Evaluation of telehealth support in an integrated respiratory clinic

Abstract

Supporting self-management is key in improving disease control, with technology increasingly utilised. We hypothesised the addition of telehealth support following assessment in an integrated respiratory clinic could reduce unscheduled healthcare visits in patients with asthma and COPD. Following treatment optimisation, exacerbation-prone participants or those with difficulty in self-management were offered telehealth support. This comprised automated twice-weekly telephone calls, with a specialist nurse triaging alerts. We performed a matched cohort study assessing additional benefits of the telehealth service, matching by: confirmed diagnosis, age, sex, FEV1 percent predicted, smoking status and ≥1 exacerbation in the last year. Thirty-four telehealth participants were matched to twenty-nine control participants. The telehealth cohort generated 165 alerts, with 29 participants raising at least one alert; 88 (53.5%) alerts received a call discussing self-management, of which 35 (21%) received definitive advice that may otherwise have required an unscheduled healthcare visit. There was a greater reduction in median exacerbation rate across both telehealth groups at 6 months post-intervention (1 to 0, p < 0.001) but not in control groups (0.5 to 0.0, p = 0.121). Similarly, there was a significant reduction in unscheduled GP visits across the telehealth groups (1.5 to 0.0, p < 0.001), but not the control groups (0.5 to 0.0, p = 0.115). These reductions led to cost-savings across all groups, but greater in the telehealth cohorts. The addition of telehealth support to exacerbation-prone patients with asthma or COPD, following comprehensive assessment and treatment optimisation, proved beneficial in reducing exacerbation frequency and unscheduled healthcare visits and thus leads to significant cost-savings for the NHS.Clinical Trial Registration: ClinicalTrials.gov: NCT03096509.

Conflict of interest statement

J.L. reports fees from Astra Zeneca for education delivery. T.L.J. reports non-financial support from Chiesi outside the submitted work. H.R. reports honoraria and lecture fees from Astra Zeneca, TEVA, Novartis, Glaxo Smith Kline and Chiesi, all of which are outside of the submitted work. T.P.B. reports personal fees from Astra Zeneca, grants, personal fees and non-financial support from Glaxo Smith Kline, personal fees and non-financial support from Teva, non-financial support from Napp Pharmaceuticals, personal fees and non-financial support from Novartis, outside the submitted work. A.J.C. reports honoraria and lecture fees from TEVA, Astra Zeneca and Sanofi, and research grants from Airsonett, Novartis and Glaxo Smith Kline, all of which are outside of the submitted work. All other authors report no conflicts of interest.

© 2022. The Author(s).

Figures

Fig. 1. Flow-chart demonstrating participant recruitment.

Following a review in a MISSION-ABC clinic, one participant did not meet the inclusion criteria of a confirmed diagnosis of asthma or COPD.