Concurrent Improvement Observed in Patient-Reported Burden and Sensor-Collected Medication Use Among Patients Enrolled in a COPD Digital Health Program.

Leanne Kaye,Meredith A Barrett,Rahul Gondalia,Melissa Williams,David A Stempel

doi:10.3389/fdgth.2021.624261

Leanne Kaye, Meredith A Barrett + Show 3 more

Open Access

https://doi.org/10.3389/fdgth.2021.624261

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Abstract

Background: The COPD assessment test (CAT) is an 8-item questionnaire widely used in clinical practice to assess patient burden of disease. Digital health platforms that leverage electronic medication monitors (EMMs) are used to track the time and date of maintenance and short-acting beta-agonist (SABA) inhaler medication use and record patient-reported outcomes. The study examined changes in CAT and SABA inhaler use in COPD to determine whether passively collected SABA and CAT scores changed in a parallel manner.Methods: Patients with self-reported COPD enrolled in a digital health program, which provided EMMs to track SABA and maintenance inhaler use, and a companion smartphone application (“app”) to provide medication feedback and reminders. Patients completing the CAT questionnaire in the app at enrollment and at 6 months were included in the analysis. Changes in CAT burden category [by the minimally important difference (MID)] and changes in EMM-recorded mean SABA inhaler use per day were quantified at baseline and 6 months.Results: The analysis included 611 patients. At 6 months, mean CAT improved by −0.9 (95% CI: −1.4, −0.4; p < 0.001) points, and mean SABA use decreased by −0.6 (−0.8, −0.4; p < 0.001) puffs/day. Among patients with higher burden (CAT ≥ 21) at enrollment, CAT improved by −2.0 (−2.6, −1.4; p < 0.001) points, and SABA use decreased by −0.8 (−1.1, −0.6; p < 0.001) puffs/day.Conclusion: Significant and parallel improvement in CAT scores and SABA use at 6 months were noted among patients enrolled in a digital health program, with greater improvement for patients with higher disease burden.

Highlights

Chronic obstructive pulmonary disease (COPD) is a progressive respiratory illness with substantial impact on the patient’s wellbeing [1]
Baseline short-acting beta-agonist (SABA) use was greater among patients with higher burden COPD Assessment Test (CAT) scores compared to patients with lower burden CAT scores [median (IQR): 1.4 (0.4, 3.9) vs. 0.8 (0.1, 2.4) puffs/day; Wilcoxon rank-sum test p < 0.001], while baseline maintenance adherence was consistent [median (IQR): 93.3 (72.5, 98.3)% vs. 93.3 (80.7, 100.0)%; Wilcoxon rank-sum test p = 0.08]
Linear mixed-effect models found that, from baseline to 6 months, mean CAT improved by −0.9 points, mean SABA use decreased by −0.6 puffs/day, and mean adherence decreased by −4.0 percent

Summary

Introduction

Chronic obstructive pulmonary disease (COPD) is a progressive respiratory illness with substantial impact on the patient’s wellbeing [1]. The COPD Assessment Test (CAT) is a validated questionnaire designed to assess the disease burden [2]. Remote patient monitoring (RPM) with digital health tools for COPD may enhance the current standard of care through regular monitoring of symptoms and medication-taking behaviors [3, 4]. There exists an abundance of digital tools to support RPM, including wearables, smartphone or mobile phone applications, short-messaging services (SMS), and sensors to track medication use. These tools may help collect data between office visits and provide regular insight into patient health. The COPD assessment test (CAT) is an 8-item questionnaire widely used in clinical practice to assess patient burden of disease. The study examined changes in CAT and SABA inhaler use in COPD to determine whether passively collected SABA and CAT scores changed in a parallel manner

Methods

Results

Conclusion