A VIRTUAL COPD MANAGEMENT PROGRAMME (VCMP) USING REMOTE MONITORING (RM) TO REDUCE ACUTE HEALTHCARE UTILISATION

S. Nolan¹, C. Gillen¹, M. McCallan¹

¹Our Lady of Lourdes Hospital, Physiotherapy, Drogheda, Ireland

Background: VCMP is a physiotherapy led, quality improvement initiative designed for COPD patients that frequently present to the hospital setting with an acute exacerbation. More than 80% of exacerbations can be managed on an outpatient basis (GOLD 2021). RM was used extensively during the COVID-19 pandemic in the acute setting to rapidly identify and triage patients showing signs of deterioration, while also facilitating earlier discharge from hospital. This project was the first of its kind to use continuous Respiratory Rate monitoring in the community setting in Ireland.

Purpose: To explore the use of RM technology in improving patients’ self-management of their COPD in collaboration with local GPs. VCMP included education, daily monitoring of vital signs and individualised shared management plans. A primary goal of the programme was to educate patients’ in recognising the early signs of an exacerbation and seeking timely and appropriate intervention, with the aim of reducing presentation to the acute hospital setting.

Methods: 18 patients with COPD, 9 females and 9 males were enrolled onto the VCMP using strict inclusion criteria. Patients were monitored for between 4-6months using a bluetooth pulse oximeter to upload patients’ and HR onto a secure digital platform. Any deviation from the individualised baseline parameters triggered a telephone call and/or home visit from the VCMP team or escalation to the GP/Respiratory consultant as clinically indicated. 6 patients also underwent continuous respiratory rate monitoring for a period of 4 weeks.

Results: 100% participation rate with no dropouts. 83% patients had a reduction in their GP presentations during their 4-6month period versus the year prior to commencing on the programme. 7 patients had fewer ED presentations and hospital admissions, while monitored. 78% patients had reductions in the number of antibiotics and steroids prescribed. 67% of patients reported an improvement in their Healthscore, 57% improved in their CAT score and 86% improved their mMRC upon completion of the programme.

Conclusions: High levels of acceptability to remote monitoring were shown and there was 100% compliance with the programme. The programme was found to have no adverse patient outcomes. The majority of patients reported increased self-management of their condition and ability to recognise the signs of an AECOPD. There was a reduction in the number of Hospital admissions/ED presentations, GP presentations and Antibiotics/Steroids prescribed for the majority of patients compared to the previous year, representing potential cost savings. However GP presentation figures should be interpreted with caution as this workload shifted to the VCMP team and the cost benefit of same should be evaluated.

Implications: Technological advances have the potential to enhance healthcare service delivery at home. It requires access to real time data and timely escalation of care to the relevant clinician. Remote monitoring may be most useful in targeted COPD patients and used in combination with Early Supported Discharge. However a cost benefit should be established due to the intensive workload demands of such a programme. Continuous RR monitoring of respiratory patients in the community setting could potentially be a valuable piece of the puzzle to aid in clinical decision making in the future.

Funding acknowledgements: The mPower project funded through the European Union's INTERREG VA Programme, managed by the Special EU Programmes Body (SEUPB).

Keywords:
Remote monitoring
COPD
Self-management

Topics:
Cardiorespiratory
Health promotion & wellbeing/healthy ageing/physical activity
Innovative technology: information management, big data and artificial intelligence

Did this work require ethics approval? No

Reason: This was a quality improvement initiative using innovation to adapt established methods to meet the changing needs of practice, ethics approval was not required.