Introduction
Chronic Obstructive Pulmonary Disease (COPD) is a highly prevalent disease worldwide [1]. As the disease progresses, patients become more susceptible to respiratory exacerbations which cause frequent hospital admissions and readmissions and, thus, have a considerable impact on patients’ quality of life and healthcare costs [2], [3]. This poses COPD as a public health problem of increasing concern to healthcare systems worldwide [4]. A number of interventions have been developed to help patients self-manage their disease and improve their quality of life, therefore reducing pressures on healthcare resources. Recent studies have shown that the number of patients with COPD being managed at home is increasing to reduce health-related costs while trying to increase patients’ comfort [5].
Home telemonitoring is a relatively new approach (dating back to the early 1990s) which facilitates patients’ management at home [6]. It is defined as the use of telecommunication technologies to transmit data on patients’ health status (e.g., oxygen saturation, vital signs) from home to a healthcare center [6], [7]. By systematically monitoring patients’ health condition, home telemonitoring can be used for a timely assessment of an acute exacerbation or as a mechanism to generate alarms to the patients and/or healthcare professionals when clinical changes that may constitute a risk to the patient occur [8]. This approach aims to empower patients to manage their disease (e.g., by recognizing the early signs of exacerbations), improve patient-professional interactions and prevent unplanned hospital admissions [8], [9].
Five systematic reviews are available on the topic of home telemonitoring in respiratory patients [7] and, specifically, in patients with COPD [5], [10], [11], [12]. However, they focus on clinical outcomes (e.g., quality of life) [7], [11], [12], reduction in healthcare service utilization [5], [7], [11], [12], feasibility and use [7], and on economic [5], [7] and organizational [10] impacts of telemonitoring. None of these studies provides a comprehensive description of the telemonitoring methodologies, which is essential to enhance the design of future telemonitoring interventions and facilitate comparisons between studies. Furthermore, optimal interventions require patients’ adherence [13], but there is still limited information about adherence to telemonitoring in COPD research. Previous studies on telemonitoring in different health conditions have suggested that adherence is related to patients’ satisfaction with the telemonitoring regimens [14], [15], [16], so satisfaction should be considered when assessing patients’ adherence. Thus, this systematic review aimed to: (1) provide a comprehensive description of the methodologies used in home telemonitoring for COPD; and (2) describe the current state of literature on patients’ adherence and satisfaction with the use of telemonitoring systems.