Nfhk2011 birthe dinesen_parallel17

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Preventive home monitoring of COPD patients across sectors–an advantage for the patients and healthcare professionals. Birthe Dinesen, Associate professor,
Department of Health Science and Technology, Aalborg University, Denmark

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Nfhk2011 birthe dinesen_parallel17

  1. 1. Preventive home monitoring of COPD patients across sectors– an advantage for the patients and healthcare professionals Birthe Dinesen, Associate professor, Department of Health Science and Technology, Aalborg University, Denmark
  2. 2. Agenda1. Background and aim of the study2. Presentation of the TELEKAT-project3. Methods4. Results/findings The aim with the presentation is to give an overview of the main results/findings in the project
  3. 3. Background (1)• Over 400.000 Danes have chronic obstructive pulmonary lungediasease (COPD)• Rehospitalisation – After 1 month 14 % – After 1 year 46 %• Prognose – Death during hospitalisation 9 % – Death after 1 year 36 % (Eriksen et al: Ugeskrift for Læger 2003; 165: 3499-502)
  4. 4. Background (2)• COPD patients often live with – Reduced physical functionality – Frustrations – Social isolation – Reduced quality of life• Medical treatment can only ease the symptoms to a certain degree
  5. 5. Aims of the Telekat project• To prevent readmissions of COPD patients by promoting homebased rehabilitation• To develop new methods and concepts for COPD patients to monitor themselves at home by the use of telehomecare technology across sectors
  6. 6. Target groupPatients with server and very server COPD
  7. 7. User driven innovation
  8. 8. The programme of telerehabilitation
  9. 9. Patients Healthcare professionals home
  10. 10. The telerehabilitation programme• The patients have the telehealth technology for 4 months• A doctor prescrib how often the patients have to measure values fx blodpressure, spiometry, etc.• Individual instruction from a physiotherapist• Patients use Stepcounter, Wii consol• The patients can see their data and communicate with the healthcare professionals via the portal
  11. 11. Methods• Casestudy (Yin 2009) as the overall strategy• Randomised study (n=111)• Triangulation of data collection techniques: – Documentary materials – Participant-observation (total hours: 163 hours) – Qualitative interviews: • Healthcare professionals: GPs (n=6), nurses and doctors at hospital (n=6), nurses at the healthcare center (n=6), district nurses (n=11), management district nursing (n=4), management healthcare center (n=1), management hospital (n=4) , IT and administration municipality (n=3) • COPD patients (n=22) in the intervention group were interviewed three times while doing home monitoring (n=64 interviews; drop out of two) interviews).• Analysis perspectives – Clinical; economical; organizational and patient perspective
  12. 12. Total number COPD patients screened (n=122) Excluded (n=11) Not meeting inclusion criteria (n=8) Declined participation (n=3 ) Suitable for inclusion and consented to be randomized (n=111)Allocated to intervention (n= 60) Received allocated intervention Allocated to intervention (n= 51) (n=59)Lost to follow-up (n= 3) Lost to follow-up (n= 3) Declined participation Declined participationTele-rehabilitation group (n= 57) Control group (n= 48)4 months of tele-rehabilitation 4 months of conventional rehabilitation
  13. 13. Variable Telerehabilitation group (n=57) Control group (n=48) Male Female Male FemaleNumber 23 33 22 26Age in years, 69.6 67.20 70.60 59.90interquartile range (IQR) (53.20;82.30) (44.60;81.10) (51.90;82.60) (45.50; 88.90)Forced expiratory 1.10 0.75 1.16 0.74volume in 1 second, in (0,62; 2,09) (0,26; 1,49) (0,48; 2,13) (0,33; 1,45)litres (IQR) 79.61 67.53 79.56 60.67Weight in kg (IQR) (45,00; 116,00) (39,00; 118,00) (50,00; 123,70) (38,00;98,40)Body mass index in 25.74 25.31 26.8 22.76kg/m2 (IQR) (17,00; 35,70) (16,00; 41,00) (15,80; 38,50) (13,50; 37,00)Oxygen saturation (% on 93.3 93.6 94.1 94.4ambient air) (90,00; 97,00) (89,00; 99,00) (86,00; 98,00) (90,00; 98,00)Blood pressure in 137/79 136/82 136/80 132/77mmHg (IQR) (107/62; 180/90) (97/52; 179/126) (107/57;165/98) (110/65 ; 164/90)Heart rate in minutes 77 85 80 80(IQR) (57; 106) (61; 111) (60; 115) (46; 110)MRC dyspnea score 3.5 3.6 3.6 4.0(IQR) (2; 5) (3; 5) (2; 5) (3; 5)
  14. 14. Findings (1)COPD patients• Become more aware of development of own symptoms• Contact the GP early on in order to start treatment plans• Sharing data between hospital and GP promoted dialogue and learning about the disease among both patients and healthcare professionals.• Avoid admission to hospitals• Adds a feeling of security to patients with a very severe COPD• Measured values that were accessible and visualised through graphics gave the patients an overview of their disease.• Integrate and maintain changes of lifestyle in their everyday life
  15. 15. Findings (2)Healthcare professionals• Healthcare professionals have adapted new approaches for empowering COPD patients and a more integrated collaboration across sectors.• Have adapted a new approach for carrying out preventive rehabilitation of COPD patients.• Home monitoring leads to more individual counselling to the COPD patients compared to traditional counselling on rehabilitation.• Interaction between healthcare professionals and COPD patients has moved from an authority relationship to a more equal dialogue.• Healthcare professionals state that they learn more about the everyday life of the COPD patients.
  16. 16. Findings (2)Healthcare professionals• Healthcare professionals have adapted new approaches for empowering COPD patients and a more integrated collaboration across sectors.• Have adapted a new approach for carrying out preventive rehabilitation of COPD patients.• Home monitoring leads to more individual counselling to the COPD patients compared to traditional counselling on rehabilitation.• Interaction between healthcare professionals and COPD patients has moved from an authority relationship to a more equal dialogue.• Healthcare professionals state that they learn more about the everyday life of the COPD patients.
  17. 17. Findings (3)Economical• Readmission rate decrease with over 50 % for the intervention group• Preventive telerehabilitation seems cost-effective
  18. 18. FutureThere is a need for larger scale randomized studies also inmulticenter setting in order to have more solid evidence forimplementation of the telerehabilitation for this group ofpatients
  19. 19. The project i sponsored by• The Danish Enterprise and Construction Authority – The National Program for User driven Innovation• Center for Healthcare Technology, Aalborg University• All partnersTotal budget 9 million kroners (1.3 million Euro)
  20. 20. Thank you for your attentionFor further informations please contact:Birthe Dinesen, Associate Professor, bid@hst.aau.dkDepartment of Health Science and TechnologyAalborg University, Denmark See www.telecat.eu

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