Abstract
BackgroundHospitalization for acute exacerbation of chronic obstructive pulmonary disease (COPD) is associated with poor prognosis. eHealth interventions might improve outcomes and decrease costs.ObjectiveThis study aimed to evaluate the effect of an eHealth program on COPD hospitalizations and exacerbations.MethodsThis was a real-world study conducted from April 2018 to December 2019 in the Bravis Hospital, the Netherlands. An eHealth program (EmmaCOPD) was offered to COPD patients at risk of exacerbations. EmmaCOPD consisted of an app that used questionnaires (to monitor symptoms) and a step counter (to monitor the number of steps) to detect exacerbations. Patients and their buddies received feedback when their symptoms worsened or the number of steps declined. Generalized estimating equations were used to compare the number of days admitted to the hospital and the total number of exacerbations 12 months before and (max) 18 months after the start of EmmaCOPD. We additionally adjusted for the potential confounders of age, sex, COPD severity, and inhaled corticosteroid use.ResultsThe 29 included patients had a mean forced expiratory volume in 1 second of 45.5 (SD 17.7) %predicted. In the year before the intervention, the median total number of exacerbations was 2.0 (IQR 2.0-3.0). The median number of hospitalized days was 8.0 days (IQR 6.0-16.5 days). Afterwards, there was a median 1.0 (IQR 0.0-2.0) exacerbation and 2.0 days (IQR 0.0-4.0 days) of hospitalization. After initiation of EmmaCOPD, both the number of hospitalized days and total number of exacerbations decreased significantly (incidence rate ratio 0.209, 95% CI 0.116-0.382; incidence rate ratio 0.310, 95% CI 0.219-0.438). Adjustment for confounders did not affect the results.ConclusionsThe eHealth program seems to reduce the number of total exacerbations and number of days of hospitalization due to exacerbations of COPD.
Highlights
Chronic obstructive pulmonary disease (COPD) is a treatable, preventable, chronic lung disease that accounts for years lived with disability [1] and reduced life expectancy [2]
It is known that hospitalization for an acute exacerbation of chronic obstructive pulmonary disease (COPD) is associated with poor prognosis and increased risk of death [4]
The secondary outcome of this study was to assess the effect of this program on the number of total exacerbations. This was a retrospective study with a pre-post research design using real-world data that were retrieved from the electronic record system at the Bravis Hospital and from EmmaCOPD
Summary
Chronic obstructive pulmonary disease (COPD) is a treatable, preventable, chronic lung disease that accounts for years lived with disability [1] and reduced life expectancy [2]. Hospitalization for acute exacerbation of chronic obstructive pulmonary disease (COPD) is associated with poor prognosis. An eHealth program (EmmaCOPD) was offered to COPD patients at risk of exacerbations. EmmaCOPD consisted of an app that used questionnaires (to monitor symptoms) and a step counter (to monitor the number of steps) to detect exacerbations Patients and their buddies received feedback when their symptoms worsened or the number of steps declined. In the year before the intervention, the median total number of exacerbations was 2.0 (IQR 2.0-3.0). After initiation of EmmaCOPD, both the number of hospitalized days and total number of exacerbations decreased significantly (incidence rate ratio 0.209, 95% CI 0.116-0.382; incidence rate ratio 0.310, 95% CI 0.219-0.438).
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