Abstract
BackgroundPatients with chronic obstructive pulmonary disease (COPD) are often hospitalised with acute exacerbations (AECOPD) and many patients get readmitted. Intervening with hospitalised patients may be optimal timing to provide support. Our previous work demonstrated use of a digital monitoring and self-management support tool in the community. However, we wanted to explore the feasibility of recruiting patients whilst hospitalised for an AECOPD, and to identify the rate of dropout attrition around admission for AECOPD.MethodsPatients were recruited to the EDGE2 study between May 2019 and March 2020. Patients were identified by the clinical teams and patients were recruited by members of the clinical research team. Participants were aged 40 years or older, had a diagnosis of COPD and were attending or admitted to hospital for an AECOPD. Participants were given a tablet computer, Bluetooth-linked pulse oximeter and wrist-worn physical activity monitor to use until 6 months post-discharge. Use of the system aimed to support COPD self-management by enabling self-monitoring of vital signs, COPD symptoms, mood and physical activity, and access to multi-media educational resources.Results281 patients were identified and 126 approached. The main referral source was the specialist respiratory nursing and physiotherapist team (49.8% of patients identified). Twenty-six (37.1%) patients were recruited. As of 21 April 2020, 14 (53.8%) participants withdrew and 11 (of 14; 78.6%) participants withdrew within four weeks of discharge. The remaining participants withdrew between one and three months follow-up (1 of 14; 7.1%) and between three and six months follow-up (2 of 14; 14.3%).ConclusionA large number of patients were screened to recruit a relatively small sample and a high rate of dropout was observed. It does not appear feasible to recruit patients with COPD to digital interventional studies from the hospital setting when they have the burden of coping with acute illness.
Highlights
Patients with chronic obstructive pulmonary disease (COPD) are often hospitalised with acute exacerbations (AECOPD), presenting a mean age of 67 Æ 8 years.[1]
This study summarises the feasibility of recruiting patients whilst hospitalised for an AECOPD and identifies the extent to which study participants withdraw
The sElf-management anD support proGrammE (EDGE2) for COPD research study was approved by the London-Surrey Research Ethics Committee in December 2018 and prospectively registered (ISRCTN82570166)
Summary
Patients with chronic obstructive pulmonary disease (COPD) are often hospitalised with acute exacerbations (AECOPD), presenting a mean age of 67 Æ 8 years.[1] This is a common cause of emergency admission to hospital[2] and costs the NHS nearly £2 billion a year.[3] Nearly half of patients are discharged within three days of admission[4] but a quarter of patients are readmitted within 30 days of discharge.[5] To further complicate COPD management, nearly three quarters of patients have additional comorbidities (including coronary artery disease and diabetes mellitus) and the prevalence of comorbid conditions increases with more advanced disease.[6] This patient group has a high readmission rate, and in further testing the use of remote monitoring, our rationale for introducing the technology in a hospital setting is to minimise any delay in monitoring on return to the community. We wanted to explore the feasibility of recruiting patients whilst hospitalised for an AECOPD, and to identify the rate of dropout attrition around admission for AECOPD
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