The impact of a telemetric chronic obstructive pulmonary disease monitoring service: randomised controlled trial with economic evaluation and nested qualitative study

Admissions for chronic obstructive pulmonary disease (COPD)
are increasing, at considerable cost to healthcare systems,
with many patients experiencing multiple admissions1. Such
exacerbations reduce quality of life and drive disease progression2,3.
There is good evidence that early identification of COPD exacerbations reduces the risk of hospital admission, improves quality of life and may slow disease progression4. Telemetric-supported self-monitoring of COPD has the potential to engage the patient in their care, and enables
timely response to deterioration. In addition, tele-monitoring
may support ‘Hospital-at-Home’ and ‘Early Supported
Discharge’ services, which are known to reduce admissions
and bed-days in selected patients5. Pilot work has shown that
tele-monitoring is feasible and acceptable to patients and
professionals6,7. This approach resonates with three key health service
policies: the shift of care into the community8,9. the drive for
technological solutions to healthcare problems10 and the
importance of expert patients and self-management of longterm conditions
11,12. While evidence can be gleaned both from international research into telemetric solutions for chronic disease management and UK pilot studies,
6,13,14 there remains a need for rigorous, multi-faceted evaluation of such
interventions in UK NHS settings. Our randomised controlled trial, incorporating quantitative and qualitative evaluations, will investigate the
clinical and cost effectiveness and social and service impact of
introducing telemetrically supported self-monitoring of COPD
in primary care in Scotland.