TY - JOUR
T1 - Home-Based Telemanagement in Advanced COPD
T2 - Who Uses it Most? Real-Life Study in Lombardy
AU - Vitacca, Michele
AU - Fumagalli, Lia Paola
AU - Borghi, Gabriella
AU - Colombo, Fausto
AU - Castelli, Alberto
AU - Scalvini, Simonetta
AU - Masella, Cristina
PY - 2016
Y1 - 2016
N2 - Current evidence indicates that the benefits of tele-health may not be uniform across all patients. Therefore, to understand what specific variables influence use of home-based telemanagement in COPD, we conducted this retrospective study. A 6-month home-based telemanagement program (HTP) was offered to 1,074 COPD patients over a 4-year period. Multivarible linear regression analysis was used to identify predictors of HTP use/week (phone calls and specialist consultations) among all variables: clinical (body mass index, co-morbidities, HTP prescription not following an exacerbation, long-term oxygen therapy use, COPD severity, hospital readmissions, exacerbations and death), socio-demographic (sex, age, place of abode), smoking history, arterial blood gases (ABG), and specialist/general practitioner (GP) urgent need. Logistic regression was conducted to predict relapses/hospitalizations risk as well as the disease impact (COPD Assessment Test, CAT) at the end of the program. Presence of relapses (p <0.001), ABGs (p <0.001) and GP request (p <0.001) were significantly associated with higher HTP-use. Smoking history (OR 1.542 [IC 95% 1.069-2.217], p = 0.020), specialist (OR 2.895 [2.144–3.910], p <0.001) and GP consultations (OR 6.575 [4.521–9.561], p <0.001) were the only independent risk factors for relapse. No predictor of hospitalization was found. High final CAT score was inversely related to oxygen therapy use (p = 0.001) and HTP prescription (p <0.001), and positively related to presence of co-morbidities (p = 0.001) and baseline CAT (p <0.001). This HTP in Lombardy shows that relapsers, people requiring several ABGs and urgent GP visits are the patient subgroup most likely to consume telemanagement services (scheduled and unscheduled). We propose a patient ‘identikit’ to improve prioritization for HTP prescriptions.
AB - Current evidence indicates that the benefits of tele-health may not be uniform across all patients. Therefore, to understand what specific variables influence use of home-based telemanagement in COPD, we conducted this retrospective study. A 6-month home-based telemanagement program (HTP) was offered to 1,074 COPD patients over a 4-year period. Multivarible linear regression analysis was used to identify predictors of HTP use/week (phone calls and specialist consultations) among all variables: clinical (body mass index, co-morbidities, HTP prescription not following an exacerbation, long-term oxygen therapy use, COPD severity, hospital readmissions, exacerbations and death), socio-demographic (sex, age, place of abode), smoking history, arterial blood gases (ABG), and specialist/general practitioner (GP) urgent need. Logistic regression was conducted to predict relapses/hospitalizations risk as well as the disease impact (COPD Assessment Test, CAT) at the end of the program. Presence of relapses (p <0.001), ABGs (p <0.001) and GP request (p <0.001) were significantly associated with higher HTP-use. Smoking history (OR 1.542 [IC 95% 1.069-2.217], p = 0.020), specialist (OR 2.895 [2.144–3.910], p <0.001) and GP consultations (OR 6.575 [4.521–9.561], p <0.001) were the only independent risk factors for relapse. No predictor of hospitalization was found. High final CAT score was inversely related to oxygen therapy use (p = 0.001) and HTP prescription (p <0.001), and positively related to presence of co-morbidities (p = 0.001) and baseline CAT (p <0.001). This HTP in Lombardy shows that relapsers, people requiring several ABGs and urgent GP visits are the patient subgroup most likely to consume telemanagement services (scheduled and unscheduled). We propose a patient ‘identikit’ to improve prioritization for HTP prescriptions.
KW - COPD
KW - functional status
KW - home telemanagement
KW - prognosis
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U2 - 10.3109/15412555.2015.1113243
DO - 10.3109/15412555.2015.1113243
M3 - Article
AN - SCOPUS:84954225931
SP - 1
EP - 8
JO - COPD: Journal of Chronic Obstructive Pulmonary Disease
JF - COPD: Journal of Chronic Obstructive Pulmonary Disease
SN - 1541-2555
ER -