Preventative telehealth supported services for early stage chronic obstructive pulmonary disease: Lessons from a pilot randomised controlled trial Deborah A. Fitzsimmons1 Claire Bentley2, Gail A. Mountain2Jill Kenny2, Kinga Lowrie2, Stuart G Parker2, Mark S Hawley2 1School of Health Studies, University of Western Ontario, London, ON, Canada 4School of Health and Related Research, University of Sheffield, Sheffield, UK
Faculty/Presenter Disclosure • Faculty: Deborah A. Fitzsimmons PhD • Relationships with commercial interests: None • This program has received financial support from: The National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care, South Yorkshire (CLAHRC SY)in the form of grant funding for the research team. • This program has received in-kind support from: NHS Barnsley and Barnsley Metropolitan Council in the form of staff time and the procurement of the devices.
Barnsley characteristics • Aging Population • 2008 – 2031: Population increase by 16% • 65 – increase by 67% • 75 – increase by 80.5% • History of coal mining history • One of most deprived areas • Adverse lifestyle factors (diet, smoking) • High incidence of COPD • 2.5% vs. UK avg. of 1.5%
Outcome measures • Re-admitted to hospital with COPD • Change in self-reported health status and quality of life at baseline, 8 weeks and eight months after start of service • Requiring unscheduled healthcare support • Cost effectiveness through quality adjusted life years (QALYs)
Innovative Partnership Barnsley Primary Care Trust Barnsley Hospital Barnsley Metropolitan Borough Council
Care Pathway HOSPITAL PCT COUNCIL Patient admitted to hospital with COPD Equipment maintained / cleaned Patient discharged from hospital Patient referred to COPD service Patient accepted on COPD service Equipment installed 8 week service Repairs / replacement Patient discharged from service Equipment removed
Patient Profile Age
Patient Views of Tele-health “It was quite simple to use...It’s not rocket science is it?” “I haven’t been back to hospital since that machine came in” “I knew somebody was keeping an eye on me which was the main thing – there’s somebody there for you “I’m lost without it” “It became a bit of a chore” “It didn’t do anything for me – it didn’t build my confidence or anything like that” “I can stay at home and feel safe” What do users really think of tele-health monitoring? Quotes from interviews with users with COPD “It’s like having someone to turn to” “The best service I’ve ever had” “It’s one of the best things... I showed it to the chap who lives two doors away... They are going to put him on it” “I knew someone was watching and any indication that I was getting ill or anything, they’d get in touch” “The questions, they were a bit puzzling sometimes... The (answers) ought to be more in-between instead of black and white”
RCT Eligibility Criteria • Male or female over age of 16 • Discharged from hospital with COPD as primary or secondary diagnosis • 1 – 3 hospital admissions in prior 12 months for COPD including this discharge • PCT definition of early stage COPD • Willing to use telehealth • Home landline in place • Able to read English (technology requirement)
Outcomes of the Pilot • Planned to recruit 60 patients in 3 months (30 per arm) • Recruited 63 (randomized 5 with no/unsuitable landline) so needed to recruit 65 patients in total but this took 12 months • Lack of funding and support for full trial • Staff to be reassigned in organization shuffle • Testing alternate technology / approach introduced by new department management
References Telehealth RCT protocol: Fitzsimmons, D.A., Thompson, J., Hawley, M., Mountain, G.A., http://www.trialsjournal.com/content/12/1/6.