Randomised crossover trial of telemonitoring in chronic respiratory patients (TeleCRAFT trial)

M Chatwin, G Hawkins, L Panicchia, A Woods, A Hanak, R Lucas, E Baker, E Ramhamdany, B Mann, J Riley, M R Cowie, A K Simonds, M Chatwin, G Hawkins, L Panicchia, A Woods, A Hanak, R Lucas, E Baker, E Ramhamdany, B Mann, J Riley, M R Cowie, A K Simonds

Abstract

Design: Randomised crossover trial with 6 months of standard best practice clinical care (control group) and 6 months with the addition of telemonitoring.

Participants: 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.

Outcome measures: 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).

Results: 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.

Conclusions: 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.

Trial registration number: NCT02180919 (ClinicalTrials.gov).

Figures

Figure 1
Figure 1
Consort diagram; analysis was on an intention-to-treat basis.
Figure 2
Figure 2
(A) Time to first exacerbation requiring hospital admission telemonitoring versus control for the overall results. (B) Time to first exacerbation requiring hospitalisation in COPD and non-COPD groups.

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