Abstract
BackgroundChronic Obstructive Pulmonary Disease (COPD) is a prevalent debilitating long term condition. It is the second most common cause of emergency admission to hospital in the UK and remains one of the most costly conditions to treat through acute care.Tele-health monitoring offers potential to reduce the rates of re-hospitalisation and emergency department visits and improve quality of life for people with COPD. However, the current evidence base to support technology adoption and implementation is limited and the resource implications for implementing tele-health in practice can be very high. This trial will employ tele-health monitoring in a preventative capacity for patients diagnosed with early stage COPD following discharge from hospital to determine whether it reduces their need for additional health service support or hospital admission and improves their quality of life.Methods/DesignWe describe a pilot study for a two arm, one site randomized controlled trial (RCT) to determine the effect of tele-health monitoring on self-management, quality of life and patient satisfaction. Sixty patients who have been discharged from one acute trust with a primary diagnosis of COPD and who have agreed to receive community clinical support following discharge from acute care will be randomly assigned to one of two groups: (a) Tele-health supported Community COPD Service; or (b) Usual Care. The tele-health supported service involves the patient receiving two home visits with a specialist COPD clinician (nurse or physiotherapist) then participating in daily tele-monitoring over an eight week period. Usual care consists of six home visits to the patient by specialist COPD clinicians again over eight successive weeks. Health status and quality of life data for all participants will be measured at baseline, on discharge from the service and at six months post discharge from the service.DiscussionThe tele-health service under study is a complex service delivered through a collaboration between local authority and health care partners. The implementation of this service demanded significant changes to established working patterns and has been a challenging process requiring considerable planning - a challenge that many providers are likely to face in the future.Trial registrationCurrent Controlled Trials ISRCTN68856013
Highlights
Chronic Obstructive Pulmonary Disease (COPD) is a prevalent debilitating long term condition
The tele-health service under study is a complex service delivered through a collaboration between local authority and health care partners
The study will test the following specific hypotheses: 1. Tele-health monitoring will reduce the proportion of patients with early stage COPD who require further hospital re-admissions to manage their COPD for the duration of, and for six months following discharge from the Tele-health-supported Community COPD Service when compared with those who received the standard Community COPD Service; and Primary and Secondary Outcome Measures for the Definitive Trial Two primary outcomes will be measured: 1. The health service primary outcome will be the proportion of patients who are re-admitted to hospital with COPD as the primary or secondary cause of their admission, either during, or six months following their discharge from the Tele-health supported or standard Community COPD Service
Summary
The high local prevalence of COPD contributed to the £2.2 million cost of related admissions billed to the local health service between April 2006 and March 2007 [16]. Whilst the need to improve care delivery modalities and reduce reliance on the acute sector is recognized, in reality, the shift to the primary sector is proving more difficult to enact than initially anticipated This project is posing a number of challenges for the PCT undertaking the implementation of the tele-health supported Community COPD Service. The Local Authority had established a service providing a 24-hour, 365 day a year emergency response service for approximately 7,000 residents of the Borough, with approximately 4,700 service users linked to the service using Individual Alarm Units and the remainder in Local Authority and Housing Association accommodation linked by hard-wired intercom systems This centre had experience in installing comparable technology into people’s homes, so the PCT created a partnership with the Local Authority, tasking them with the installation of the tele-health equipment within 72 hours of hospital discharge. Preparation for this RCT has provided evidence of specific challenges in implementing tele-health supported services which may require quite innovative solutions
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