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Early Assisted Discharge With Generic Telemedicine for Chronic Obstructive Pulmonary Disease Exacerbations: Results of a Randomized Controlled Trial FREE TO VIEW

Patricia Mínguez, MD; Beatriz Cadavid, MD; Carmen Mata, RN; Rosa Malo, MD; Miriam Aguilar, MD; Manuel Valle, MD; Andrea Trisan, MD; Antolín Lopez, MD; Mario Pascual; Juan Fragua; Piedad Ussetti, MD
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Hospital Puerta de Hierro, Madrid, España, Majadahonda, Spain

Chest. 2014;145(3_MeetingAbstracts):198A. doi:10.1378/chest.1793561
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SESSION TITLE: Telemedicine Posters

SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: To determine if an early assisted discharge program for chronic obstructive pulmonary disease (COPD) exacerbations, with telemonitoring and telephone control, is equally effective and more efficient in terms of use of health care resources, that a home care provided by hospital department respiratory

METHODS: Patients admitted to the hospital with an acute exacerbation of COPD (AECOPD). Patients with no or limited improvement, severe unstable comorbidities or social problems were excluded. Experimental prospective randomized study with two groups. Both groups had a visit before discharge from the hospital and a discharge visit from the program at home (pulmonologist and nurse).In the intervention group there was a visit the following day by a nurse and a technician in telemedicine (installation and explanation of the monitor). Successive visits: control group: daily nursing visits; Telemedicine group: only one required and performed daily home monitoring vital signs and biomedical parameters, sent to the telemedicine platform and call phone by the pulmonologist later. Primary endpoint: time to first exacerbation. Secondary endpoints: use of health resources, satisfaction, quality of life, anxiety and adherence to treatment. Questionnaires: Satisfad 10, STAI state-trait, Morinsky-green, CAT. Follow-up: 6 months with an intermediate visit in a month.

RESULTS: The first 30 patients were randomized (16 intervention group, 14 control group). There weren’t readmission. Median days to first exacerbation: control 113 (8 exacerbations) and intervention 47 ( 7 exacerbations), no statistically significant difference (p=0.103, non-parametric). These results are heavily influenced by the small sample size and more severity COPD in telemedicine with statistically significant differences in scale mMRC (control: degree: 1 (7), 2 (5), 3 (1), intervention: degree: 1 (4), 2 (6) 3 (6); p=0.047) and BODEx (control 2.79 +/- 1.5, intervention 4.1 +/- 1.8; p=0.041). Total visits: control 5.5 +/- 2.8 and intervention 4.06 +/- 1.4, near statistically significant (p=0.079). No statistically significant differences in days of home care, also in quality of life, anxiety, adherence to treatment or satisfaction.

CONCLUSIONS: Home Telemonitoring in AECOPD with an early discharge from hospital could be at least as effective as home visits visits with a tendency toward a higher efficiency.

CLINICAL IMPLICATIONS: Application of telemedicine in healthcare could improve the use of health resources, without worsening the quality of care.

DISCLOSURE: The following authors have nothing to disclose: Patricia Mínguez, Beatriz Cadavid, Carmen Mata, Rosa Malo, Miriam Aguilar, Manuel Valle, Andrea Trisan, Antolín Lopez, Mario Pascual, Juan Fragua, Piedad Ussetti

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