死亡率没有差异。未报告严重不良事件。
基于远程医疗的症状报告程序促进了症状的早期治疗，并改善了肺功能和功能状态。
