title: Exploring barriers to participation and adoption of telehealth and telecare within the Whole System Demonstrator trial: a qualitative study A feasibility study to investigate the acceptability and potential effectiveness of a telecare service for older people with chronic obstructive pulmonary disease Integrated care prevents hospitalisations for exacerbations in COPD patients Effects of home telemonitoring to support improved care for chronic obstructive pulmonary diseases. Proactive integrated care improves quality of life in patients with COPD Pilot study of remote telemonitoring in COPD. Using home telehealth to empower patients to monitor and manage long term conditions. Home telemonitoring and quality of life in stable, optimised chronic obstructive pulmonary disease 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. Does Home Telemonitoring after Pulmonary Rehabilitation Reduce Healthcare Use in Optimized COPD?? A Pilot Randomized Trial Continuity, but at what cost? The impact of telemonitoring COPD on continuities of care: a qualitative study.
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 AIMS To investigate the feasibility , acceptance and potential effectiveness of delivering a telecare service on the health outcomes and hospital service utilization of community-dwelling patients with chronic obstructive pulmonary disease . METHODS Eligible participants were older people , with moderate or severe chronic obstructive pulmonary disease , and who had been admitted to hospital at least once for exacerbation during the previous year . The participants were r and omly assigned to the intervention or control group . Participants in the intervention group received a telecare device kit and they were asked to monitor their oxygen saturation , pulse rate and respiration rate using the device and to transmit the data to an online network platform . A medication and purse-lip breathing reminder with a feedback function is also provided in the device kit . A community nurse monitors changes in the physiological parameters and takes immediate action to address the patients ' needs . Participants in the control group received no other extra care . Study outcomes include user satisfaction , health-related quality of life , pulmonary function , hospital re-admission and use of emergency room services . RESULTS Twenty-two participants in the intervention group and 18 in the control group were included in the analysis . The mean age of all 40 participants was 72.93 years . Overall , the participants in the intervention group expressed satisfaction with the telecare service . Some patients reported difficulty in reading the screen of the mobile phone and manipulating the tiny key-in buttons . No significant differences were found between the two time points ( baseline and post-test period ) with regard to health-related quality of life . No significant differences in pulmonary function and in the number of emergency department visits and hospital re-admissions between the study groups were found . CONCLUSION The high level of user satisfaction indicated the feasibility of conducting a large-scale r and omized control trial to evaluate the effects of a telecare service on health outcomes of patients with chronic obstructive pulmonary disease Hospital admissions due to chronic obstructive pulmonary disease ( COPD ) exacerbations have a major impact on the disease evolution and costs . The current authors postulated that a simple and well-st and ardised , low-intensity integrated care intervention can be effective to prevent such hospitalisations . Therefore , 155 exacerbated COPD patients ( 17 % females ) were recruited after hospital discharge from centres in Barcelona ( Spain ) and Leuven ( Belgium ) . They were r and omly assigned to either integrated care ( IC ; n = 65 ; age mean±sd 70±9 yrs ; forced expiratory volume in one second ( FEV1 ) 1.1±0.5 L , 43 % predicted ) or usual care ( UC ; n = 90 ; age 72±9 yrs ; FEV1 1.1±0.05 L , 41 % pred ) . The IC intervention consisted of an individually tailored care plan upon discharge shared with the primary care team , as well as accessibility to a specialised nurse case manager through a web-based call centre . After 12 months ’ follow-up , IC showed a lower hospitalisation rate ( 1.5±2.6 versus 2.1±3.1 ) and a higher percentage of patients without re-admissions ( 49 versus 31 % ) than UC without differences in mortality ( 19 versus 16 % , respectively ) . In conclusion , this trial demonstrates that a st and ardised integrated care intervention , based on shared care arrangements among different levels of the system with support of information technologies , effectively prevents hospitalisations for exacerbations in chronic obstructive pulmonary disease patients OBJECTIVE To assess the impact of a home telemonitoring technology on patients with chronic obstructive pulmonary disease in terms of care satisfaction , patient empowerment , improved quality of life , and utilization of hospital and home care . DESIGN A quasi-experimental retrospective and prospect i ve design was developed with a matched control group to compare the effects of telemonitoring  ( the experimental group , n = 23 ) with the traditional homecare offering  ( the control group , n = 23 ) . MEASUREMENTS Satisfaction , patient empowerment , and quality of life were measured using vali date d Likert scales , whereas the data on care utilization were collected from the participating patients ' medical record . RESULTS Mixed results were observed . The clinical effects of home telemonitoring were very positive in terms of patients ' satisfaction and empowerment . The perceptions of care providers as well as those of patients were congruent in this respect . Also , the study suggests that telemonitoring may have a positive effect on quality of life for patients with chronic obstructive pulmonary diseases . In contrast , the results were disappointing in terms of re source savings for the use of both homecare and hospital care . CONCLUSION Capturing the full potential of these new technologies will require a much more fundamental reorganization of work than just a simple deployment of the technology 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 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 This article describes a pilot telehealth project in Swansea where patients with heart failure and chronic obstructive pulmonary disease were provided with telehealth monitoring equipment . While early evaluation points to some potential economic benefits , supporting patient empowerment was a significant outcome We conducted a six-month r and omised controlled trial of home telemonitoring for patients with chronic obstructive pulmonary disease ( COPD ) . A total of 40 stable patients with moderate to severe COPD who had completed pulmonary rehabilitation took part . They were r and omised to receive st and ard care ( controls ) or st and ard care plus home telemonitoring ( intervention ) . During the monitoring period , patients in the telemonitoring group recorded their symptoms and physical observations twice daily . The data were transmitted automatically at night via the home telephone line . Nurses could access the data through a website and receive alerting email messages if certain conditions were detected . The patients completed the St George 's Respiratory Question naire , Hospital Anxiety and Depression and the EuroQoL EQ-5D quality of life scores before and after pulmonary rehabilitation , and then periodically during the trial . There were significant and clinical ly important improvements in the scores immediately following pulmonary rehabilitation , but thereafter there were no differences in quality of life scores between the groups at any time , or consistently within either group over time . The study showed that telemonitoring was safe but , despite being well used , it was not associated with changes in quality of life in patients who had stable COPD 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 ABSTRACT Aim . To see if home telemonitors reduce healthcare use in those with optimized chronic obstructive pulmonary disease ( COPD ) . Methods . We r and omized 40 stable patients with moderate to severe COPD , who had completed at least 12 sessions of outpatient pulmonary rehabilitation ( PR ) , to receive st and ard care ( Controls ) for 52 weeks or st and ard care plus Docobo HealthHUB monitors at home for 26 weeks followed by 26 weeks st and ard care ( Tm Group ) . During the monitoring period , the Tm Group completed  symptoms and physical observations  twice daily which were stored and then uploaded at 2 am through a freephone l and line . Nurses could access the data through a secure web site and received alerting e-mails if certain combinations of data occurred . Results . There were fewer primary care contacts for chest problems ( p < 0.03 ) in the Tm group , but no differences between the groups in emergency room visits , hospital admissions , days in hospital or contacts to the specialist COPD community nurse team , during the monitoring period . After the monitors were removed , there were no differences between the groups for any of the health care contacts ( p > 0.20 throughout ) . Conclusion . In stable , optimized COPD patients who have already completed PR , telemonitoring in addition to best care , reduces primary care chest contacts but not hospital or specialist team utilization BACKGROUND Continuity of care is widely regarded as an important marker of quality in the management of patients with long-term conditions . New services that integrate telemonitoring into care pathways have potential to change aspects of continuity in both positive and negative ways . AIMS A telemonitoring service for patients with chronic obstructive pulmonary disease ( COPD ) was introduced in Lothian , Scotl and , in 2009 . A qualitative study , nested within the TELESCOT COPD r and omised control trial , was undertaken to explore the views of patients and professionals on  telemonitoring . The perceived impact of telemonitoring on continuity of care was investigated as part of the research . METHODS Semi-structured interviews were undertaken with 38 patients ( 47 % male , mean age 67.5 years ) . A maximum variation sample in relation to age , sex , socio-economic background , disease severity , and compliance with telemonitoring was recruited . Thirty-two stakeholders ( healthcare professionals and managers ) were interviewed . Transcribed coded data were analysed thematically using the framework approach . Interpretation was supported by multidisciplinary discussion . RESULTS Patients and healthcare professionals considered that relationship-based continuity of care was important in the delivery of telemonitoring services . Managers placed emphasis on improved continuity of clinical management as a means of reducing healthcare costs . However , professionals described many operational challenges arising from the ' bolting-on ' of telemonitoring provision to existing usual care provision which , they considered , result ed in the proliferation of additional managerial discontinuities . CONCLUSIONS Managers and healthcare professionals face major challenges in meeting dem and s for both relationship continuity and continuity of clinical management in the development of telemonitoring services
target: Patients were generally satisfied and found the systems useful to help them manage their disease and improve healthcare provision .
  Nevertheless , they reported some difficulties in their use , which in some studies were related to lower compliance rates .
background: AIM This systematic review aim ed to provide a comprehensive description of the method ologies used in home telemonitoring interventions for Chronic Obstructive Pulmonary Disease ( COPD ) and to explore patients ' adherence and satisfaction with the use of telemonitoring systems .