title: Effect of tele health care on exacerbations and hospital admissions in patients with chronic obstructive pulmonary disease: a randomized clinical trial.
abstract: OBJECTIVE
  Tele monitoring (TM) of patients with chronic obstructive pulmonary disease (COPD) has gained much interest, but studies have produced conflicting results. Our aim was to investigate the effect of TM with the option of video consultations on exacerbations and hospital admissions in patients with severe COPD.
  
  
  METHODS
  Patients with severe COPD at high risk of exacerbations were eligible for the study. Of 560 eligible patients identified, 279 (50%) declined to participate. The remaining patients were equally randomized to either TM (n=141) or usual care (n=140) for the 6-month study period. TM comprised recording of symptoms, saturation, spirometry, and weekly video consultations. Algorithms generated alerts if readings breached thresholds. Both groups received standard care. The primary outcome was number of hospital admissions for exacerbation of COPD during the study period.
  
  
  RESULTS
  Most of the enrolled patients had severe COPD (forced expiratory volume in 1 second <50%pred in 86% and ≥hospital admission for COPD in the year prior to enrollment in 45%, respectively, of the patients). No difference in drop-out rate and mortality was found between the groups. With regard to the primary outcome, no significant difference was found in hospital admissions for COPD between the groups (P=0.74), and likewise, no difference was found in time to first admission or all-cause hospital admissions. Compared with the control group, TM group patients had more moderate exacerbations (ie, treated with antibiotics/corticosteroid, but not requiring hospital admission; P<0.001), whereas the control group had more visits to outpatient clinics (P<0.001).
  
  
  CONCLUSIONS
  Our study of patients with severe COPD showed that TM including video consultations as add-on to standard care did not reduce hospital admissions for exacerbated COPD, but TM may be an alternative to visits at respiratory outpatient clinics. Further studies are needed to establish the optimal role of TM in the management of severe COPD.
authors.affiliation: Department of Pulmonary Medicine, Hvidovre Hospital, Hvidovre, Denmark ; Institute of Clinical Medicine, University of Copenhagen, Herlev, Denmark.
authors.forename: Thomas
authors.initials: T
authors.lastname: Ringbæk
authors.affiliation: Department of Pulmonary Medicine, Hvidovre Hospital, Hvidovre, Denmark.
authors.forename: Allan
authors.initials: A
authors.lastname: Green
authors.affiliation: Institute of Clinical Medicine, University of Copenhagen, Herlev, Denmark ; Pulmonary Unit, Department of Internal Medicine, Herlev Hospital, Herlev, Denmark.
authors.forename: Lars Christian
authors.initials: LC
authors.lastname: Laursen
authors.affiliation: Department of Pulmonary Medicine, Hvidovre Hospital, Hvidovre, Denmark.
authors.forename: Ejvind
authors.initials: E
authors.lastname: Frausing
authors.affiliation: Department of Pulmonary Medicine, Hvidovre Hospital, Hvidovre, Denmark.
authors.forename: Eva
authors.initials: E
authors.lastname: Brøndum
authors.affiliation: Department of Pulmonary Medicine, Hvidovre Hospital, Hvidovre, Denmark ; Institute of Clinical Medicine, University of Copenhagen, Herlev, Denmark.
authors.forename: Charlotte Suppli
authors.initials: CS
authors.lastname: Ulrik
mesh_terms: D000368:Aged; D000465:Algorithms; D000553:Ambulatory Care; D000886:Anthropometry; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001835:Body Weight; D003718:Denmark; D018450:Disease Progression; D004636:Emergency Service, Hospital; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010092:Oximetry; D010343:Patient Admission; D011237:Predictive Value of Tests; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D012720:Severity of Illness Index; D013147:Spirometry; D013256:Steroids / Q000627:therapeutic use; D017216:Telemedicine / Q000379:methods*; D013686:Telemetry; D013997:Time Factors; D016896:Treatment Outcome; D049269:Videoconferencing
chemical_list: D000900:Anti-Bacterial Agents; D013256:Steroids
keywords: COPD; admissions; exacerbations; tele health care; video consultations