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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
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Transcript of 2 lewin-telehealth ifa-may_2012
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
