Talboom-Kamp Esther, Holstege Marije, Chavannes Niels, Kasteleyn Marise
Leids Universitair Medisch Centrum, afdeling volksgezondheid en eerstelijnszorg, Leiden, Nederland.
Nationaal eHealth Living Lab, Universiteit Leiden, Nederland.
Tijdschr Gerontol Geriatr. 2020 Dec 10;51(4). doi: 10.36613/tgg.1875-6832/2020.04.03.
Integrated disease management with self-management for Chronic Obstructive Pulmonary Disease (COPD) is effective to improve clinical outcomes. eHealth can improve patients' involvement to be able to accept and maintain a healthier lifestyle. Eventhough there is mixed evidence of the impact of eHealth on quality of life (QoL) in different settings.
The primary aim of the e-Vita-COPD-study was to investigate the effect of use of eHealth patient platforms on disease specific QoL of COPD patients.
We evaluated the impact of an eHealth platform on disease specific QoL measured with the clinical COPD questionnaire (CCQ), including subscales of symptoms, functional state and mental state. Interrupted time series (ITS) design was used to collect CCQ data at multiple time points. Multilevel linear regression modelling was used to compare trends in CCQ before and after the eHealth intervention.
Of 742 invited COPD patients, 244 signed informed consent. For the analyses, we only included patients who actually used the eHealth platform (n = 123). The decrease of CCQ-symptoms was 0,20% before the intervention and 0,27% after the intervention; this difference was statistically significant (P=0.027). The decrease of CCQ-mental was 0,97% before the intervention and after the intervention there was an increase of 0,017%; this difference was statistically significant (P=0,01). No significant difference was found in the slopes of CCQ (P=0,12) and CCQ-function (P=0,11) before and after the intervention.
The e-Vita eHealth platform had a potential beneficial impact on the CCQ-symptoms of COPD patients, but not on functional state. The CCQ-mental state remained stable after the intervention, but this was a deterioration compared to the improving situation before the start of the eHealth platform. In conclusion, this study shows that after the introduction of the COPD platform, patients experienced fewer symptoms, but their mental state deteriorated slightly at the same time. Therefore, health care providers should be aware that, although symptoms improve, there might be a slight increase in anxiety and depression after introducing an eHealth intervention to support self-management.
慢性阻塞性肺疾病（COPD）的综合疾病管理与自我管理对改善临床结局有效。电子健康可提高患者的参与度，使其能够接受并维持更健康的生活方式。尽管在不同环境下，电子健康对生活质量（QoL）影响的证据不一。
e-Vita-COPD研究的主要目的是调查使用电子健康患者平台对COPD患者特定疾病生活质量的影响。
我们评估了一个电子健康平台对用临床COPD问卷（CCQ）测量的特定疾病生活质量的影响，CCQ包括症状、功能状态和精神状态子量表。采用中断时间序列（ITS）设计在多个时间点收集CCQ数据。使用多水平线性回归模型比较电子健康干预前后CCQ的趋势。
在742名受邀的COPD患者中，244人签署了知情同意书。为进行分析，我们仅纳入了实际使用电子健康平台的患者（n = 123）。干预前CCQ症状评分下降0.20%，干预后下降0.27%；这一差异具有统计学意义（P = 0.027）。干预前CCQ精神状态评分下降0.97%，干预后上升0.017%；这一差异具有统计学意义（P = 0.01）。干预前后CCQ（P = 0.12）和CCQ功能（P = 0.11）的斜率未发现显著差异。
e-Vita电子健康平台对COPD患者的CCQ症状有潜在的有益影响，但对功能状态没有影响。干预后CCQ精神状态保持稳定，但与电子健康平台启用前的改善情况相比有所恶化。总之，本研究表明，引入COPD平台后，患者症状减少，但同时精神状态略有恶化。因此，医疗保健提供者应意识到，尽管症状有所改善，但引入支持自我管理的电子健康干预措施后，焦虑和抑郁可能会略有增加。
