Transcript
Telehealth Monitoring of People with
COPD – Are We Fostering Self
Management or Service Dependency?
Gill Lewin
Joanna Smith, Kristen De San Miguel,
IFA Conference, Prague, May 2012
Background
• Silver Chain, WA. Health and community care provider.
• 40,000+ clients with 50,000+ hospital admissions annually
• Diagnosis of COPD increases risk of admission
• Tested telehealth remote monitoring
• Two trials with people with COPD
Western
Australia
What is Telehealth Self Monitoring?
Intervention
Daily Measurements
Equipment
Nurse Monitoring
First Study
• Randomised controlled trial
• Telehealth remote monitoring vs Information only
• 40 participants in each group
• Monitored for six months
• Measured: Health Service Use and Quality of Life
• Results promising
Hospital Admissions
8 9
8
17
0
5
10
15
20
25
30
Telehealth Information
Nu
mb
er
Group
Hospital Admissions COPD Hospital Admissions Not COPD
Days in Hospital
21 21
85
162
0
20
40
60
80
100
120
140
160
180
200
Telehealth Information
Nu
mb
er
of
Day
s
Group
Hospital LOS COPD Hospital LOS Not COPD
ED Presentations
12 10
6 11
0
5
10
15
20
25
Telehealth Information
Nu
mb
er
Group
ED Presentations COPD
ED Presentations Not COPD
Questions…
• Would results be same over winter?
• Were people now dependent on
ongoing monitoring?
Second Study
Telehealth
n=36
Information
n=35
Tele-Tele
n=18
Tele-Info
n=17
Info-Tele
n=18
Info-Info
n=16
71 Individuals
completed first study
69 recruited into 2nd
study
Cross Over Trial
Outcomes monitored for
further 6 months +
compared to first 6 months
Mean Change in Hospitalisations
0,3 0,3 0,1
0,3
0,3
-0,5
-0,1 -0,2
-0,6
-0,4
-0,2
0,0
0,2
0,4
0,6
0,8
INFO-INFO INFO-TELE TELE-INFO TELE-TELE
Me
an C
han
ge
Group
Other Hosp
COPD Hops
Mean Change in Days in Hospital
3,9
0,8 0,4
1,9
0,8
-1,2
-0,3 -0,8
-2,0
-1,0
0,0
1,0
2,0
3,0
4,0
5,0
INFO-INFO INFO-TELE TELE-INFO TELE-TELE
Me
an C
han
ge
Group
Other LOS
COPD LOS
Mean Change in ED Presentations
0,3 0,1
0,2
0,4
0,3
-0,5
-0,4 -0,3
-0,6
-0,4
-0,2
0,0
0,2
0,4
0,6
0,8
INFO-INFO INFO-TELE TELE-INFO TELE-TELE
Me
an C
han
ge
Group
Other ED
COPD ED
Cost Difference
$7 466
-$46 -$1 448
$1 344
-$2 000
-$1 000
$-
$1 000
$2 000
$3 000
$4 000
$5 000
$6 000
$7 000
$8 000
INFO-INFO INFO-TELE TELE-INFO TELE-TELE
Co
st D
iffe
ren
ce
Group
Conclusions
• The benefits of telehealth remote monitoring are evident in all
seasons
• Telehealth remote monitoring has an impact on all health service
use – not just COPD related
• The benefits remain even after the monitoring equipment is
removed (if the individual has learned to take notice)
• Telehealth can result in large cost
savings for the health system
Acknowledgements
Commonwealth Department of Health and Ageing
State Health Research Advisory Council
Study Participants
Research Colleagues
Contact Details
Further information:
glewin@silverchain.org.au
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