Department of Respiratory Medicine, National Health Service Highland, Inverness, United Kingdom.
Division of Biomedical Sciences, University of the Highlands and Islands, Inverness, United Kingdom.
JMIR Mhealth Uhealth. 2022 Feb 7;10(2):e30782. doi: 10.2196/30782.
Chronic obstructive pulmonary disease (COPD) is a common, costly, and incurable respiratory disease affecting 1.2 million people in the United Kingdom alone. Acute COPD exacerbations requiring hospitalization place significant demands on health services, and the incidence of COPD in poor, remote, and rural populations is up to twice that of cities.
myCOPD is a commercial, digital health, self-management technology designed to improve COPD outcomes and mitigate demands on health services. In this pragmatic real-world feasibility study, we aimed to evaluate myCOPD use and its clinical effectiveness at reducing hospitalizations, inpatient bed days, and other National Health Service (NHS) resource use.
myCOPD engagement and NHS resource use was monitored for up to 1 year after myCOPD activation and was compared against health service use in the year prior to activation. A total of 113 participants from predominantly remote and rural communities were recruited via community-based care settings, including scheduled home visits, outpatient appointments, pulmonary rehabilitation, and phone or group appointments. There were no predetermined age, disease severity, geographical, or socioeconomic inclusion or exclusion criteria.
Out of 113 participants, 89 activated myCOPD (78.8%), with 56% (50/89) of those participants doing so on the day of enrollment and 90% (80/89) doing so within 1 month. There was no correlation between participant enrollment, activation, or myCOPD engagement and either age, socioeconomics, rurality, or COPD severity. Most active participants used at least one myCOPD module and entered their symptom scores at least once (79/89, 89%). A subgroup (15/89, 17%) recorded their symptom scores very frequently (>1 time every 5 days), 14 of whom (93%) also used four or five myCOPD modules. Overall, there were no differences in hospital admissions, inpatient bed days, or other health service use before or after myCOPD activation, apart from a modest increase in home visits. Subgroup analysis did, however, identify a trend toward reduced inpatient bed days and hospital admissions for those participants with very high myCOPD usage.
Our results suggest that neither age, wealth, nor geographical location represent significant barriers to using myCOPD. This finding may help mitigate perceived risks of increased health inequalities associated with the use of digital health technologies as part of routine care provision. Despite high levels of activation, myCOPD did not reduce overall demands on health services, such as hospital admissions or inpatient bed days. Subgroup analysis did, however, suggest that very high myCOPD usage was associated with a moderate reduction in NHS resource use. Thus, although our study does not support implementation of myCOPD to reduce health service demands on a population-wide basis, our results do indicate that highly engaged patients may derive benefits.
慢性阻塞性肺疾病（COPD）是一种常见的、代价高昂的、无法治愈的呼吸系统疾病，仅在英国就影响了 120 万人。需要住院治疗的 COPD 急性加重对医疗服务提出了巨大需求，贫困、偏远和农村地区 COPD 的发病率是城市的两倍。
myCOPD 是一种商业性的、数字化的、用于自我管理的健康技术，旨在改善 COPD 预后并减轻医疗服务需求。在这项实用的真实世界可行性研究中，我们旨在评估 myCOPD 的使用情况及其在降低住院率、住院天数和其他国民保健服务（NHS）资源使用方面的临床效果。
myCOPD 的使用情况和 NHS 资源使用情况在激活后最多监测 1 年，并与激活前 1 年的服务使用情况进行比较。共有 113 名参与者来自偏远和农村社区，通过社区护理环境招募，包括定期家访、门诊预约、肺康复以及电话或小组预约。没有预先设定的年龄、疾病严重程度、地理位置或社会经济纳入或排除标准。
在 113 名参与者中，有 89 名（78.8%）激活了 myCOPD，其中 56%（50/89）在入组当天激活，90%（80/89）在 1 个月内激活。参与者的入组、激活或 myCOPD 参与与年龄、社会经济状况、农村或 COPD 严重程度之间没有相关性。大多数活跃参与者至少使用了一个 myCOPD 模块并至少输入了一次症状评分（79/89，89%）。一个亚组（15/89，17%）非常频繁地记录症状评分（>每 5 天 1 次），其中 14 名（93%）还使用了四个或五个 myCOPD 模块。总体而言，在激活前后，住院、住院天数或其他卫生服务使用方面没有差异，除了家访略有增加。然而，亚组分析确实发现，对于那些高度使用 myCOPD 的参与者，住院天数和住院人数呈下降趋势。
我们的结果表明，年龄、财富或地理位置都不是使用 myCOPD 的显著障碍。这一发现可能有助于减轻与作为常规护理提供一部分使用数字健康技术相关的健康不平等增加的感知风险。尽管激活水平很高，但 myCOPD 并没有降低医疗服务的整体需求，例如住院或住院天数。然而，亚组分析确实表明，高度使用 myCOPD 与 NHS 资源使用的适度减少有关。因此，尽管我们的研究不支持在人群范围内使用 myCOPD 来降低医疗服务需求，但我们的结果确实表明，高度参与的患者可能会从中受益。
