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Innovating the treatment of COPD exacerbations: a phone interactive telesystem to increase COPD Action Plan adherence
  1. Raquel Farias1,
  2. Maria Sedeno1,
  3. Danielle Beaucage2,
  4. Isabelle Drouin2,
  5. Isabelle Ouellet2,
  6. Alexandre Joubert2,
  7. Rita Abimaroun2,
  8. Meena Patel1,
  9. Mira Abou Rjeili1 and
  10. Jean Bourbeau1,2
  1. 1Respiratory Epidemiology and Clinical Research Unit, Department of Medicine, McGill University Health Center, McGill University, Montreal, Quebec, Canada
  2. 2Montreal Chest Institute, McGill University Health Centre, Montreal, Quebec, Canada
  1. Correspondence to Dr Jean Bourbeau; jean.bourbeau{at}mcgill.ca

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.

  • COPD
  • self-management
  • telehealth
  • action plan adherence
  • exacerbations

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Footnotes

  • Presented at Information in this article was presented as an abstract in the following meetings: (1) 2017 American Thoracic Society International Conference, May 2017, Washington DC, USA; (2) 12es Journées Francophones Alvéole, March 2018, Nantes, France; (3) Canadian Respiratory Conference 2018, April 2018, Vancouver, BC, Canada; (4) European Respiratory Society International Congress 2018, September 2018, Paris, France.

  • Contributors JB and RF had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. JB, MS and RF contributed substantially to the study design. JB, RF, MS, DB, ID, IO, AJ, RA and MP contributed to the study implementation. MP, RF and MAR substantially contributed to data collection. RF contributed to data analysis and interpretation. JB and RF contributed to the writing of the manuscript.

  • Funding Funding for this project was provided by GlaxoSmithKline as an Investigator-Initiated project (ClinicalTrials.gov identifier:NCT02275078).

  • 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.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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