Innovating the treatment of COPD exacerbations: a phone interactive telesystem to increase COPD Action Plan adherence

Abstract

Introduction: Self-management interventions with Written Action Plans and case management support have been shown to improve outcomes in patients with chronic obstructive pulmonary disease (COPD). Novel telehealth technologies may improve self-management interventions. The objectives of this study were to determine whether the use of an interactive phone telesystem increases Action Plan adherence, improves exacerbation recovery and reduces healthcare use in a real-life practice of a COPD clinic.

Methods: Initially, 40 patients were followed by a COPD telesystem for 1 year. Detailed data from patients' behaviours during exacerbations was recorded. The telesystem use was then extended to 256 patients from a real-life COPD clinic. Healthcare utilisation for the year before and after telesystem enrolment was then assessed through hospital administrative databases.

Results: Thirty-three of the 40 patients completed the initial 1-year study. Eighty-one exacerbations were reported in the 1-year follow-up. Action Plan adherence was observed for 72% of the exacerbations and those who were adherent had a significantly faster exacerbation recovery time. The large-scale implementation of the telesystem resulted in a significant decrease in the proportion of patients with ≥1 respiratory-related emergency room (ER) visits (120 before vs 110 after enrolment, p<0.001) and with ≥1 COPD-related hospitalisations (75 before vs 65 after enrolment, p<0.001).

Discussion: COPD Written Action Plan adherence was further enhanced with the use of telehealth technologies in a specialised clinic with experience in COPD self-management. Patients followed by the telesystem recovered faster from exacerbations and had a further decrease in COPD-related ER visits and hospitalisations.

Trial registration number: NCT02275078.

Keywords: COPD; action plan adherence; exacerbations; self-management; telehealth.

Conflict of interest statement

Competing interests: JB reports grants from CIHR, Canadian Respiratory Research Network (CRRN), grants and personal fees from GLAXOSMITHKLINE, GRIFOLS, grants from AEROCRINE, grants and personal fees from BOEHRINGER INGELHEIM, ASTRAZENECA, NOVARTIS, grants from the Foundation of the MUHC, personal fees from NOVARTIS, all outside the lifespan of the submitted work.

Figures

Figure 1

The telesystem. Patients received regular automated calls from a computer-linked telesystem. Patients could also directly contact the telesystem at any time. During the telesystem calls, patients were asked about their general health status, which could be reported as better than usual, as usual or worse than usual. Patients were also asked if they wanted to be contacted by their curse manager. Depending on patients’ answers to the automated calls, healthcare professionals received notifications indicating patient’s health status (well-being, callback or alarm). If patient’s health status was reported as worse than usual, the telesystem programmed an automated follow-up call and captured information on patients’ symptoms, quality of life (with the COPD assessment test, CAT) and patients’ actions (treatment and healthcare use). Healthcare professionals received an alarm notification email which allowed them to follow-up with patients by phone as soon as possible. COPD, chronic obstructive pulmonary disease.

Figure 2

Time-to-treatment during COPD exacerbations. (A) Time to medication use (days). (B) Time to healthcare utilisation (days). Box plots from left to right: circles to the left box plots, outliers; left whisker, lowest observation; left box border, lower quartile (25th percentile); vertical line dividing the box, median; diamonds within the box, mean; right box border, upper quartile (75th percentile); right whisker, highest observation; circles to the right of box plots, outliers.

Figure 3

COPD Action Plan adherence. Proportion of exacerbations in which patients took their Action Plan medication, contacted their HCP and did both, take their Action Plan medication and contact their HCP. Overall adherence was considered for exacerbations in which patients either took their medication or contacted their HCP within 72 hours of exacerbation onset. COPD, chronic obstructive pulmonary disease; HCP, healthcare professional.

Figure 4

Exacerbation recovery time by Action Plan adherence category. Time to recover from a COPD exacerbation in days for the following categories: (A) patients taking their COPD Action Plan medication within 72 hours of exacerbation onset; (B) patients contacting a HCP within 72 hours of exacerbation onset and (C) patients that either took their Action Plan medication or contacted their HCP within 72 hours of exacerbation onset. Box plots from top to bottom: circles above box plot, outliers; top whisker, highest observation; top box border, upper quartile (75th percentile); diamond inside box plot, mean; horizontal line dividing the box, median; bottom box border, lower quartile (25th percentile); bottom whisker, lowest observation. Results were compared with Mann-Whitney’s test; *p