Effectiveness of tele-monitoring by patient severity and intervention type in chronic obstructive pulmonary disease patients: A systematic review and meta-analysis

https://doi.org/10.1016/j.ijnurstu.2018.12.006Get rights and content

Abstract

Background

Chronic obstructive pulmonary disease is a major burden on healthcare systems worldwide. Tele-monitoring has recently been used for management of chronic obstructive pulmonary disease patients.

Objectives

We analyzed the effect of tele-monitoring on chronic obstructive pulmonary disease patients and performed subgroup analysis by patient severity and intervention type.

Data source

Electronic databases including Ovid-Medline, Ovid-Embase, and the Cochrane Library.

Review methods

We conducted a meta-analysis of randomized controlled trials published up to April 2017. Three databases were searched, two investigators independently extracted data and assessed study quality using risk of bias.

Results

Out of 1,185 studies, 27articles were identified to be relevant for this study. The included studies were divided by intervention: 15studies used tele-monitoring only, 4studies used integrated tele-monitoring (pure control), and 8studies used integrated tele-monitoring (not pure control). We also divided the studies by patient severity: 16studies included severely ill patients, 8studies included moderately ill patients, and 3studies did not discuss the severity of the patients’ illness. Meta-analysis showed that tele-monitoring reduced the emergency room visits (risk ratio 0.63, 95% confidence interval 0.55-0.72) and hospitalizations (risk ratio 0.88, 95% confidence interval 0.80–0.97). The subgroup analysis of patient severity showed that tele-monitoring more effectively reduced emergency room visits in patients with severe vs. moderate disease (risk ratio 0.48, 95% confidence interval 0.31–0.74; risk ratio 1.28, 95% confidence interval 0.61–2.69, retrospectively) and hospitalizations (risk ratio 0.92, 95% confidence interval 0.82–1.02; risk ratio 1.24, 95% confidence interval 0.57–2.70, retrospectively). The mental health quality of life score (mean difference 3.06, 95% confidence interval 2.15–3.98) showed more improved quality of life than the physical health quality of life score (mean difference -0.11, 95% confidence interval -0.83–0.61).

Conclusions

Tele-monitoring reduced rates of emergency room visits and hospitalizations and improved the mental health quality of life score. Integrated tele-monitoring including the delivery of coping skills or education by online methods including pulmonary rehabilitation is recommended to produce significant improvement. This application of integrated tele-monitoring (the delivery of education, exercise etc. in addition to tele-monitoring) is more useful for patients with (very) severe chronic obstructive pulmonary disease than those with moderate disease. Tele-monitoring might be a useful application of information and communication technologies, if the intervention includes the appropriate intervention components for eligible patients. Further studies such as large size randomized controlled trials with sub-group by patient severity and intervention type is needed to confirm these finding.

Section snippets

What is already known about the topic?

  • •

    Tele-monitoring has recently been used for management of chronic obstructive pulmonary disease patients.

  • •

    It can promote interactions between patients and medical teams by monitoring the patient’s symptoms, and may assist with unexpected patient hospitalizations or emergency room visits.

  • •

    The conflicting outcomes of systematic reviews are that while some studies require more research to reach definite conclusions, others show a positive effect of tele-monitoring.

What this paper adds

  • •

    Our results showed that tele-monitoring reduced emergency room visits, hospitalizations, and the mental health quality of life, while there were no differences in mortality, outpatient visits, or length of stay.

  • •

    Tele-monitoring has proved to be more useful in reducing the number of emergency room visits and hospitalization of patients with (very) severe chronic obstructive pulmonary disease than those with moderate diseases.

  • •

    Active integrated tele-monitoring, which includes the act of delivering

Search strategy

We performed a systemic review to identify relevant articles that compared the tele-monitoring group with a control group that didn’t receive tele-monitoring for chronic obstructive pulmonary disease using three English databases Ovid-Medline (1946 – May 2017), Ovid-EMBASE(1974-May 2017), and the Cochrane Central Register of controlled Trials (Central). We designed strategies that included Medical Subject Headings (MeSH), keywords such as “Pulmonary Disease, Chronic Obstructive”, “tele

Results

After a full-text review, 24 articles were identified to be relevant for this study. Three additional articles were found by manually searching relevant bibliographies, and 27 publications were finally selected for inclusion in the meta-analysis. (Fig. 1)

Discussion

We included 27 studies related to tele-monitoring for chronic obstructive pulmonary disease at home in our systematic review. Our study is the most updated and comprehensive systematic review, and the only one that analyzed subgroups by patient severity and intervention type. The principal finding of this systematic review is that tele-monitoring reduced emergency room visits, hospitalizations, and the mental health quality of life, but did not make a difference in mortality, outpatient visits,

Conclusion

The cost of care assistance in chronic obstructive pulmonary disease patients is dramatically increasing. Based on this systematic review, tele-monitoring reduced rates of emergency room visits, hospitalization, and the SF-36 mental component summery. Active integrated tele-monitoring including the delivery of coping skills or education online, including pulmonary rehabilitation, is recommended in order to produce significant improvement. This application of integrated tele-monitoring is more

Author contributions

S.H.L. contributed to the design of the study. All authors undertook the searches and screened studies for eligibility, assessed the quality of papers and performed statistical analyses. S.H.L. drafted the manuscript. All authors critically revised the manuscript for important intellectual content and the manuscript and approved the final version.

Competing interests

The authors declare that no competing interests exist.

Funding

This research was supported by the Gachon University research fund of 2017(GCU-2017-0179).

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