A systematic diagnostic evaluation combined with an internet-based self-management support system for patients with asthma or COPD

The State of the Art of eHealth Self-Management Interventions for People With Chronic Obstructive Pulmonary Disease: Scoping Review

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a common chronic incurable disease. Treatment of COPD often focuses on symptom management and progression prevention using pharmacological and nonpharmacological therapies (eg, medication, inhaler use, and smoking cessation). Self-management is an important aspect of managing COPD. Self-management interventions are increasingly delivered through eHealth, which may help people with COPD engage in self-management. However, little is known about the actual content of these eHealth interventions.

OBJECTIVE

This literature review aimed to investigate the state-of-the-art eHealth self-management technologies for COPD. More specifically, we aimed to investigate the functionality, modality, technology readiness level, underlying theories of the technology, the positive health dimensions addressed, the target population characteristics (ie, the intended population, the included population, and the actual population), the self-management processes, and behavior change techniques.

METHODS

A scoping review was performed to answer the proposed research questions. The databases PubMed, Scopus, PsycINFO (via EBSCO), and Wiley were searched for relevant articles. We identified articles published between January 1, 2012, and June 1, 2022, that described eHealth self-management interventions for COPD. Identified articles were screened for eligibility using the web-based software Rayyan.ai. Eligible articles were identified, assessed, and categorized by the reviewers, either directly or through a combination of methods, using Atlas.ti version 9.1.7.0. Thereafter, data were charted accordingly and presented with the purpose of giving an overview of currently available literature while highlighting existing gaps.

RESULTS

A total of 101 eligible articles were included. This review found that most eHealth technologies (91/101, 90.1%) enable patients to self-monitor their symptoms using (smart) measuring devices (39/91, 43%), smartphones (27/91, 30%), or tablets (25/91, 27%). The self-management process of "taking ownership of health needs" (94/101, 93.1%), the behavior change technique of "feedback and monitoring" (88/101, 87%), and the positive health dimension of "bodily functioning" (101/101, 100%) were most often addressed. The inclusion criteria of studies and the actual populations reached show that a subset of people with COPD participate in eHealth studies.

CONCLUSIONS

The current body of literature related to eHealth interventions has a strong tendency toward managing the physical aspect of COPD self-management. The necessity to specify inclusion criteria to control variables, combined with the practical challenges of recruiting diverse participants, leads to people with COPD being included in eHealth studies that only represent a subgroup of the whole population. Therefore, future research should be aware of this unintentional blind spot, make efforts to reach the underrepresented population, and address multiple dimensions of the positive health paradigm.

Revealing the Nature of Chronic Obstructive Pulmonary Disease Using Self-tracking and Analysis of Contact Patterns: Longitudinal Study

Background

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death and is characterized by a progressive loss of pulmonary function over time with intermittent episodes of exacerbations. Rapid and proactive interventions may reduce the burden of the condition for the patients. Telehealth solutions involving self-tracking of vital parameters such as pulmonary function, oxygen saturation, heart rate, and temperature with synchronous communication of health data may become a powerful solution as they enable health care professionals to react with a proactive and adequate response. We have taken this idea to the next level in the Epital Care Model and organized a person-centered technology-assisted ecosystem to provide health services to COPD patients.

Objective

The objective is to reveal the nature of COPD by combining technology with a person-centered design aimed to benefit from interactions based on patient-reported outcome data and to assess the needed kind of contacts to best treat exacerbations. We wanted to know the following: (1) What are the incidences of mild, moderate, and severe exacerbations in a mixed population of COPD patients? (2) What are the courses of mild, moderate, and severe exacerbations? And (3) How is the activity and pattern of contacts with health professionals related to the participant conditions?

Methods

Participants were recruited by convenience sampling from November 2013 to December 2015. The participants’ sex, age, forced expiratory volume during the first second, pulse rate, and oxygen saturation were registered at entry. During the study, we registered number of days, number of exacerbations, and number of contact notes coded into care and treatment notes. Each participant was classified according to GOLD I-IV and risk factor group A-D. Participants reported their clinical status using a tablet by answering 4 questions and sending 3 semiautomated measurements.

Results

Of the 87 participants, 11 were in risk factor group A, 24 in B, 13 in C, and 39 in D. The number of observed days was 31,801 days with 12,470 measurements, 1397 care notes, and 1704 treatment notes. A total of 254 exacerbations were treated and only 18 caused hospitalization. Those in risk factor group D had the highest number of hospitalizations (16), exacerbations (151), and contacts (1910). The initial contacts during the first month declined within 3 months to one-third for care contacts and one-half for treatment contacts and reached a plateau after 4 months.

Conclusions

The majority of COPD patients in risk factor group D can be managed virtually, and only 13% of those with severe exacerbations required hospitalization. Contact to the health care professionals decreases markedly within the first months after enrollment. These results provide a new and detailed insight into the course of COPD. We propose a resilience index for virtual clinical management making it easier to compare results across settings.