Effects and barriers to deployment of telehealth wellness programs for chronic patients across 3 European countries.
BACKGROUND
Benefits of cardiopulmonary rehabilitation (CPR) in patients with chronic obstructive pulmonary disease (COPD) are well established, but long-term sustainability of training-induced effects and its translation into healthy lifestyles are unsolved issues. It is hypothesized that Integrated Care Services supported by Information and Communication Technologies (ICS-ICT) can overcome such limitations. In the current study, we explored 3 ICS-ICT deployment experiences conducted in Barcelona, Trondheim and Athens.


METHODS
In the 3 sites, a total of 154 patients completed an 8-week supervised CPR program. Thereafter, they were allocated either to an ICS-ICT group or to usual care (CPR + UC) during a follow-up period of at least 12 months with assessment of 6-min walking test (6MWT) as main outcome variable at all time points in the 3 sites. Because real deployment was prioritized, the interventions were adapted to site heterogeneities.


RESULTS
In the ICS-ICT group from Barcelona (n = 77), the use of the personal health folder (PHF) was the cornerstone technological tool to empower COPD patients for self-management showing high applicability and user-acceptance. Long-term sustainability of training-induced increase in exercise capacity was observed in ICS-ICT compared to the control group (p = 0.01). Likewise, ICS-ICT enhanced the activities domain of the SGRQ (p < 0.01) and daily physical activity (p = 0.03), not seen in controls. No effects of ICS-ICT were observed in Trondheim (n = 37), nor in Athens (n = 40), due to technological and/or organizational limitations.


CONCLUSIONS
The study results suggest the potential of the ICS-ICT Barcelona's approach to enhance COPD management. Moreover, it allowed identification of the factors limiting transferability to the other sites. The research prompts the need for large multicenter trials specifically designed to assess effectiveness, efficiencies and transferability of this type of intervention.
Hospital Clínic de Barcelona, Thorax Clinic Institute (ICT), Pulmonary Medicine Department, Respiratory Diagnostic Center, 170 Villarroel, 08036 Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyner (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain; CIBER en Enfermedades Respiratorias (CIBERES), Bunyola, Mallorca, Spain. Electronic address: anbarber@clinic.ub.es.
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Barberan-Garcia
1st Department of Respiratory Medicine, National and Kapodistrian University of Athens, Athens, Greece; Thorax Foundation, 3 Ploutarhou Str, 10675 Kolonaki, Athens, Greece. Electronic address: gianvog@hed.uoa.gr.
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Vogiatzis
Norwegian University of Science and Technology (NTNU), Øya Helsehus*153.003.009 Håkon Jarls Gate 11, Trondheim, Norway. Electronic address: hilde.s.solberg@ntnu.no.
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Solberg
Facultat de Ciències de la Salut Blanquerna, Universitat Ramon Llull, Physiotherapy Research Group (GReFis), 326-332 Padilla, Barcelona, Catalonia, Spain. Electronic address: jordivc@blanquerna.url.edu.
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Vilaró
Hospital Clínic de Barcelona, Thorax Clinic Institute (ICT), Pulmonary Medicine Department, Respiratory Diagnostic Center, 170 Villarroel, 08036 Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyner (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain; CIBER en Enfermedades Respiratorias (CIBERES), Bunyola, Mallorca, Spain; Muscle and Respiratory System Research Unit and Respiratory Medicine Department, IMIM-Hospital del Mar, Health and Experimental Sciences Department (CEXS), Universitat Pompeu Fabra (UPF), 88 Dr. Aiguader, 08003 Barcelona, Catalonia, Spain. Electronic address: darodriguez@parcdesalutmar.cat.
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Rodríguez
Department of Public Health and General Practice, Norwegian University of Science and Technology, Øya Helsehus*153.003.009 Håkon Jarls Gate 11, Trondheim, Norway; Department of Health and Welfare Services, City of Trondheim, Trondheim, Norway. Electronic address: helge.garasen@ntnu.no.
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Garåsen
Katholieke Universiteit Leuven, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Leuven, Belgium; Respiratory Rehabilitation and Respiratory Division, UZ Gasthuisberg, Herestraat 49 bus 706, Onderwijs & Navorsing I, Labo Pneumologie, Leuven B-3000, Belgium. Electronic address: thierry.troosters@med.kuleuven.be.
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Troosters
Centre de Recerca en Epidemiologia Ambiental (CREAL), Epidemiology Department, 88 Dr. Aiguader, 08003 Barcelona, Catalonia, Spain; CIBER en Epidemiologia y Salud Pública (CIBERESP), Barcelona, Catalonia, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain. Electronic address: jgarcia@creal.cat.
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Garcia-Aymerich
Hospital Clínic de Barcelona, Thorax Clinic Institute (ICT), Pulmonary Medicine Department, Respiratory Diagnostic Center, 170 Villarroel, 08036 Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyner (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain; CIBER en Enfermedades Respiratorias (CIBERES), Bunyola, Mallorca, Spain. Electronic address: jroca@clinic.ub.es.
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Roca
D000368:Aged; D015897:Comorbidity; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005060:Europe; D005080:Exercise Test / Q000379:methods; D005260:Female; D006293:Health Promotion / Q000458:organization & administration*; D006302:Health Services Research / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000534:rehabilitation*; D011788:Quality of Life; D012648:Self Care / Q000379:methods; D017216:Telemedicine / Q000458:organization & administration*; D016138:Walking
COPD; Cardiopulmonary rehabilitation; Exercise; Expert patient; Integrated care; Physical activity, eHealth