title: Home-Based Telemanagement in Advanced COPD: Who Uses it Most? Real-Life Study in Lombardy.
abstract: Current evidence indicates that the benefits of tele-health may not be uniform across all patients. Therefore, to understand what specific variables influence use of home-based telemanagement in COPD, we conducted this retrospective study.  A 6-month home-based telemanagement program (HTP) was offered to 1,074 COPD patients over a 4-year period. Multivarible linear regression analysis was used to identify predictors of HTP use/week (phone calls and specialist consultations) among all variables: clinical (body mass index, co-morbidities, HTP prescription not following an exacerbation, long-term oxygen therapy use, COPD severity, hospital readmissions, exacerbations and death), socio-demographic (sex, age, place of abode), smoking history, arterial blood gases (ABG), and specialist/general practitioner (GP) urgent need. Logistic regression was conducted to predict relapses/hospitalizations risk as well as the disease impact (COPD Assessment Test, CAT) at the end of the program.  Presence of relapses (p < 0.001), ABGs (p < 0.001) and GP request (p < 0.001) were significantly associated with higher HTP-use. Smoking history (OR 1.542 [IC 95% 1.069-2.217], p = 0.020), specialist (OR 2.895 [2.144-3.910], p < 0.001) and GP consultations (OR 6.575 [4.521-9.561], p < 0.001) were the only independent risk factors for relapse. No predictor of hospitalization was found. High final CAT score was inversely related to oxygen therapy use (p = 0.001) and HTP prescription (p < 0.001), and positively related to presence of co-morbidities (p = 0.001) and baseline CAT (p < 0.001).  This HTP in Lombardy shows that relapsers, people requiring several ABGs and urgent GP visits are the patient subgroup most likely to consume telemanagement services (scheduled and unscheduled). We propose a patient 'identikit' to improve prioritization for HTP prescriptions.
authors.affiliation: a Salvatore Maugeri Foundation , IRCCS Institute of Care and Scientific Research , Lumezzane (Brescia) , Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Vitacca
authors.affiliation: b Department of Management, Economics and Industrial Engineering , Politecnico di Milano , Milano , Italy.
authors.forename: Lia Paola
authors.initials: LP
authors.lastname: Fumagalli
authors.affiliation: c CEFRIEL, Politecnico Milano, Milano , Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Borghi
authors.affiliation: d Respiratory Unit , Macchi Hospital Foundation , Varese , Italy.
authors.forename: Fausto
authors.initials: F
authors.lastname: Colombo
authors.affiliation: c CEFRIEL, Politecnico Milano, Milano , Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Castelli
authors.affiliation: a Salvatore Maugeri Foundation , IRCCS Institute of Care and Scientific Research , Lumezzane (Brescia) , Italy.
authors.forename: Simonetta
authors.initials: S
authors.lastname: Scalvini
authors.affiliation: b Department of Management, Economics and Industrial Engineering , Politecnico di Milano , Milano , Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Masella
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D029721:Drosophila Proteins; D005260:Female; D005541:Forced Expiratory Volume; D006699:Home Care Services; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy; D016014:Linear Models; D008297:Male; D009026:Mortality; D015999:Multivariate Analysis; D010102:Oxygen Inhalation Therapy; D010359:Patient Readmission; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000628:therapy*; D012720:Severity of Illness Index; D017216:Telemedicine; D013689:Telephone; D014797:Vital Capacity
chemical_list: D029721:Drosophila Proteins; C518413:loj protein, Drosophila
keywords: COPD; functional status; home telemanagement; prognosis