Understanding Remote Patient Monitoring in COPD
Author: John Sharp, Director, Thought Advisory, Personal Connected Health Alliance
Treatment of pulmonary conditions is increasingly turning to continuous monitoring through connected health devices. Part of the incentive in Chronic Obstructive Pulmonary Disease (COPD) is the Medicare Hospital Readmissions Reduction Program which penalizes hospitals for readmissions for COPD and other conditions. The use of digital monitoring for these conditions illustrates encouraging outcomes: COPD, asthma and sleep apnea.
While there is much enthusiasm for remote monitoring as a solution for management of chronic conditions, there has been limited review of careful evaluation of outcomes, what facilitates success and what barriers exist. A recent review article in JMIR Medical Informatics dives into studies from the last six years and outlines a model for evaluation of studies on remote monitoring for other conditions.
In examining outcomes of these studies, the authors found mixed results. Positive outcomes included reduced hospitalization rates, improved patient satisfaction, lower patient reported anxiety and depression as well as better clinical outcomes. Others found no significant improvement or actual reduced patient outcomes. Specifically, 31% of the studies showed a reduced number of clinical visits including primary care and emergency department visits. One study showed improvement especially among rural patients. Three studies found that adding videoconferencing and phone support to monitoring services reduced admissions for exacerbations.
The list of facilitators to the adoption of telemedicine included:
- Improved patient outcomes or satisfaction
- Reduced need for in-person visits
- Better disease management
- Bolstered patient-provider relationship
- High quality data
- Patient empowerment
- Ease of use
- Predictability of exacerbations
Regarding COPD and the use of digital inhalers, a recent study showed a reduction in COPD related healthcare costs despite a 44% adherence rate. The study concludes that electronic inhaler monitoring, in conjunction with a disease management program, may play a role in reducing healthcare utilization in COPD patients with a history of high utilization.
A third article on asthma and COPD notes that only 25% of patients fill their first prescription for an inhaler and when monitored, only 25 – 50% use the prescribed dose. This can lead to acerbations and increased healthcare utilization. Add-on or integrated adherence monitoring can maximize clinical effectiveness. While cost can be a concern, avoiding the need for biologics could produce a return on investment.
The authors also note that upload and feedback systems must not be burdensome for healthcare professionals or patients and express caution about low resource environments being a challenge for these monitoring devices. They also note regulatory challenges and the need for empathy for patients regarding their adherence behavior and problems with insurance coverage.
The growing evidence of digital health in respiratory disease is encouraging. However, better design, more research and methods to decrease provider and patient burden need further examination. With proper management of these monitoring devices, they will demonstrate improved clinical outcomes and reduced costs.