Telehealthcare for chronic obstructive pulmonary disease

Susannah McLean, Ulugbek Nurmatov, Joseph L. Y. Liu, Claudia Pagliari, Josip Car, Aziz Sheikh

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    Abstract

    Background Chronic obstructive pulmonary disease (COPD) is a disease of irreversible airways obstruction in which patients often suffer exacerbations. Sometimes these exacerbations need hospital care: telehealthcare has the potential to reduce admission to hospital when used to administer care to the patient from within their own home.

    Objectives

    To review the effectiveness of telehealthcare for COPD compared with usual face-to-face care.

    Search strategy

    We searched the Cochrane Airways Group Specialised Register, which is derived from systematic searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, AMED, and PsycINFO; last searched January 2010. Selection criteria We selected randomised controlled trials which assessed telehealthcare, defined as follows: healthcare at a distance, involving the communication of data from the patient to the health carer, usually a doctor or nurse, who then processes the information and responds with feedback regarding the management of the illness. The primary outcomes considered were: number of exacerbations, quality of life as recorded by the St George's Respiratory Questionnaire, hospitalisations, emergency department visits and deaths.

    Data collection and analysis

    Two authors independently selected trials for inclusion and extracted data. We combined data into forest plots using fixed-effects modelling as heterogeneity was low (I-2 < 40%).

    Main results

    Ten trials met the inclusion criteria. Telehealthcare was assessed as part of a complex intervention, including nurse case management and other interventions. Telehealthcare was associated with a clinically significant increase in quality of life in two trials with 253 participants (mean difference -6.57 (95% confidence interval (CI) -13.62 to 0.48); minimum clinically significant difference is a change of -4.0), but the confidence interval was wide. Telehealthcare showed a significant reduction in the number of patients with one or more emergency department attendances over 12 months; odds ratio (OR) 0.27 (95% CI 0.11 to 0.66) in three trials with 449 participants, and the OR of having one or more admissions to hospital over 12 months was 0.46 (95% CI 0.33 to 0.65) in six trials with 604 participants. There was no significant difference in the OR for deaths over 12 months for the telehealthcare group as compared to the usual care group in three trials with 503 participants; OR 1.05 (95% CI 0.63 to 1.75).

    Authors' conclusions

    Telehealthcare in COPD appears to have a possible impact on the quality of life of patients and the number of times patients attend the emergency department and the hospital. However, further research is needed to clarify precisely its role since the trials included telehealthcare as part of more complex packages.

    This review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2012, Issue 8. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review

    Original languageEnglish
    Article numberCD007718
    Pages (from-to)1-51
    Number of pages51
    JournalCochrane Database of Systematic Reviews
    Issue number8
    DOIs
    Publication statusPublished - Aug 2012

    Cite this

    McLean, S., Nurmatov, U., Liu, J. L. Y., Pagliari, C., Car, J., & Sheikh, A. (2012). Telehealthcare for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews, (8), 1-51. [CD007718]. https://doi.org/10.1002/14651858.CD007718.pub2