Chatwin M, Hawkins G, Panicchia L, Woods A, Hanak A, Lucas R, Baker E, Ramhamdany E, Mann B, Riley J, Cowie M R, Simonds A K
Thorax. 2016 Apr;71(4):305-11. doi: 10.1136/thoraxjnl-2015-207045.
Randomised crossover trial with 6 months of standard best practice clinical care (control group) and 6 months with the addition of telemonitoring.
68 patients with chronic lung disease (38 with COPD; 30 with chronic respiratory failure due to other causes), who had a hospital admission for an exacerbation within 6 months of randomisation and either used long-term oxygen therapy or had an arterial oxygen saturation (SpO2) of <90% on air during the previous admission. Individuals received telemonitoring (second-generation system) via broadband link to a hospital-based care team.
Primary outcome measure was time to first hospital admission for an acute exacerbation. Secondary outcome measures were hospital admissions, general practitioner (GP) consultations and home visits by nurses, quality of life measured by EuroQol-5D and hospital anxiety and depression (HAD) scale, and self-efficacy score (Stanford).
Median (IQR) number of days to first admission showed no difference between the two groups—77 (114) telemonitoring, 77.5 (61) control ( p=0.189). Hospital admission rate at 6 months increased (0.63 telemonitoring vs 0.32 control p=0.026). Home visits increased during telemonitoring; GP consultations were unchanged. Self-efficacy fell, while HAD depression score improved marginally during telemonitoring.
Telemonitoring added to standard care did not alter time to next acute hospital admission, increased hospital admissions and home visits overall, and did not improve quality of life in chronic respiratory patients.
NCT02180919 (ClinicalTrials.gov).
随机交叉试验，一组接受6个月的标准最佳临床护理（对照组），另一组在标准护理基础上增加6个月的远程监测。
68例慢性肺病患者（38例慢性阻塞性肺疾病；30例因其他原因导致的慢性呼吸衰竭），这些患者在随机分组后6个月内因病情加重入院治疗，且要么使用长期氧疗，要么在上次入院时空气中动脉血氧饱和度（SpO2）<90%。个体通过宽带链接与医院护理团队进行远程监测（第二代系统）。
主要观察指标是首次因急性加重入院的时间。次要观察指标包括住院次数、全科医生（GP）会诊次数和护士家访次数、用欧洲五维健康量表（EuroQol-5D）测量的生活质量以及医院焦虑抑郁量表（HAD）评分和自我效能感评分（斯坦福量表）。
两组首次入院天数的中位数（四分位间距）无差异——远程监测组为77（114）天，对照组为77.5（61）天（p = 0.189）。6个月时的住院率有所增加（远程监测组为0.63，对照组为0.32，p = 0.026）。远程监测期间护士家访次数增加；全科医生会诊次数未变。自我效能感下降，而远程监测期间HAD抑郁评分略有改善。
在标准护理基础上增加远程监测并未改变下次急性入院的时间，总体上增加了住院次数和家访次数，且未改善慢性呼吸疾病患者的生活质量。
NCT02180919（ClinicalTrials.gov）。
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