Telemedicine, the effect of nurse-initiated telephone follow up, on health status and health-care utilization in COPD patients: A randomized trial

Background and objectiveTelemedicine, care provided by electronic communication, may serve as an alternative or extension to traditional outpatient visits. This pilot study determined the effects of telemedicine on health-care utilization and health status of chronic obstructive pulmonary disease (COPD) patients. MethodsOne hundred and one patients were randomized, 52 patients received telemedicine care and 49 had traditional outpatient visits. The primary outcome was COPD-specific health status, measured with the Clinical COPD Questionnaire (CCQ). Secondary outcomes included St. George's Respiratory Questionnaire (SGRQ) and the Short Form-36 (SF-36) and resource use in primary and secondary care. ResultsThe mean age of the participants was 689 years and the mean per cent of predicted forced expiratory volume in 1s was 40.412.5. The CCQ total score deteriorated by 0.14 +/- 0.13 in the telemedicine group, and improved by -0.03 +/- 0.14 in the control group (difference 0.17 +/- 0.19, 95% confidence interval (CI): -0.21-0.55, P=0.38). The CCQ symptom domain showed a significant and clinically relevant difference in favour of the control group, 0.52 +/- 0.24 (95% CI: 0.04-0.10, P=0.03). Similar results were found for the SGRQ, whereas results for SF-36 were inconsistent. Patients in the control group had significantly fewer visits to the pulmonologist in comparison to patients in the telemedicine group (P=0.05). The same trend, although not significant, was found for exacerbations after 6 months. ConclusionsThis telemedicine model of initiated phone calls by a health-care provider had a negative effect on health status and resource use in primary and secondary care, in comparison with usual care and therefore cannot be recommended in COPD patients in its current form. Telemedicine has the potential to improve continuity of care, increase efficiency of outpatient management and prevent deterioration of health status in COPD patients. However, the effectiveness of telemedicine is still under debate. This study demonstrated that telemedicine alone, without any form of education, pulmonary rehabilitation or training, had no benefits for COPD patients at all.