Review
Home telemonitoring in COPD: A systematic review of methodologies and patients’ adherence

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Highlights

  • Telemonitoring interventions should be adjusted to their target population.

  • Assessment of patients’ acceptance of telemonitoring technology should be considered prior to its implementation.

  • Future research should consider the inclusion of easy-to-use technology and more training sessions.

  • Frequency of data collection/transmission should be flexible to improve adherence.

  • Changes in patients’ self-management behavior should be explored in future studies.

Abstract

Aim

This systematic review aimed to provide a comprehensive description of the methodologies used in home telemonitoring interventions for Chronic Obstructive Pulmonary Disease (COPD) and to explore patients’ adherence and satisfaction with the use of telemonitoring systems.

Methods

A literature search was performed from June to August and updated until December of 2012 on Medline, Embase, Web of Science and B-on databases using the following keywords: [tele(-)monitoring, tele(-)health, tele(-)homecare, tele(-)care, tele-home health or home monitoring] and [Chronic Obstructive Pulmonary Disease or COPD]. References of all articles were also reviewed.

Results

Seventeen articles were included, 12 of them published from 2010 to the present. The methodologies were similar in the training provided to patients and in the data collection and transmission processes. However, differences in the type of technology used, telemonitoring duration and provision of prompts/feedback, were found. Patients were generally satisfied and found the systems useful to help them manage their disease and improve healthcare provision. Nevertheless, they reported some difficulties in their use, which in some studies were related to lower compliance rates.

Conclusions

Telemonitoring interventions are a relatively new field in COPD research. Findings suggest that these interventions, although promising, present some usability problems that need to be considered in future research. These adjustments are essential before the widespreading of telemonitoring.

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.

Section snippets

Information sources and search strategy

A literature search was performed from June to August of 2012 in the medical databases Medline (1948–2012) and Embase (1974–2012) and wide-ranging scientific databases Web of Science (1970–2012) and B-on Online Knowledge Library (1999–2012). These databases were included to ensure that all relevant articles were retained. Search terms were based on a combination of the following keywords: [tele(-)monitoring or tele(-)health or tele(-)homecare or tele(-)care or tele-home health or home

Study selection

The database search identified 455 records. After duplicates removal, 130 records were screened for relevant content. During title, abstract and keyword screening, 109 articles were excluded due to the following reasons: non-original articles (n = 55), case studies (n = 3), no abstract provided (n = 6), inclusion of non-COPD patients (n = 17), absence of telemonitoring interventions (n = 22) and other languages rather than English, Portuguese or Spanish (n = 6). The full-text of the 21 potentially relevant

Discussion

This systematic literature review provided a comprehensive description of the methodologies of home telemonitoring interventions in COPD and summarized the findings related to patients’ adherence and satisfaction with the use of telemonitoring systems. The majority of the articles were published from 2010 to the present, suggesting that telemonitoring interventions are a relatively new field in COPD research. Protocols of the telemonitoring studies were similar in several aspects such as the

Conclusion

Home telemonitoring interventions are a relatively new field in COPD research. Findings suggest that these interventions, although promising, still need to be adjusted to ensure their suitability to the target population. This study provides important recommendations for future telemonitoring interventions, such as the inclusion of additional training sessions to facilitate patients’ education on the use of the systems and the assessment of patients’ characteristics and acceptance of the

Authors’ contributions

All authors contributed in different processes in the systematic review. JC and AM worked on the definition of appropriate search terms, quality assessment, data extraction and analysis. JC performed the search in the electronic databases and provided a draft of the manuscript, which was revised by all authors. All authors read and approved the final manuscript.

Conflict of interest

Support for this study was provided by Fundação para a Ciência e Tecnologia (FCT – Ref. SFRH/BD/81328/2011), Portugal. The authors report no conflict of interest.

Summary points

What is already known on the topic:

  • The number of patients with COPD being managed at home is increasing to reduce health-related costs while trying to increase patients’ comfort.

  • Home telemonitoring is an innovative approach which facilitates patients’ management at home, by exchanging information between patients and

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