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Remote monitoring in COPD ; how much & how often ?
As a GP associated with the East Lancs COPD Telehealth Project I have been considering what evidence there currently is for the model of Telehealth which is being proposed.
I was asked to join this project in spring 2012. The choice of providers & type of teleheath technology had already been agreed. The aim was to explore how the technology could be used in East Lancashire COPD patients, and shed some light on how much impact this could have on the patients experience of COPD and what impact it had on the healthcare workload.
We are planning on using remote monitoring technology to enable remote recording of the patients blood pressure, pulse oximetry and temperature. These readings are taken by the patient ONCE a day and sent to a remote monitoring hub which effectively aims to spot significant changes and decides if the patient needs to have contact with a clinical team member.
Patients will be selected on the basis of those at high risk of needing a medical admission in the following year using the Blackpool NHS Predictive Risk Tool. This tool is being incorporated into the GP patient record systems of practices which signup to working with the project.
We are NOT using a video conferencing service like skype , and the patients will NOT be provided with a means of accessing the internet at home.
The big question is “Does remote monitoring of particular parameters result in a more timely intervention ( antibiotics + / – oral steroids ) , compared to the usual monitoring ?”
Unfortunately there is quite a variation in what constitutes as usual management of the COPD patient in East Lancs. We already have a “virtual ward” which enables patients to have regular nurse visits , but at home as opposed to on a real hospital ward. The virtual ward also delivers an education package that helps the patient to understand more about COPD, the benefits of stopping smoking, rehab and how to spot signs of deterioration.
The expert COPD patient their carer is likely to appreciate what the early signs of a clinical deterioration look like. They probably keep a supply of “rescue antibiotics and rescue steroids at home”. Not all patients are highly motivated expert patients who have “signed up” to the benefits of pulmonary rehab and the advantages of taking an active role in managing their COPD ( where appropriate ).
Remote monitoring could help all patients with COPD to manage their condition more effectively and reduce the risk of admission to hospital.
There is some discussion about how frequently the technology should prompt the patient to provide a reading.
What is the ideal frequency of monitoring ? 7 days a week, 5 days a week( Monday to Friday ) , or two days a week ? Opting for the 7 day a week monitoring will result in a higher cost per patient ; this will mean less patients taking part in this project.
What difference does the remote monitoring make over and above having an informed patient ?
If there is no evidence in support of any one of these frequencies I wonder if we should be looking at joining forces with another project to try and evaluate what is the most cost effective use of this technology.
Telehealth & remote monitoring will become more useful and cost effective as the technology develops. It isn’t too hard to imagine a situation in which a patient uses their own mobile telephone to act as the hub that collects and monitors the readings. Many patients already own BP measuring devices.
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