Kruimelpad

ERS 2018

  • Aanvrager: Mevrouw A. Lenferink

Congresbezoek ERS 2018 periode 15 september 2018 t/m 19 september 2018 Betrokken project 3.4.11.061 Posterpresentatie "Predictors for adherence to COPD exacerbation action plans"

In the context of a rapidly-evolving digital world, there are increased opportunities to integrate m-health and e-health in the care of Chronic Obstructive Pulmonary Disease (COPD). For example, online exercise and education to patients with COPD by telerehabilitation is currently implemented in healthcare systems worldwide and has the potential to reach patients who do not participate in regular pulmonary rehabilitation (1,2). Specific attention toward involvement of the health professionals in the decision process combined with sufficient education and skill training is highly essential to support a successful implementation of telerehabilitation in clinical practice (2). Moreover, patients and healthcare providers consider a m-health intervention as support to improve self-management and to be complementary to regular contact with healthcare providers (3).
Next to ageing of the population, it can be assumed that drivers for COPD m-health solutions are similar to those for asthma: high disease prevalence, non-adherence to medication, nonattendence to consults (4). The focus of digital health in COPD could therefore be similar as in asthma care. In asthma, there is a recent trend toward a ‘complete’ digital health system focusing on remotely monitoring the use of medication, physiology and environment to identify those patients poorly controlled and in need of additional attention to help them to achieve better disease control and predict future risk of poor control (4). In COPD care, this can be done by improving the access to healthcare (different consult options 24/7), remote monitoring (biometric devices, self-monitoring), care coordination, and by improving the quality of care (physicians who may provide information e.g. by telephone counseling).4 The analysis, modelling and sensing of both physiological and environmental factors may lead to improved patient-tailored and predictive self-management of COPD (4). In our research presented at the ERS 2018, we identified being male and having good mobility were predictors for better adherence to COPD exacerbation action plans. This implies that exploring patients’ mobility and offering more tailored support to female COPD patients who are less mobile, e.g. by providing online exercises to this specific population, may positively influence the adherence to COPD exacerbation action plans. However, insufficient evidence (studies of moderate quality, short-term, heterogeneity in study end points, different study designs) remain a challenge for the implementation of digital health (5).
Conclusion
COPD patients may receive benefits of using m-health or e-health for COPD selfmanagement. However, there remains a challenge to implement digital health in COPD care as there is still a lack of sufficient evidence. Future development and evaluations of m-health and e-health interventions should focus on selecting effective techniques and take into account potential barriers of its use by patients and healthcare providers.

References
1. Damhus CS, et al. What are the enablers and barriers of COPD telerehabilitation? - a frontline staff perspective. Poster discussion presentation ERS Congress 2018 Paris.
2. Damhus CS, Emme C, Hansen H. Barriers and enables of COPD telerehabilitation - a frontline staff perspective. Int J COPD 2018:13:2473-2482.
3. Korpershoek YJG, Vervoort SCJM, Trappenburg JCA, Schuurmans MJ. Perceptions of patients with chronic obstructive pulmonary disease and their health care providers towards using mHealth for self-management of exacerbations: a qualitative study. BMC Health Services Research 2018:18:757:1-13.
4. Usmani OS. The digital evolution in respiratory medicine: a personalised approach? Oral presentation ERS Congress 2018 Paris.
5. McCartney M. Innovation without sufficient evidence is a disservice to all. BMJ 2017:358.