A Clinical Management Centre Value in Triage of COPD Telemonitoring Patients
Telemonitoring is the systematic collection of clinical data from the patient’s home and its examination by a healthcare team. Chronic obstructive pulmonary disease COPD exacerbations contribute to disease progression and worse prognosis. Aim: to determine the benefits achieved by early detection of acute exacerbations of COPD (AECOPD) by telemonitoring, describing the experience of a specialised clinical management centre (CMC) which triaged the received alerts, confirmed the AECOPD, stratified them according to their level of severity and notified the doctors. Methods: 15 male COPD patients, all “C” and “D” GOLD groups were monitored of spO2, heart rate, blood pressure and skin temperature. For each patient, individual clinical alert thresholds were defined and calculated. Clinical alerts resulted in the CMC phoning the patient, completing a clinical questionnaire and confirming the presence of AECOPD and stratifying its severity. Only true positives were referred to a doctor. Results: During 18 months, 1,137 clinical alerts were detected but only 4.3% were true positives. Of these, 55.1% were level I, 36.7% level II and 8.2% level III. Conclusion: The study demonstrates the essential role of a clinical management centre in identifying, categorising and appropriately acting upon only real alerts to ensure that patients with AECOPD receive the right treatment as quickly and efficiently as possible.
GOLD. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease 2017 report. Available at: http://www.goldcopd.com accessed 10 January 2016.
Vitacca M, Bianchi L, Guerra A, et al. Tele-assistance in chronic respiratory failure patients: a randomised clinical trial. Eur Respir J 200933(2):411–418.
Calvo GS, Gómez-Suárez C, Soriano JB, et al A home telehealth program for patients with severe COPD: The PROMETE study. Resp Med 2014;108(3):453-462.
Bashshur RL, Shannon GW, Brian R. et al. The empirical foundations of telemedicine interventions for chronic disease management. Telemed J E Health 2014;20(9):769-800. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4148063/ accessed 10 January 2016.
Yohannes AM. Telehealthcare management for patients with chronic obstructive pulmonary disease. Expert Rev Respir Med 2012;6(3):239-242. Available at: http://www.tandfonline.com/doi/full/10.1586/ers.12.28 accessed 10 January 2016.
American Thoracic Society. Statement on home care for patients with respiratory disorders. Am J Respir Crit Care Med 2005;171(12): 1443–1464
Parker CM, O’Donnell DE. COPD exacerbations: 3 Pathophysiology. Thorax 2006;61(4):354-361
Yañez AM, Guerrero D, de Alejo RP, et al. Monitoring breathing rate at home allows early identification of COPD exacerbations. Chest 2012;142(6):1524-1529.
Terzano C, Romani S, Conti V, et al. Atrial fibrllation in the acute, hypercapnic exacerbations of COPD. Europ Rev Med Pharmacol Sci 2014;18(19):2908-2917.
Copyright (c) 2017 Joana Belchior, Margarida Guedes, Diana António, Sandra Guedes, Maria Inmaculata Ramos, Syed Jafri, Pedro Costa, João Pereira
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.