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Program to Test the Effectiveness of Remote Monitoring of COPD Patients

The University of California Los Angeles (UCLA) and eResearch Technology Inc. (ERT) have announced that they will be launching a program to test whether remote health monitoring will benefit patients suffering from chronic obstructive pulmonary disease (COPD).

Researchers believe that if COPD patients can identify the symptoms and concerns of exacerbations early, their quality of life will improve and result in delayed or decreased demand for expensive medical care. To make this possible, UCLA and ERT have designed a program that will provide enhanced services to the patient outside of the physician’s office and beyond the normal process of care. This includes home-based spirometry, activity monitoring, adherence scoring and self-reported symptom monitoring, all enabled through technology.

However, before making this program available to COPD patients, the organizations will run a 12-month study designed to test its effectiveness. The study—known as the CLEAR Study—will test whether the remote health monitoring:

  • Is feasible in patients with moderate to severe COPD
  • Improves treatment adherence, symptoms, activity level and quality of life
  • Enables early detection of COPD exacerbations, facilitating early interventions and reducing health related expenditures

Researchers will test for these outcomes using a randomized study for patients 40 years of age and older receiving care for COPD in the Los Angeles community. Patients will be required to track their lung function on a daily basis using ERT’s SpiroPro®, which will also track symptoms such as breathlessness and cough. They will also use devices to access the new CLEAR Rx and CLEAR Ex Assessment instruments to determine prescription adherence and perceived activity levels. Lastly, enrollees will be required to record their physical activity levels, such as the number of steps taken per day and total activity time, using a wearable accelerometer. All tests will be performed daily from the patient’s home.

Throughout the study, researchers will track metrics to determine:

  • The adoption rate of remote health monitoring
  • Time to first COPD exacerbation
  • Treatment adherence
  • Respiratory function
  • Daily activity level and symptom scores
  • Utilization information, such as number of physician visits, emergency department visits, hospitalizations, number of days spent in hospital, and inferred healthcare costs

More than 200 patients are expected to enroll in this study, with the first one beginning the program in February 2012. Patient outcomes will be reported in late 2013.

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New COPD Clinic Could Reduce or Eliminate Hospital Stays

The Internal Medicine Clinics (IMC) has launched a new multidisciplinary clinic for chronic obstructive pulmonary disease (COPD) patients that is expected to reduce the admission rates and length of stay for COPD patients at the Thunder Bay Regional Health Sciences Centre in Ontario, Canada.

Known as the COPD Chronic Disease Management Clinic, this home-grown program combines a number of coordinated services to better manage the health of people living with COPD. The goal of the program is to educate COPD patients about self-managing their disease through monitoring and educational programs.

Included in this is a secure home monitoring system called TeleHomeCare, provided by the Ontario Telemedicine Network (OTN). With TeleHomeCare, each day patients are asked to measure their vital signs and answer a series of questions through a device called a Turtle, which is connected to their phone line. A nurse practitioner then reviews the results, looking for early warning signs of a symptom flare-up, so that an intervention can be made before the patient needs hospitalization.

While few studies exist that look at how COPD can be monitored at home, Dr. Zaki Ahmed, Chief of Internal Medicine at Thunder Bay and IMC lead, notes that people with COPD who require recurrent hospital treatment typically experience symptoms three to five days prior to entering the hospital. These symptoms include increased phlegm, fever, cough, shortness of breath, and wheezing.

“If we can get to them earlier, we can treat them earlier so they don’t get that bad,” he said in a statement from the hospital. “We try to change personal habits and try to educate [patients], eventually giving them the tools and education to manage their disease themselves.”

As part of the COPD Chronic Disease Management Clinic, IMC also provides support and education for patients, including visits to a respiratory therapist, a nurse practitioner and Dr. Ahmed, as necessary. Dr. Ahmed also notes that because home monitoring can be handled remotely, this program can reach across the entire Northwestern Ontario region.

Programs similar to the COPD Chronic Disease Management Clinic have resulted in patients becoming more involved in their own health and taking positive steps to managing their disease better.

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