Study Identifies COPD Telehealth Services Needing Improvement

Although the coronavirus disease 2019 (COVID-19) pandemic led to increased adoption of remote care for chronic obstructive pulmonary disease (COPD) recent study results show that clinicians and patients feel many areas, including video consultations and oxygenator access, could benefit from improvements.

Investigators said that their results, published in BMK Open Respiratory Research, help describe “what new models of remote care delivery should look like,” as National Health Service (NHS) organizations in the United Kingdom “move from reacting to the pandemic to considering the broader role of digital technologies in providing care of COPD in systems where capacity for face-to-face care may be limited for some time.”

In the United Kingdom, the pandemic limited access to COPD specialists, and anecdotal evidence suggested that many practices worked rapidly to incorporate more remote services. However, there is little evidence on whether telehealth has an impact on quality of care, mortality, outpatient visits, length of stay, and quality of life for patients with COPD.

To understand the current scope of remote COPD specialty care provisions, the investigators used surveys, 1 for clinicians and 1 for patients, and a consensus-building process to assess the strengths and limitations of telehealth services.

The surveys and consensus-building process were hosted on an online platform and promoted on several health care research and advocacy organizations’ social media accounts. To be eligible, clinicians (including those who work on respiratory care teams or in palliative care) had to provide specialty care for patients with COPD, and patients had to be aged 18 or older, have a COPD diagnosis, and have accessed specialty COPD care in the last 3 months. Fifty-five clinicians and 19 patients met the eligibility criteria.

During the consensus-building process, respondents identified immediate priorities for improving remote specialty COPD care by using a 5-point scale from “not urgent” to “very urgent.” These are the most urgent items identified:

• Establishing a telephone line for urgent questions: 87%
• Developing new or highlighting existing online education resources on how to best deliver remote consultations: 81%
• Expanding access to video consultations, including training and support: 87%
• Providing pulse oximeters for patients to measure blood oxygen levels at home: 83%
• Developing standard remote consultation guidelines: 80%

The investigators also noted that reliance on phone-only contact and limited uptake of video communication technology may be barriers to access because of the limited interaction and services that can take place over the phone.

Additionally, 23 of the clinicians and 20 of the patients who participated rated 14 items on their appropriateness for remote application using a 9-point scale, with 1 indicating “not at all appropriate” and 9, “highly appropriate.” Results from this portion showed that consensus— meaning that 70% or more of respondents scored each item with a 7, 8, or 9—was reached for these 5 of the 14 items:

• Collecting information on patients’ overall health status through questions: 77%
• Providing education about COPD and treatments and developing self-management plans: 74%
• Assisting patients with smoking cessation: 81%
• Deciding whether a face-to-face meeting is necessary for patients: 72%
• Aiding patients’ decisions on whether to use a rescue pack: 76%

Clinicians agreed more than patients that collecting information on patients’ COPD and health status was appropriate (85% vs 68%), and patients agreed more than clinicians that performing lung function tests was inappropriate (73% vs 50%).

Limitations of the study included its online nature and the patient cohort being 100% White, suggesting that the responses may not be representative of COPD specialty care. Additionally, social media advertising for the study may have affected generalizability as there is a higher prevalence of COPD among populations who are less likely to have social media access, such as those who are older or socioeconomically disadvantaged.

“Further work is required to more fully understand the degree to which both planned and unplanned care activities can safely be carried out remotely in a way acceptable to patients and clinicians, what kind of hybrid models can be implemented based on patient preferences, new work-flows that need to be established to coordinate between clinicians and across care settings, and critical organisational investments needed to develop telehealth in meaningful ways,” said the investigators.

Reference

Wu F, Burt J, Chowdhury T, et al. Specialty COPD care during COVID-19: patient and clinician perspectives on remote delivery. BMJ Open Resp Res. 2021;8(1):e000817. doi:10.1136/bmjresp-2020-000817