Encyclopedia
Please note this is a comparison between Version 2 by Jessie Wu and Version 1 by Saeed M Alghamdi.
Chronic obstructive pulmonary disease (COPD) is a common, progressive respiratory disease that is growing in prevalence worldwide. The Global Initiative for Chronic Obstructive Lung Disease (GOLD 2023) defines COPD “as a heterogeneous lung condition characterized by chronic respiratory symptoms (dyspnea, cough, expectoration and/or exacerbations) due to abnormalities of the airways (bronchitis, bronchiolitis) and/or alveoli (emphysema) that cause persistent, often progressive, airflow obstruction.”. GOLD is a well-known international organization, which is working to provide guidelines for COPD diagnosis, treatment, prevention, and management in order to assess the characteristics of COPD at a global scale, and to maximize available resources to support COPD care. In COPD management, pharmacological and non-pharmacological treatments are mostly administrated together.
- digital health
- telehealth
- COPD
1. Digital Solutions in Healthcare Services
The term telehealth (TH) became the most common terminology to describe this integration of information and communication technologies (ICTs) and healthcare services. It is currently the preferred term because it captures the broad applications of this technology in providing healthcare services [9][1]. The term digital health is a relatively new concept, defined as “the use of digital technologies for health” [10][2]. Both TH and digital health are broad concepts that might include planning, monitoring, assessment, diagnosis, education, and treatment [10][2]. In the literature, TH or digital health have been used successfully within different health care disciplines, including cardio-respiratory disease management, and in the provision of home care or self-management for patients with chronic diseases such as Chronic OPD [11,12]bstructive Pulmonary Disease (COPD) [3][4]. In addition, technology can be used in COPD care to improve the timeframe of therapeutic contact, or as an alternative tool when access to care is not available [13][5] Figure 1.
Figure 1.
TH or Digital health concepts in COPD care.
2. Benefits of THelehealth with COPD hronic Obstructive Pulmonary Disease Management
Systematic reviews and meta-analysis showed that TH solutions that support self-management could contribute to improve user’s skills in controlling COPD, especially those with transport or economic limitations, or geographical barriers [12,14][4][6]. Considering the high cost of health care services, the TH approach could lower costs while maintaining quality of treatment in primary care clinics, decrease the pressure on the specialty care clinics, deliver tailored care, and facilitate the coordination of care among healthcare professionals [15][7]. Also, TH could be an opportunity to facilitate education reinforcement for professionals, patients and/or caregivers [16][8]. Additionally, digital health allows for frequent reminders to be provided to users to practice behavior which strengthens an existing behavior, like self-monitoring and self-efficacy, or facilitates early interventions for COPD conditions by detecting their exacerbation at an early stage, and could therefore prevent unnecessary emergency visits and hospital readmissions [17[9][10],18], as shown in Figure 2.
Figure 2.
Benefits of TH with COPD management.
3. Structures of THelehealth Solutions
Development and innovation in digital health are steadily increasing [19][11]. Looking to digitalization alone as effective tool is not going to provide us with a better result in clinical practice. As clinicians, wresearchers could look at this technology as a key part of the package provided to the users. The package usually contains multiple components, which include complex mediums and interventions (i.e., telerehabilitation). However, it is difficult to evaluate the functionality of TH solutions that support disease management without considering three important components: (1) the context that was provided, (2) the mechanisms that package components went through, and (3) the outcomes that the solutions are targeting. The answers to these questions still need further clarification [20,21][12][13]. One way to resolve this conflict is understanding the functionality of digital health solutions in COPD management [22,23][14][15]. This functionality could be understood from a theoretical perspective by identifying the associations between the context, mechanisms, and outcomes of current TH solutions that support disease management, in other words, the conceptual frameworks that enhance the connection between these elements and make technology a valuable tool in the delivery of care (Figure 3).
Figure 3.
Structure of TH applications.
4. Context of Digital Health Solutions
The context of TH in COPD management includes three important factors: (1) the clinical setting, (2) digital health development, and (3) targeted populations. A summary of the literature is provided in Table 1.
Table 1.
TH interventions’ characteristics from 2008 to 2023.
| Authors | Settings | Intervention with TH | Mode of Delivery | Intensity | Control Group Treatment | Summary of TH Outcomes Compared to Control Group |
|---|---|---|---|---|---|---|
| Trappenburg et al., 2008 [24][16] | Patient home (n = 165) | Software COPD self-management education | Telephone | 1×/day for 6 months |
Usual care | Reduction in AECOPD and hospitalization |
| Koff et al., 2009 [25][17] |
Patient home (n = 40) | Online COPD self- management education |
Web-based and telephone |
1×/day for 3 months |
Usual care | Improved quality of life |
| Halpin et al., 2011 [26][18] |
Patient home (n = 79) | Automated text messages system |
Text message | 1×/day for 4 months |
NR | Lower AECOPD but no change in quality of life |
| Lewis et al., 2011 [27][19] |
Patient home (n = 40) | Home monitoring | Telephone | 2×/day for 6 months |
Usual care | No difference in hospitalization or length of stay |
| Stickland et al., 2011 [25][17] | Community center (n = 409) |
Online COPD self- management education |
Web-based and video calls |
2×/week | In-person rehabilitation | Improvements in quality of life |
| Antoniades et al., 2012 [9][1] |
Patient home (n = 44) | Online COPD self-management education | Web-based | 1×/day for 12 months |
Usual care | No reduction in hospitalization or improvement in quality of life |
| Chau et al., 2012 [28][20] |
Patient home (n = 40) | Telecare services | Web-based and telephone |
3×/day for 2 months |
Community services | No difference in health-related quality of life |
| Dinesen et al., 2012 [29][21] |
Patient home (n = 111) | Telerehabilitation | Video calls | 1×/day for 4 months |
Instructional book | Reduced hospitalization |
| Nield et al., 2012 [30][22] |
Patient home (n = 22) | Online COPD self- management education |
Video calls | 1×/week for 1 month |
Usual care and in-person education | Decreased dyspnea |
| De San Miguel et al., 2013 [31][23] |
Patient home (n = 80) | Written COPD self- management education |
Telephone | 1×/day for 6 months |
Usual care | Reduced hospitalization and length of stay |
| Pedone et al., 2013 [32][24] |
Patient home (n = 99) | Telemonitoring | Web-based, telephone, and algorithm |
1×/day for 9 months |
Usual care | Reduced respiratory events and hospitalization |
| Pinnock et al., 2013 [33][25] |
Patient home (n = 256) | Online COPD self- management education |
Web-based, telephone, and algorithm |
1×/day for 12 months |
Usual care | Reduced admission to hospital but no change in quality of life |
| Schou et al., 2013 [34][26] |
Patient home (n = 44) | NR | Video calls | 1× /day for 3 months |
Regular Hospitalization. |
Improvements in lung volumes and oxygen saturation |
| Calvo et al., 2014 [17][9] |
Patient home Medical center (n = 60) |
Home care with TH | Web-based and telephone |
1×/day for 7 months |
Usual care | Reduction in ER visits, hospitalization, and length of stay |
| Tabak et al., 2014 [35][27] |
Patient home (n = 29) | Online COPD self- management education |
Web-based and Video calls |
1×/day for 9 months |
Usual care | Increased patient adherence to exercise |
| Berkhof et al., 2015 [36][28] | Medical center & patient home (n = 101) |
Phonecalls, education and follow ups | Telephone | Call/2 weeks for 6 months |
Usual care | No improvements in health status |
| Jakobsen et al., 2015 [6][29] | Patient home (n = 57) | Virtual hospital | NR | 1×/day for 6 months |
Regular hospitalization |
Reduced re-admission to hospital due to AECOPD |
| McDowell, 2015 [37][30] | Patient home (n = 110) | Home-based health care | Telephone | 1×/day for 6 months |
Usual care | Improved health related quality of life. |
| Ringbeak et al., 2015 [38][31] | Patient home (n = 281) | Online COPD self- management education and home exercise |
Video calls | 3×/week for 6 months |
Usual care | No change in dropout or mortality |
| Tucker et al., 2016 [39][32] | Patient Home (n = 65) |
Written home exercise with TH | Telephone | Call/2 weeks |
Usual care | Improvement in physical activity |
| Ho et al., 2016 [40][33] |
Patient home (n = 106) | Telemonitoring | Web-based and telephone |
1×/day for 2 months |
Usual care | Reduced number of hospitalizations due to AECOPD |
| Ringbeak et al., 2016 [41][34] |
Patient home and outpatient (n = 116) |
Online COPD self- management education and home exercise |
Web-based, video calls |
NR | In-person rehabilitation | Improved physical capacity but no improvement in CAT score. |
| Vianello et al., 2016 [42][35] | Hospital (n = 334) | Online COPD self-management education | Web-based and telephone |
1×/day for 12 months |
Usual care | Reduced readmission rate due to AECOPD |
| Farmer et al., 2017 [43][36] |
Patient home (n = 116) | COPD self-management education with TH |
Web-based | 1×/day for 12 months |
COPD self- Management education without TH |
Improved health status and quality of life |
| Lilholt et al., 2017 [44][37] |
Patient home and community center (n = 1225) | Telerehabilitation | Web-based, and telephone |
NR | In-person rehabilitation | No difference in quality of life |
| Shany et al. ,2017 [45][38] |
Patient home (n = 42) | Online COPD self- management education |
Web-based and telephone |
1×/day for 12 months |
Home care | Reduction in hospitalization and length of stay |
| Tsai et al., 2017 [46][39] | Patient home (n = 37) | Online COPD self- management education and home exercise |
Video calls | 3×/week | Usual PR | Improvements in physical capacity and quality of life |
| Soruano et al., 2018 [47][40] | Patient home (n = 237) | Telemonitoring | Internet modem | 1×/day for 12 months |
Usual care | TH did not reduce hospitalization due to AECOPD |
| Jolly et al., 2019 [48][41] | Patient home (n = 58) | Multimedia COPD self- management education and telephone coaching |
Telephone | 1×/day for 12 months |
Usual care | Improvement in uptake in PR program |
| Jiang et al., 2020 [49][42] | Patient home (n = 106) | TelePR program | 3×/week for 6 months | Usual PR | No difference in symptoms score between TelePR and UC | |
| Rassouli et al., 2021 [50][43] | Patients home (n = 168) | Online COPD self- management education |
Web-based and telephone | 5×/week for 6 months | Usual care | TH use improved CAT score and satisfaction with care. |
| Zanaboni et al., 2022 [51][44] | Patients home (n = 120) | TelePR | Video calls | 3×/week for 2 years | Treadmill at home | TH redued hospitalization. |
| Polo et al., 2023 [52][45] | Hospital and participants’ home (n = 209) | COPD TelePR program | Zoom and web-conferencing | 2×/week for 2 months | Usual PR | TH improved COPD symptoms, fatigue, self- management, and lung volumes. |
TH: telehealth, COPD: chronic obstructive pulmonary disease, PR: pulmonary rehabilitation, NR: not reported, TelePR: telepulmonary rehabilitation, AECOPD: acute exacerbation of COPD, ER: emergency room, CAT: COPD assessment tool, x: times, n: total number of participants in the study.
References
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- Chau, J.P.; Lee, D.T.; Yu, D.S.; Chow, A.Y.; Yu, W.C.; Chair, S.Y.; Lai, A.S.; Chick, Y.L. A feasibility study to investigate the acceptability and potential effectiveness of a telecare service for older people with chronic obstructive pulmonary disease. Int. J. Med. Inform. 2012, 81, 674–682.
- Dinesen, B.; Haesum, L.K.; Soerensen, N.; Nielsen, C.; Grann, O.; Hejlesen, O.; Toft, E.; Ehlers, L. Using preventive home monitoring to reduce hospital admission rates and reduce costs: A case study of telehealth among chronic obstructive pulmonary disease patients. J. Telemed. Telecare 2012, 18, 221–225.
- Nield, M.; Hoo, G.W. Real-time telehealth for COPD self-management using Skype. COPD 2012, 9, 611–619.
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