Can Telemonitoring Services Improve COPD Outcomes?

As the US healthcare system continues to move toward value-based care, uptake of telemedicine has increased. However, while the digital health technology has been shown to improve patient outcomes and decrease costs for some diseases, the jury is still out on its impact on chronic obstructive pulmonary disease (COPD). According to a new analysis, there is high variability between studies assessing the impact of telemedicine on the disease.

The researchers searched databases for articles published between February 1, 2011 and February 1, 2017, analyzing a total of 29 articles that used telemonitoring services to regularly assess and assess disease state and health status. While 13 (45%) articles found improvements in things like patient outcomes, satisfaction, anxiety and depression, and hospitalization rates, the other 11 (38%) found that there was no significant improvement across outcomes.

“The results were mixed regarding the efficacy of telemonitoring to reduce complications associated with COPD,” wrote the researchers. “Any clear positive relationship with the use of telemonitoring to manage COPD was obscured.”

Nine (13%) of the studies revealed a reduced number of inpatient visits among patients with COPD who were engaged in telemonitoring care, and 2 studies found that this was particularly beneficial in rural areas where patients had less access to care.

A common reason cited for these improvements was that providing telemonitoring services added more service lines to a practice, and as more service options, including videoconferencing and phone support, were included, the more reductions were observed.

Other benefits reported with the telemonitoring services included better disease management, improved patient-provider relationships, high-quality data, ease of use, patient empowerment, patient engagement, and communication.

However, the analysis also identified several barriers reported by providers, including that the telemonitoring services actually worsened patient outcomes or resulted in no improvement. Other barriers included low-quality or limited data, increased workload for providers, heterogeneity of care, lack of service standardization, and time consumption.

“With 17% (5/29) studies referencing no improvement or reduced patient outcomes, the literature suggests that caregivers are hesitant before providing telemonitoring care that is not cost-effective,” wrote the researchers.

Another factor commonly cited in the articles was the cost of the technology. While some articles reported savings of up to nearly $270,000, others reported increased costs of care.

Reflecting on the findings, the researchers recommend future research focus on the importance of standardizing the telemonitoring techniques for these patients, as well as the ability of the technology to predict exacerbations. According to the researchers, predictability of exacerbations will lead to a drop in in-person visits and allow patients to recognize warning signs of their condition.

Reference:

Kruse C, Pesek B, Anderson M, Brennan K, Comfort H. Telemonitoring to manage chronic obstructive pulmonary disease: systematic literature review [published March 20, 2019]. JMIR Med Inform. doi: 10.2196/11496.