title: Telehealthcare for chronic obstructive pulmonary disease: Cochrane Review and meta-analysis.
abstract: BACKGROUND
  Chronic obstructive pulmonary disease (COPD) is common. Telehealthcare, involving personalised health care over a distance, is seen as having the potential to improve care for people with COPD.
  
  
  OBJECTIVE
  To systematically review the effectiveness of telehealthcare interventions in COPD to improve clinical and process outcomes.
  
  
  METHODS
  Cochrane Systematic Review of randomised controlled trials.
  
  
  METHODS
  The study involved searching the Cochrane Airways Group Register of Trials, which is derived from the Cochrane Central Register of Controlled Trials, MEDLINE, embase, and CINAHL, as well as searching registers of ongoing and unpublished trials. Randomised controlled trials comparing a telehealthcare intervention with a control intervention in people with a clinical diagnosis of COPD were identified. The main outcomes of interest were quality of life and risk of emergency department visit, hospitalisation, and death. Two authors independently selected trials for inclusion and extracted data. Study quality was assessed using the Cochrane Collaboration's risk of bias method. Meta-analysis was undertaken using fixed effect and/or random effects modelling.
  
  
  RESULTS
  Ten randomised controlled trials were included. Telehealthcare did not improve COPD quality of life: mean difference -6.57 (95% confidence interval [CI] = -13.62 to 0.48). However, there was a significant reduction in the odds ratios (ORs) of emergency department attendance (OR = 0.27; 95% CI = 0.11 to 0.66) and hospitalisation (OR = 0.46; 95% CI = 0.33 to 0.65). There was a non-significant change in the OR of death (OR = 1.05; 95% CI = 0.63 to 1.75).
  
  
  CONCLUSIONS
  In COPD, telehealthcare interventions can significantly reduce the risk of emergency department attendance and hospitalisation, but has little effect on the risk of death.
authors.affiliation: Allergy and Respiratory Research and eHealth Research Groups, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK. susannah.mclean@ed.ac.uk
authors.forename: Susannah
authors.initials: S
authors.lastname: McLean
authors.forename: Ulugbek
authors.initials: U
authors.lastname: Nurmatov
authors.forename: Joseph L Y
authors.initials: JL
authors.lastname: Liu
authors.forename: Claudia
authors.initials: C
authors.lastname: Pagliari
authors.forename: Josip
authors.initials: J
authors.lastname: Car
authors.forename: Aziz
authors.initials: A
authors.lastname: Sheikh
mesh_terms: D000553:Ambulatory Care / Q000379:methods* / Q000639:trends; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality / Q000628:therapy*; D011785:Quality Assurance, Health Care; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D017216:Telemedicine / Q000592:standards