title: Telehealthcare for chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Chronic obstructive pulmonary disease (COPD) is a disease of irreversible airways obstruction in which patients often suffer exacerbations. Sometimes these exacerbations need hospital care: telehealthcare has the potential to reduce admission to hospital when used to administer care to the pateint from within their own home.
  
  
  OBJECTIVE
  To review the effectiveness of telehealthcare for COPD compared with usual face-to-face care.
  
  
  METHODS
  We searched the Cochrane Airways Group Specialised Register, which is derived from systematic searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, AMED, and PsycINFO; last searched January 2010.
  
  
  METHODS
  We selected randomised controlled trials which assessed telehealthcare, defined as follows: healthcare at a distance, involving the communication of data from the patient to the health carer, usually a doctor or nurse, who then processes the information and responds with feedback regarding the management of the illness. The primary outcomes considered were: number of exacerbations, quality of life as recorded by the St George's Respiratory Questionnaire, hospitalisations, emergency department visits and deaths.
  
  
  METHODS
  Two authors independently selected trials for inclusion and extracted data. We combined data into forest plots using fixed-effects modelling as heterogeneity was low (I(2) < 40%).
  
  
  RESULTS
  Ten trials met the inclusion criteria. Telehealthcare was assessed as part of a complex intervention, including nurse case management and other interventions. Telehealthcare was associated with a clinically significant increase in quality of life in two trials with 253 participants (mean difference -6.57 (95% confidence interval (CI) -13.62 to 0.48); minimum clinically significant difference is a change of -4.0), but the confidence interval was wide. Telehealthcare showed a significant reduction in the number of patients with one or more emergency department attendances over 12 months; odds ratio (OR) 0.27 (95% CI 0.11 to 0.66) in three trials with 449 participants, and the OR of having one or more admissions to hospital over 12 months was 0.46 (95% CI 0.33 to 0.65) in six trials with 604 participants. There was no significant difference in the OR for deaths over 12 months for the telehealthcare group as compared to the usual care group in three trials with 503 participants; OR 1.05 (95% CI 0.63 to 1.75).
  
  
  CONCLUSIONS
  Telehealthcare in COPD appears to have a possible impact on the quality of life of patients and the number of times patients attend the emergency department and the hospital. However, further research is needed to clarify precisely its role since the trials included telehealthcare as part of more complex packages.
authors: Allergy & Respiratory Research Group, Centre for Population Health Sciences, University of Edinburgh, Doorway 1, Teviot Place, Edinburgh, Scotland, UK, EH8 9AG.
authors: Susannah
authors: S
authors: McLean
authors: Ulugbek
authors: U
authors: Nurmatov
authors: Joseph Ly
authors: JL
authors: Liu
authors: Claudia
authors: C
authors: Pagliari
authors: Josip
authors: J
authors: Car
authors: Aziz
authors: A
authors: Sheikh
mesh_terms: D018450:Disease Progression; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D018575:Home Care Services, Hospital-Based / Q000458:organization & administration; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D017216:Telemedicine / Q000379:methods*