Effectiveness of telemonitoring integrated into existing clinical services on hospital admission for exacerbation of chronic obstructive pulmonary disease

researcher blind, multicentre, randomised controlled trial

H Pinnock, J Hanley, L McCloughan, A Todd, A Krishan, S Lewis, A Stoddart, M van der Pol, W MacNee, A Sheikh, C Pagliari, B McKinstry

Research output: Contribution to journalArticle

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Abstract

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: Researcher blind, multicentre, randomised controlled trial. SETTING: UK primary care (Lothian, Scotland). PARTICIPANTS: Adults with at least one admission for chronic obstructive pulmonary disease (COPD) in the year before randomisation. 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 centrally randomised to receive telemonitoring or conventional self monitoring. Using a touch screen, telemonitoring participants recorded a daily questionnaire 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 randomisation. Other outcomes included number and duration of admissions, and validated questionnaire assessments of health related quality of life (using St George's respiratory questionnaire (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 randomised 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 (standard 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 (standard 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 (standard deviation 16.3) v 67.3 (17.3); adjusted mean difference 1.39 (95% confidence interval -1.57 to 4.35)), or on other questionnaire 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: ISRCTN96634935. 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 submit it for publication. NHS Lothian supported the telemonitoring service and the clinical services.
Original languageEnglish
Article numberf6070
JournalBMJ
Volume347
Early online date17 Oct 2013
DOIs
Publication statusPublished - 2013

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Chronic Obstructive Pulmonary Disease
Randomized Controlled Trials
Research Personnel
Random Allocation
Quality of Life
Confidence Intervals
Intention to Treat Analysis
Ego
Organized Financing
Scotland
Self Efficacy
Informed Consent
Lung Diseases
Disease Progression
Publications
Reading
Primary Health Care
Anxiety
Communication
Surveys and Questionnaires

Keywords

  • Self Care/psychology
  • Scotland/epidemiology
  • Questionnaires
  • Decision Support Systems, Clinical
  • Female
  • Medication Adherence
  • Obstructive/*epidemiology/physiopathology/psycholo
  • Patient Readmission/statistics & numerical data
  • Aged
  • *Telemedicine
  • *Quality of Life
  • *Primary Health Care
  • *Disease Progression
  • Program Evaluation
  • Pulmonary Disease, Chronic
  • Single-Blind Method
  • Health Knowledge, Attitudes, Practice
  • Hospitalization/statistics & numerical data
  • Humans
  • Male
  • Algorithms
  • Garcia Aurelio Mauro
  • AM_Ebsco_Academic_Journals
  • AECOPD
  • Admission
  • copd
  • Monitoring
  • Telemedicine
  • Exacerbation
  • COPD

Cite this

Effectiveness of telemonitoring integrated into existing clinical services on hospital admission for exacerbation of chronic obstructive pulmonary disease : researcher blind, multicentre, randomised controlled trial. / Pinnock, H; Hanley, J; McCloughan, L; Todd, A; Krishan, A; Lewis, S; Stoddart, A; van der Pol, M; MacNee, W; Sheikh, A; Pagliari, C; McKinstry, B.

In: BMJ, Vol. 347, f6070, 2013.

Research output: Contribution to journalArticle

Pinnock, H ; Hanley, J ; McCloughan, L ; Todd, A ; Krishan, A ; Lewis, S ; Stoddart, A ; van der Pol, M ; MacNee, W ; Sheikh, A ; Pagliari, C ; McKinstry, B. / Effectiveness of telemonitoring integrated into existing clinical services on hospital admission for exacerbation of chronic obstructive pulmonary disease : researcher blind, multicentre, randomised controlled trial. In: BMJ. 2013 ; Vol. 347.
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abstract = "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: Researcher blind, multicentre, randomised controlled trial. SETTING: UK primary care (Lothian, Scotland). PARTICIPANTS: Adults with at least one admission for chronic obstructive pulmonary disease (COPD) in the year before randomisation. 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 centrally randomised to receive telemonitoring or conventional self monitoring. Using a touch screen, telemonitoring participants recorded a daily questionnaire 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 randomisation. Other outcomes included number and duration of admissions, and validated questionnaire assessments of health related quality of life (using St George's respiratory questionnaire (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 randomised 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 (standard 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 (standard 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 (standard deviation 16.3) v 67.3 (17.3); adjusted mean difference 1.39 (95{\%} confidence interval -1.57 to 4.35)), or on other questionnaire 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: ISRCTN96634935. 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 submit it for publication. NHS Lothian supported the telemonitoring service and the clinical services.",
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author = "H Pinnock and J Hanley and L McCloughan and A Todd and A Krishan and S Lewis and A Stoddart and {van der Pol}, M and W MacNee and A Sheikh and C Pagliari and B McKinstry",
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TY - JOUR

T1 - Effectiveness of telemonitoring integrated into existing clinical services on hospital admission for exacerbation of chronic obstructive pulmonary disease

T2 - researcher blind, multicentre, randomised controlled trial

AU - Pinnock, H

AU - Hanley, J

AU - McCloughan, L

AU - Todd, A

AU - Krishan, A

AU - Lewis, S

AU - Stoddart, A

AU - van der Pol, M

AU - MacNee, W

AU - Sheikh, A

AU - Pagliari, C

AU - McKinstry, B

PY - 2013

Y1 - 2013

N2 - 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: Researcher blind, multicentre, randomised controlled trial. SETTING: UK primary care (Lothian, Scotland). PARTICIPANTS: Adults with at least one admission for chronic obstructive pulmonary disease (COPD) in the year before randomisation. 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 centrally randomised to receive telemonitoring or conventional self monitoring. Using a touch screen, telemonitoring participants recorded a daily questionnaire 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 randomisation. Other outcomes included number and duration of admissions, and validated questionnaire assessments of health related quality of life (using St George's respiratory questionnaire (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 randomised 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 (standard 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 (standard 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 (standard deviation 16.3) v 67.3 (17.3); adjusted mean difference 1.39 (95% confidence interval -1.57 to 4.35)), or on other questionnaire 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: ISRCTN96634935. 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 submit it for publication. NHS Lothian supported the telemonitoring service and the clinical services.

AB - 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: Researcher blind, multicentre, randomised controlled trial. SETTING: UK primary care (Lothian, Scotland). PARTICIPANTS: Adults with at least one admission for chronic obstructive pulmonary disease (COPD) in the year before randomisation. 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 centrally randomised to receive telemonitoring or conventional self monitoring. Using a touch screen, telemonitoring participants recorded a daily questionnaire 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 randomisation. Other outcomes included number and duration of admissions, and validated questionnaire assessments of health related quality of life (using St George's respiratory questionnaire (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 randomised 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 (standard 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 (standard 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 (standard deviation 16.3) v 67.3 (17.3); adjusted mean difference 1.39 (95% confidence interval -1.57 to 4.35)), or on other questionnaire 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: ISRCTN96634935. 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 submit it for publication. NHS Lothian supported the telemonitoring service and the clinical services.

KW - Self Care/psychology

KW - Scotland/epidemiology

KW - Questionnaires

KW - Decision Support Systems, Clinical

KW - Female

KW - Medication Adherence

KW - Obstructive/epidemiology/physiopathology/psycholo

KW - Patient Readmission/statistics & numerical data

KW - Aged

KW - Telemedicine

KW - Quality of Life

KW - Primary Health Care

KW - Disease Progression

KW - Program Evaluation

KW - Pulmonary Disease, Chronic

KW - Single-Blind Method

KW - Health Knowledge, Attitudes, Practice

KW - Hospitalization/statistics & numerical data

KW - Humans

KW - Male

KW - Algorithms

KW - Garcia Aurelio Mauro

KW - AM_Ebsco_Academic_Journals

KW - AECOPD

KW - Admission

KW - copd

KW - Monitoring

KW - Telemedicine

KW - Exacerbation

KW - COPD

U2 - 10.1136/bmj.f6070

DO - 10.1136/bmj.f6070

M3 - Article

VL - 347

JO - BMJ

JF - BMJ

SN - 0959-8146

M1 - f6070

ER -