title: Exploring barriers to participation and adoption of telehealth and telecare within the Whole System Demonstrator trial: a qualitative study Effectiveness of telemonitoring integrated into existing clinical services on hospital admission for exacerbation of chronic obstructive pulmonary disease: researcher blind, multicentre, randomised controlled trial Detecting exacerbations using the Clinical COPD Questionnaire Development and Implementation of the Home Asthma Telemonitoring (HAT) System to Facilitate Asthma Self-Care Effect of telehealth on quality of life and psychological outcomes over 12 months (Whole Systems Demonstrator telehealth questionnaire study): nested study of patient reported outcomes in a pragmatic, cluster randomised controlled trial Telecare for Diabetes, CHF or COPD: Effect on Quality of Life, Hospital Use and Costs. A Randomised Controlled Trial and Qualitative Evaluation Factors relating to home telehealth acceptance and usage compliance Home telemonitoring (forced expiratory volume in 1 s) in children with severe asthma does not reduce exacerbations Efficacy of multiparametric telemonitoring on respiratory outcomes in elderly people with COPD: a randomized controlled trial Proactive integrated care improves quality of life in patients with COPD Prediction of Asthma Exacerbations in Children by Innovative Exhaled Inflammatory Markers: Results of a Longitudinal Study Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Quadrupling the dose of inhaled corticosteroid to prevent asthma exacerbations: a randomized, double-blind, placebo-controlled, parallel-group clinical trial. Pilot study of remote telemonitoring in COPD. Using preventive home monitoring to reduce hospital admission rates and reduce costs: a case study of telehealth among chronic obstructive pulmonary disease patients Effects of telemonitoring in patients with chronic obstructive pulmonary disease. Cost-utility analysis of a telerehabilitation program: a case study of COPD patients. A randomised controlled trial of the effect of automated interactive calling combined with a health risk forecast on frequency and severity of exacerbations of COPD assessed clinically and using EXACT PRO.
abstract: Background Telehealth ( TH ) and telecare ( TC ) interventions are increasingly valued for supporting self-care in ageing population s ; however , evaluation studies often report high rates of non-participation that are not well understood . This paper reports from a qualitative study nested within a large r and omised controlled trial in the UK : the Whole System Demonstrator ( WSD ) project . It explores barriers to participation and adoption of TH and TC from the perspective of people who declined to participate or withdrew from the trial . Methods Qualitative semi-structured interviews were conducted with 22 people who declined to participate in the trial following explanations of the intervention ( n = 19 ) , or who withdrew from the intervention arm ( n = 3 ) . Participants were recruited from the four trial groups ( with diabetes , chronic obstructive pulmonary disease , heart failure , or social care needs ) ; and all came from the three trial areas ( Cornwall , Kent , east London ) . Observations of home visits where the trial and interventions were first explained were also conducted by shadowing 8 members of health and social care staff visiting 23 people at home . Field notes were made of observational visits and explored alongside interview transcripts to elicit key themes . Results Barriers to adoption of TH and TC  associated with non-participation and withdrawal from the trial were identified within the following themes : requirements for technical competence and operation of equipment ; threats to identity , independence and self-care ; expectations and experiences of disruption to services . Respondents held concerns that special skills were needed to operate equipment but these were often based on misunderst and ings . Respondents ’ views were often explained in terms of potential threats to identity associated with positive ageing and self-reliance , and views that interventions could undermine self-care and coping . Finally , participants were reluctant to risk potentially disruptive changes to existing services that were often highly valued . Conclusions These findings regarding perceptions of potential disruption of interventions to identity and services go beyond more common expectations that concerns about privacy and dislike of technology deter uptake . These insights have implication s for health and social care staff indicating that more detailed information and time for discussion could be valuable especially on introduction . It seems especially important for potential recipients to have the opportunity to discuss their expectations and such views might usefully feed back into design and implementation Objective To test the effectiveness of telemonitoring integrated into existing clinical services such that intervention and control groups have access to the same clinical care . Design Research er blind , multicentre , r and omised controlled trial . Setting UK primary care ( Lothian , Scotl and ) . Participants Adults with at least one admission for chronic obstructive pulmonary disease ( COPD ) in the year before r and omisation . We excluded people who had other significant lung disease , who were unable to provide informed consent or complete the study , or who had other significant social or clinical problems . Interventions Participants were recruited between 21 May 2009 and 28 March 2011 , and central ly r and omised to receive telemonitoring or conventional self monitoring . Using a touch screen , telemonitoring participants recorded a daily question naire about symptoms and treatment use , and monitored oxygen saturation using linked instruments . Algorithms , based on the symptom score , generated alerts if readings were omitted or breached thresholds . Both groups received similar care from existing clinical services . Main outcome measures The primary outcome was time to hospital admission due to COPD exacerbation up to one year after r and omisation . Other outcomes included number and duration of admissions , and vali date d question naire assessment s of health related quality of life ( using St George ’s respiratory question naire ( SGRQ ) ) , anxiety or depression ( or both ) , self efficacy , knowledge , and adherence to treatment . Analysis was intention to treat . Results Of 256 patients completing the study , 128 patients were r and omised to telemonitoring and 128 to usual care ;  baseline characteristics of each group were similar . The number of days to admission did not differ significantly between groups ( adjusted hazard ratio 0.98 , 95 % confidence interval 0.66 to 1.44 ) . Over one year , the mean number of COPD admissions was similar in both groups ( telemonitoring 1.2 admissions per person ( st and ard deviation 1.9 ) v control 1.1 ( 1.6 ) ; P=0.59 ) . Mean duration of COPD admissions over one year was also similar between groups ( 9.5 days per person ( st and ard deviation 19.1 ) v 8.8 days ( 15.9 ) ; P=0.88 ) . The intervention had no significant effect on SGRQ scores between groups ( 68.2 ( st and ard deviation 16.3 ) v 67.3 ( 17.3 ) ; adjusted mean difference 1.39 ( 95 % confidence interval −1.57 to 4.35 ) ) , or on other question naire outcomes . Conclusions In participants with a history of admission for exacerbations of COPD , telemonitoring was not effective in postponing admissions and did not improve quality of life . The positive effect of telemonitoring seen in previous trials could be due to enhancement of the underpinning clinical service rather than the telemonitoring communication . Trial registration IS RCT N96634935 . Funding : The trial was funded by an NHS applied research programme grant from the Chief Scientist Office of the Scottish government ( ARPG/07/03 ) . The funder had no role in study design and the collection , analysis , and interpretation of data and the writing of the article and the decision to su bmi t it for publication . NHS Lothian supported the telemonitoring service and the clinical services Background Early treatment of COPD exacerbations has shown to be important . Despite a non-negligible negative impact on health related quality of life , a large proportion of these episodes is not reported ( no change in treatment ) . Little is known whether ( low burden ) strategies are able to capture these unreported exacerbations . Methods The Clinical COPD Question naire ( CCQ ) is a short question naire with great evaluative properties in measuring health status . The current explorative study evaluates the discriminative properties of weekly CCQ assessment in detecting exacerbations . Results In a multicentre prospect i ve cohort study , 121 patients , age 67.4 ± 10.5 years , FEV1 47.7 ± 18.5 % pred were followed for 6 weeks by daily diary card recording and weekly CCQ assessment . Weeks were retrospectively labeled as stable or exacerbation ( onset ) weeks using the Anthonisen symptom diary-card algorithm . Change in CCQ total scores are significantly higher in exacerbation-onset weeks , 0.35 ± 0.69 compared to -0.04 ± 0.37 in stable weeks ( p < 0.001 ) . Performance of the Δ CCQ total score discriminating between stable and exacerbation onset weeks was sufficient ( area under the ROC curve 0.75 ) . At a cut off point of 0.2 , sensitivity was 62.5 ( 50.3 - 73.4 ) , specificity 82.0 ( 79.3 - 84.4 ) , and a positive and negative predictive value of 43.5 ( 35.0 - 51.0 ) and 90.8 ( 87.8 - 93.5 ) , respectively . Using this cut off point , 22 ( out of 38 ) unreported exacerbations were detected while 39 stable patients would have been false positively ' contacted ' . Conclusions Weekly CCQ assessment is a promising , low burden method to detect unreported exacerbations . Further research is needed to vali date discriminative performance and practical implication s of the CCQ in detecting exacerbations in daily care National Asthma Education and Prevention Program ( NAEPP ) suggests using asthma action plans for patient self-care . Recent studies reported that many asthma patients had difficulties in following action plans on a daily basis and had low compliance to medication regimens . The goal of our study was to design and evaluate the Home Asthma Telemonitoring ( HAT ) system aim ed to help asthma patients to follow their self-care plans according to the NAEPP recommendations . Our study result ed in the development of the system which provided patients with continuous individualized help in the daily routine of asthma self-care and notified heath care providers if certain clinical conditions occurred . This allowed early recognition of potentially dangerous situations and timely intervention . The evaluation of the HAT system underwent several stages . First we showed , that the HAT system provides reliable reciprocal exchange of all relevant information between a physician and asthma patient in home setting s. Further evaluation demonstrated that lung function test results collected during home asthma telemonitoring are comparable to those collected under the supervision of trained professionals , and Internet-based home asthma telemonitoring can be successfully implemented in a group of patients without previous computer experience . Preliminary results of an on-going HAT evaluation showed higher patient compliance to asthma action plans in comparison to the compliance reported for patients in st and ard care . The clinical impact of HAT on asthma outcomes is being currently evaluated in a r and omized clinical trial funded by NIH . HAT has a potential for improving clinical outcomes and quality of life in the studied patient population and may be a model for monitoring and self-management of patients with other chronic health conditions Objective To assess the effect of second generation , home based telehealth on health related quality of life , anxiety , and depressive symptoms over 12 months in patients with long term conditions . Design A study of patient reported outcomes ( the Whole Systems Demonstrator telehealth question naire study ; baseline n=1573 ) was nested in a pragmatic , cluster r and omised trial of telehealth ( the Whole Systems Demonstrator telehealth trial , n=3230 ) . General practice was the unit of r and omisation , and telehealth was compared with usual care . Data were collected at baseline , four months ( short term ) , and 12 months ( long term ) . Primary intention to treat analyses tested treatment effectiveness ; multilevel models controlled for clustering by general practice and a range of covariates . Analyses were conducted for 759 participants who completed question naire measures at all three time points ( complete case cohort ) and 1201 who completed the baseline assessment plus at least one other assessment ( available case cohort ) . Secondary per protocol analyses tested treatment efficacy and included 633 and 1108 participants in the complete case and available case cohorts , respectively . Setting Provision of primary and secondary care via general practice s , specialist nurses , and hospital clinics in three diverse regions of Engl and ( Cornwall , Kent , and Newham ) , with established integrated health and social care systems . Participants Patients with chronic obstructive pulmonary disease ( COPD ) , diabetes , or heart failure recruited between May 2008 and December 2009 . Main outcome measures Generic , health related quality of life ( assessed by physical and mental health component scores of the SF-12 , and the EQ-5D ) , anxiety ( assessed by the six item Brief State-Trait Anxiety Inventory ) , and depressive symptoms ( assessed by the 10 item Centre for Epidemiological Studies Depression Scale ) . Results In the intention to treat analyses , differences between treatment groups were small and non-significant for all outcomes in the complete case ( 0.480≤P≤0.904 ) or available case ( 0.181≤P≤0.905 ) cohorts . The magnitude of differences between trial arms did not reach the trial defined , minimal clinical ly important difference ( 0.3 st and ardised mean difference ) for any outcome in either cohort at four or 12 months . Per protocol analyses replicated the primary analyses ; the main effect of trial arm ( telehealth v usual care ) was non-significant for any outcome ( complete case cohort 0.273≤P≤0.761 ; available case cohort 0.145≤P≤0.696 ) . Conclusions Second generation , home based telehealth as implemented in the Whole Systems Demonstrator Evaluation was not effective or efficacious compared with usual care only . Telehealth did not improve quality of life or psychological outcomes for patients with chronic obstructive pulmonary disease , diabetes , or heart failure over 12 months . The findings suggest that concerns about potentially deleterious effect of telehealth are unfounded for most patients . Trial Registration IS RCT N43002091 Objectives To assess the effect of telecare on health related quality of life , self-care , hospital use , costs and the experiences of patients , informal carers and health care professionals . Methods Patients were r and omly assigned either to usual care or to additionally entering their data into a commercially-available electronic device that uploaded data once a day to a nurse-led monitoring station . Patients had congestive heart failure ( Site A ) , chronic obstructive pulmonary disease ( Site B ) , or any long-term condition , mostly diabetes ( Site C ) . Site C contributed only intervention patients – they considered a usual care option to be unethical . The study took place in New Zeal and between September 2010 and February 2012 , and lasted 3 to 6 months for each patient . The primary outcome was health-related quality of life ( SF36 ) . Data on experiences were collected by individual and group interviews and by question naire . Results There were 171 patients ( 98 intervention , 73 control ) . Quality of life , self-efficacy and disease-specific measures did not change significantly , while anxiety and depression both decreased significantly with the intervention . Hospital admissions , days in hospital , emergency department visits , outpatient visits and costs did not differ significantly between the groups . Patients at all sites were universally positive . Many felt safer and more cared-for , and said that they and their family had learned more about managing their condition . Staff could all see potential benefits of telecare , and , after some initial technical problems , many staff felt that telecare enabled them to effectively monitor more patients . Conclusions Strongly positive patient and staff experiences and attitudes complement and contrast with small or non-significant quantitative changes . Telecare led to patients and families taking a more active role in self-management . It is likely that subgroups of patients benefitted in ways that were not measured or visible within the quantitative data , especially feelings of safety and being cared-for . Trial Registration Australian New Zeal and Clinical Trials Registry Aim This paper investigates the acceptance of in-home telehealth by frail older adults and carers of the Transition Care Program ( TCP ) , and evaluates telehealth acceptance as a predictor for usage compliance . Method A stratified r and om sample of participants was allocated to one of five groups : either a  control group or to receive telehealth monitoring of their vital signs for a period of 12 or 24 weeks ; with or without a medical alarm pendant . Results Before being trained in and using telehealth , the majority of participants and carers demonstrated acceptance of the technology by reporting that they perceived it would be “ useful ” and “ easy to use . ” This acceptance was also reported post-TCP ( up to 12 weeks of usage ) . The “ perceived ease of use ” of the telehealth equipment increased significantly from pre-telehealth training and usage to post-TCP ( up to 12 weeks of usage ) ( P = 0.001 ) . There was no change , ( pre-training and usage to post-TCP ) in the “ perceived usefulness ” of the telehealth equipment . The telehealth acceptance constructs of “ ease of use ” and “ usefulness , ” at pre-telehealth training and usage , approached statistical significance as a predictor of future compliance ( P = 0.06 ) . “ Perceived ease of use , ” at pre-training and usage , had a positive relationship with future compliance ( P = 0.02 ) . Conclusion There is currently limited knowledge about the influences and determinants of home telehealth compliance in frail older people and their carers , potentially a significant user group for the technology into the future . This study ’s finding that frail older people and their carers perceive that home telehealth is useful and easy to use demonstrates their acceptance of home telehealth as a therapeutic tool . Further , perceived ease of use of home telehealth is a significant predictor of compliance with frail older people and their carers ’ use of home telehealth . Additional research is required in order to identify other influences and determinants of home telehealth compliance with this group . Knowledge about the influences and determinants of home telehealth compliance may assist the development of targeted interventions aim ed at encouraging high compliance with users who are recording lower reading rates Some children with severe asthma develop frequent exacerbations despite intensive treatment . We sought to assess the outcome ( severe exacerbations and healthcare use , lung function , quality of life and maintenance treatment ) of a strategy based on daily home spirometry with teletransmission to an expert medical centre and whether it differs from that of a conventional strategy . 50 children with severe uncontrolled asthma were enrolled in a 12-month prospect i ve study and were r and omised into two groups : 1 ) treatment managed with daily home spirometry and medical feedback ( HM ) and 2 ) conventional treatment ( CT ) .  The children ’s mean age was 10.9 yrs ( 95 % confidence interval 10.2–11.6 ) . 44 children completed the study ( 21 in the HM group and 23 in the CT group ) . The median number of severe exacerbations per patient was 2.0 ( interquartile range 1.0–4.0 ) in the HM group and 3.0 ( 1.0–4.0 ) in the CT group ( p=0.38 with adjustment for age ) . There were no significant differences between the two groups for unscheduled visits ( HM 5.0 ( 3.0–7.0 ) , CT 3.0 ( 2.0–7.0 ) ; p=0.30 ) , lung function ( pre-&bgr;2-agonist forced expiratory volume in 1 s ( FEV1 ) p=0.13 ) , Paediatric Asthma Quality of Life Question naire scores ( p=0.61 ) and median daily dose of inhaled corticosteroids ( p=0.86 ) . A treatment strategy based on daily FEV1 monitoring with medical feedback did not reduce severe asthma exacerbations Background Chronic obstructive pulmonary disease ( COPD ) is a highly prevalent condition associated with a high health care re source consumption and health care expenditures , driven mainly by exacerbations-related hospitalizations . Telemedicine has been proposed as a mean for timely detection of exacerbation , but the available evidence is inadequate to provide conclusive information on its efficacy . The aim of this study is to evaluate the efficacy of a telemonitoring system in reducing COPD -related hospitalizations in an elderly population with COPD . Methods This is a parallel arms , r and omized trial including patients aged 65 or older with COPD in GOLD stages II and III enrolled in a Pulmonary Medicine outpatient facility . Patients were r and omly assigned to receive a non-invasive system able to telemonitor vital signs ( oxygen saturation , heart rate , near-body temperature , overall physical activity ) or st and ard care , and were followed up for 9 months . The outcome measures were the number of exacerbations and exacerbation-related hospitalization . Results Fifty patients were included in the telemonitoring group and 49 in the control group . The incidence rate of respiratory events was 28/100 person/years in the telemonitoring group vs. 42/100 person/years in the control group ( incidence rate ratio : 0.67 , 95 % CI : 0.32 – 1.36 ) . The corresponding figures for hospital admissions where 13/100 person/years and 20/100 person/years , respectively ( IRR : 0.66 , 95 % CI : 0.21 – 1.86 ) . Conclusions In our study , COPD patients followed up with the aid of a multiparametric remote monitoring system experienced a lower rate of exacerbations and COPD -related hospitalizations compared to patients followed up using the st and ard model of care . These results need to be replicated in larger studies before they can be applied to the general COPD population . Trial registration number : NCT01481506 ( clinical trials.gov ) . Funding : co-financed by Lazio Region and Intersistemi Self-management strategies improve a variety of health-related outcomes for patients with chronic obstructive pulmonary disease ( COPD ) . These strategies , however , are primarily design ed to improve chronic disease management and have not focused on early detection and early treatment of exacerbations . In COPD , the majority of exacerbations go unreported and treatment is frequently delayed , result ing in worsened outcomes . Therefore , a r and omised clinical trial was design ed to determine whether integration of self-management education with proactive remote disease monitoring would improve health-related outcomes . A total of 40 Global Initiative for Chronic Obstructive Lung Disease stage 3 or 4 COPD patients were r and omised to receive proactive integrated care ( PIC ) or usual care ( UC ) over a 3-month period . The primary and secondary outcomes were change in quality of life , measured by the St George ’s Respiratory Question naire ( SGRQ ) , and change in healthcare costs . PIC dramatically improved SGRQ by 10.3 units , compared to 0.6 units in the UC group . Healthcare costs declined in the PIC group by US$ 1,401 , compared with an increase of US$ 1,709 in the UC group , but this was not statistically significant . PIC uncovered nine exacerbations , seven of which were unreported . Therefore , proactive integrated care has the potential to improve outcomes in chronic obstructive pulmonary disease patients through effects of self-management , as well as early detection and treatment of exacerbations Background In asthma management guidelines the primary goal of treatment is asthma control . To date , asthma control , guided by symptoms and lung function , is not optimal in many children and adults . Direct monitoring of airway inflammation in exhaled breath may improve asthma control and reduce the number of exacerbations . Aim 1 ) To study the use of fractional exhaled nitric oxide ( FeNO ) and inflammatory markers in exhaled breath condensate ( EBC )  , in the prediction of asthma exacerbations in a pediatric population . 2 ) To study the predictive power of these exhaled inflammatory markers combined with clinical parameters . Methods 96 asthmatic children were included in this one-year prospect i ve observational study , with clinical visits every 2 months . Between visits , daily symptom scores and lung function were recorded using a home monitor . During clinical visits , asthma control and FeNO were assessed . Furthermore , lung function measurements were performed and EBC was collected . Statistical analysis was performed using a test data set and validation data set for 1 ) conditionally specified models , receiver operating characteristic-curves ( ROC-curves ) ; 2 ) k-nearest neighbors algorithm . Results Three conditionally specified predictive models were constructed . Model 1 included inflammatory markers in EBC alone , model 2 included FeNO plus clinical characteristics and the ACQ score , and model 3 included all the predictors used in model 1 and 2 . The area under the ROC-curves was estimated as 47 % , 54 % and 59 % for models 1 , 2 and 3 respectively . The k-nearest neighbors predictive algorithm , using the information of all the variables in model 3 , produced correct predictions for 52 % of the exacerbations in the validation data set . Conclusion The predictive power of FeNO and inflammatory markers in EBC for prediction of an asthma exacerbation was low , even when combined with clinical characteristics and symptoms . Qualitative improvement of the chemical analysis of EBC may lead to a better non-invasive prediction of asthma exacerbations The effects of broad-spectrum antibiotic and placebo therapy in patients with chronic obstructive pulmonary disease in exacerbation were compared in a r and omized , double-blinded , crossover trial . Exacerbations were defined in terms of increased dyspnea , sputum production , and sputum purulence . Exacerbations were followed at 3-day intervals by home visits , and those that resolved in 21 days were design ated treatment successes . Treatment failures included exacerbations in which symptoms did not resolve but no intervention was necessary , and those in which the patient 's condition deteriorated so that intervention was necessary . Over 3.5 years in 173 patients , 362 exacerbations were treated , 180 with placebo and 182 with antibiotic .  The success rate with placebo was 55 % and with antibiotic 68 % . The rate of failure with deterioration was 19 % with placebo and 10 % with antibiotic . There was a significant benefit associated with antibiotic .  Peak flow recovered more rapidly with antibiotic treatment than with placebo .  Side effects were uncommon and did not differ between antibiotic and placebo RATIONALE Asthma exacerbations are unpredictable , disruptive , and frightening , and are therefore important to prevent . OBJECTIVES We investigated whether a policy of quadrupling the dose of inhaled corticosteroid when asthma control starts to deteriorate reduces asthma exacerbations requiring treatment with oral corticosteroids . METHODS A total of 403 people with asthma were given a self-management plan and r and omized to take an active or placebo corticosteroid inhaler in addition to their usual asthma treatment when their PEF fell by 15 % on 2 consecutive days or by 30 % on 1 day . The study inhalers provided a quadrupling or no change in corticosteroid dose . MEASUREMENTS AND MAIN RESULTS Eighteen of 197 ( 9 % ) and 29 of 203 ( 14 % ) participants had an exacerbation of asthma requiring treatment with oral corticosteroids  in the active and placebo groups , respectively , giving a risk ratio of 0.64 ( 95 % confidence interval , 0.37 - 1.11 , P = 0.11 ) . Of the 94 participants who started the study inhaler far fewer required treatment with oral corticosteroids in the active compared with the placebo group : 12 of 56 ( 21 % ) in the active group and 19 of 38 ( 50 % ) in the placebo group , giving a risk ratio of 0.43 ( 95 % confidence interval , 0.24 - 0.78 , P = 0.004 ) . CONCLUSIONS Although our primary outcome did not reach statistical significance , quadrupling the dose of inhaled corticosteroid when asthma control starts to deteriorate appears to reduce acute exacerbations of asthma and deserves further investigation . Clinical trial registered with www.controlled-trials.com ( IS RCT N 46018181 ) BACKGROUND Remote in-home monitoring ( RM ) of symptoms and physiological variables may allow early detection and treatment of exacerbations of chronic obstructive pulmonary disease ( COPD ) . It is unclear whether RM improves patient outcomes or healthcare re source utilization . This study determined whether RM is feasible in patients with COPD and if RM  reduces hospital admissions or length of stay ( LOS ) or improves health-related quality of life ( HRQOL ) . SUBJECTS AND METHODS Forty-four patients were r and omized to st and ard best practice care ( SBP ) ( n=22 ) or SBP+RM ( n=22 ) . RM involved daily recording of physiological variables , symptoms , and medication usage . RESULTS There were no differences ( mean±SD , SBP versus SBP+RM ) in age ( 68±8 versus 70±9 years ) , gender ( male : female 10:12 in both groups ) , or previous computer familiarity ( 59 % versus 50 % ) between groups . The SBP group had a lower forced expiratory volume in 1 s ( 0.66±0.24 versus 0.91±0.34 L , p<0.01 ) and more current smokers ( six versus none , p<0.05 ) . There were no differences in number of COPD -related admissions/year ( 1.5±1.8 versus 1.3±1.7 , p=0.76 ) , COPD -related LOS days/year ( 15.6±19.4 versus 11.4±19.6 , p=0.66 ) , total admissions/year ( 2.2±2.1 versus 2.0±2.3 , p=0.86 ) , total LOS days/year ( 22.1±29.9 versus 21.6±30.4 , p=0.88 ) , or HRQOL between the two groups . CONCLUSIONS The addition of RM to SBP was feasible but did not reduce healthcare utilization or improve quality of life in this group of patients already receiving comprehensive respiratory care We studied whether preventive home monitoring of patients with chronic obstructive pulmonary disease ( COPD ) could reduce the frequency of hospital admissions and lower the cost of hospitalization .  Patients were recruited from a health centre , general practitioner ( GP ) or the pulmonary hospital ward . They were r and omized to usual care or tele-rehabilitation  with a telehealth monitoring device installed in their home for four months . A total of 111 patients were suitable for inclusion and consented to be r and omized : 60 patients were allocated to intervention and three were lost to follow-up . In the control group 51 patients were allocated to usual care and three patients were lost to follow-up . In the tele-rehabilitation group , the mean hospital admission rate was 0.49 per patient per 10 months compared to the control group rate of 1.17 ; this difference was significant ( P = 0.041 ) . The mean cost of admissions was € 3461 per patient in the intervention group and € 4576 in the control group ; this difference was not significant . The Kaplan-Meier estimates for time to hospital admission were longer for the intervention group than the controls , but the difference was not significant . Future work requires large-scale studies of prolonged home monitoring with more extended follow-up The objective of this study was to determine the effects of a homebased telemonitoring device , The Health Buddy ( HB ) , on health consumption and health-related quality of life ( HRQoL ) in patients with moderate to severe chronic obstructive pulmonary disease ( COPD ) . The HB provides daily symptom-surveillance by a case manager and education to enhance disease knowledge and self-management . A nonr and omized controlled multicenter study was established comparing the effectiveness of telemonitoring as an add-on to care as usual with a follow-up of 6 months . Four hospitals took part in the experimental group and 2 hospitals formed an equivalent control group with 59 and 56 patients , respectively .  HRQoL was measured by the Clinical COPD Question naire . Healthcare consumption was assessed using medical records in the 6 months preceding study entry and during the study . Compared with the control group , the HB group showed a significant decrease in hospital admission rates ( HB -0.11 + /- 1.16 vs. control + 0.27 + /- 1.0 , p = 0.02 ) and in the total number of exacerbations ( HB -0.35 + /- 1.4 vs. control + 0.32 + /- 1.2 , p = 0.004 ) . There was a tendency toward decreased hospital days and outpatient visits . No significant changes in HRQoL were observed at follow-up between both study groups . Despite inherent limitations of the study , these findings suggest that adopting telemonitoring in everyday clinical practice is feasible and can substantially improve care and decrease healthcare utilization of patients with moderate to severe COPD OBJECTIVE The present study seeks to conduct cost-utility analysis ( CUA ) of the Danish TELEKAT ( Telehomecare , Chronic Patients and the Integrated Healthcare System ) project . The TELEKAT project seeks to test and develop a preventive home monitoring concept across sectors for chronic obstructive pulmonary disease ( COPD ) patients . The concept of the TELEKAT project is to reduce admissions by enabling the COPD patients to conduct self-monitoring and maintain rehabilitation activities in their own home . COPD patients with severe and very severe COPD were included in the study . SUBJECTS AND METHODS This economic evaluation follows international guidelines for the conduction of a CUA alongside a clinical r and omized controlled trial . The analysis is based on a health sector perspective . RESULTS The mean incremental cost efficiency ratio , located in the southeast quadrant , shows that telerehabilitation is less costly and more effective than the rehabilitation given to the control group . The telerehabilitation program produces more value for money and generates savings on healthcare budgets . CONCLUSIONS The telerehabilitation program appears to be more cost-effective than the conventional rehabilitation program for COPD patients . Further studies of cost-effectiveness with a focus on large-scale studies are needed BACKGROUND We have developed a winter forecasting service to predict when patients with COPD are at higher risk of an exacerbation and alert them via an automated telephone call . AIMS To assess the effect of the service and its ability to predict periods of increased risk . METHODS A 4-month prospect i ve r and omised controlled trial using clinical criteria and the EXACT PRO question naire to identify exacerbations . Patients were r and omly allocated to receive alert calls . All patients completed a diary including the EXACT PRO question naire on a BlackBerry Smartphone each day . They were contacted and assessed if they appeared to be exacerbating . RESULTS 79 patients participated , 40 received alert calls .  The exacerbation frequency per patient per week was significantly greater during periods of predicted high risk ( 0.086 ± 0.010 v 0.055 ± 0.010 ) . The exacerbation frequency ( ± st and ard error of the mean , SEM ) in patients receiving alert calls was lower ( 0.95 ± 0.27 v 1.17 ± 0.29 ) but this was not statistically significant . Fewer patients receiving alert calls had one or more EXACT event compared to the controls ( 34 % v 53 % , p=0.11 ) , their duration was shorter ( 8.2 ± 2.0 v10.1 ± 1.9 days , p=0.481 ) and they were less severe ( AUC 65 ± 21 v 115 ± 22 , p=0.118 ) . There were no significant differences in the mean change ( ± SEM ) in SGRQ scores between the groups . CONCLUSIONS The ability of the forecast to predict high risk periods was confirmed unequivocally . Alert calls appeared to reduce the frequency and severity of exacerbations but these effects did not reach statistical significance , perhaps because of the number of participants , lower than expected exacerbation rates , and the fact that there was contact with patients in both groups whenever they appeared to be exacerbating
target: Only then will telemonitoring achieve the aim of preventing hospital admissions , contributing to the reduction of health re source utilization and improving the quality of life of patients
background: Major reported factors associated with the limited effectiveness of home telemonitoring interventions in chronic respiratory conditions include the lack of useful early predictors , poor patient compliance and the poor performance of conventional algorithms for detecting deteriorations .
  This article provides a systematic review of existing algorithms and the factors associated with their performance in detecting exacerbations and supporting clinical decisions in patients with chronic obstructive pulmonary disease ( COPD ) or asthma .