m-health PROGRAM Integrated Care for COPD patients Pilot study: HU La Princesa,XII Octubre, Clinic,Madrid
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1 m-health PROGRAM Integrated Care for COPD patients Pilot study: HU La Princesa,XII Octubre, Clinic,Madrid
2 HappyAir A COMPLEMENTARY SERVICE AREAS OF ENGAGEMENT
3 CARE SUPPORT IN EACH STAGE Self-care management Prevention HC professionals can design & deliver specific prevention programs via the platform+ educator network Education Direct communication via educator network +platform+telecare support allows more effective and efficient patient self-management Improves integral treatment & medication capabilities across Improved chronic-disease, comorbidities and clinical care diagnosis specifics. Gives a better picture of the patients overall health status.enables new therapies+treatment interventions Direct access to patient activity. Monitoring & Interconnected HC professionals & Follow-up educators for better patient evaluation, feedback and adjustment on specific programs.doctor s recommendations to improve Educators + care-givers guide patient in personal response to patient events. program with disease specifics: presential + virtual, workshop Sessions, home-visits, tele-care services + CRM tools Generate value in chronic -care: respiratory disease EIP Active & Healthy Ageing FP7/Horizons2020
4 Background: Activity WHAT WE HAVE LEARNED ABOUT PATIENTS WITH CHRONIC LUNG DISEASE
5 Activity levels In Healthy elderly (n 25) In COPD (n 50) 11% 6% 42% 27% 42% 52% Walking Standing Sitting Lying Down Others Pitta et al. Am J Respir Crit Care Med % 12%
6 Physical Inactivity & Severity Inactive Active Walking Time 100 Subjects (%) Normal Drecramer, M. et al COPD 2008 GOLD I GOLD II GOLD III GOLD IV
7 Exacerbation & Activity % Patients Pulmonary Function Days Donaldson, G et al. Am J Respir Crit Care Med Symptoms Time remaining at home 50
8 Activity & Readmissions Walking time (min) p< day 7 1mth discharge Readmitted Pitta, F et al. Chest 2006 Day 7 1mth discharge Not Readmitted (18 min/d)
9 Activity & Supervision 2000 Work (kj) Supervised Not Supervised 0 week 1 week 4 Training time Puente-Maestu, L. et al. ERJ, 2000 week 8
10 Activity & Supervision Long Term ESWT distance (m) Tel follow-up Hosp PR + Tel follow-up Hosp PR Hosp PR no Tel follow-up Commun PR Commun PR + Tel follow-up No Tel follow-up Commun PR no Tel follow-up basal 5 10 Time (month) Waterhouse, JC. et al. Health Tech Asses
11 Activity & Follow-up Long Term Barberan, A. et al. Respir Med 2014
12 Motivation & Barriers Motivation Hartman, J et al. J Physiother 2013 Barriers
13 Pilot Study m-health Program with Integrated Care for COPD Patients
14 Study Goals Evaluate Adherence improvement & Quality of Life in an integral care program, post- pulmonary rehabilitation, when the patient is managed and monitored using tele-care and TICs.
15 Hypothesis Incorporating ICTs in an integrated care program for patients with COPD to improve adherence and thus Quality of Life
16 Intervention Control Group Conventional rehab Hospital 2 months M-health program Self-care+ exercise ICT supervision Conventional follow-up M-health program Self-care+ exercise ICT supervision Conventional follow-up 10 months home-setting NB: the study exempted prior education on self-care in COPD. Only allowed 2 x 1hour sessions on digital literacy 4th evaln post rehab Intervention Group Conventional rehab Hospital 3rd evaln post rehab Lovexair team: patient tele-care support+ monitoring 2nd evaln 1st evaln+randomized Hospital Pulmonary Dept +Rehab team
17 Pilot study.evaluation criteria 1st Evaln 2nd Evaln Spirometry CAT SGRQ EUROQOL-5D 6MWT CAT SGRQ EUROQOL-5D 6MWT 3rd Evaln 4th Evaln CAT CAT SGRQ SGRQ EUROQOL-5D EUROQOL-5D 6MWT Test Adherence CAP Fisio Questionaire CAT SGRQ EUROQOL-5D Test Adherence CAP Physio Questionaire Adherence Phys ex. Morisky-Green 6MWT Adherence Phys ex. Morisky-Green 6MWT
18 Patient Group Inc O2 44 patients 17 use O2 During exercise 1 not confirmed as user O2 Doesn't complete study 21 oxygen users 22 non- oxygen users 11 intervention group 10 control group 8 intervention group 14 control group 10 complete study 10 complete study 7 complete study 14 complete study
19 Recruitment process 3 Hospitales in Madrid: XII de Octubre, La Princesa, Clínico San Carlos Period: 24 February -17 July 2016 Patients from each hospital: XII October: 20 patients (9 intervention & 11 control) La Princesa: 12 patients (5 intervention & 7 control) Clínico San Carlos : 12 patients (6 intervention & 6 control) NB: Nº patients assigned to each group is different due to low resources & Nºs recruited for Pulmonary rehabilitation in general. Start dates different in each hospital.
20 Study Group Profiles 44 patients Men 26 Women 17 Average age 69,55 years GOLD stages II,III,IV
21 Adverse events Intervention Group Respiratory problems with hospital admission Respiratory failure due to exacerbation: 8 admissions for 7 different patients Respiratory problems without hospital admission: Broncoespasms 1 Neumonia 3 Catarrh symptoms 2 Muscular-skeletal injuries: Herpes zoster with pain lateral side right Sacrum Fractura Shoulder Fracture Others Post- hospital admission for respiratory failure walks with a stick due to severe dyspnoea Tele-care with educator enables patients evolution to be more Closely monitored via patient feedback
22 M-health program ICTs APP Web-based Clinical tool in data platform
23 Clinical tool EHR patient Evaluations Medication Adverse events with alert PRO Data collected via data forms in app by patients
24 HappyAir app Daily self-care monitoring Lung health: Alerts Lung hygiene Rescue Inhaler O2 saturation Exercise plan Wellbeing: How am I feeling today Physical activity: Google Fit connected to platform My educator: Direct contact messaging+calls with my Coach:
25 Educator tasks Ensure evaluations are met in hospital settings Review patients' daily PRO in their selfcare plan Contact patients > 3 days no activity recorded Resolve issues or problems in self-care plan, illness or adverse events Act on alerts and filter genuine vs perceived Offer guidance on resolving difficulties inc. technical problems ( app/mobile) Overview and reporting to Lovexair &/or Hospital rehab teams + physicians when necessary
26 Total Nº Contacts during 365 days
27 Channel for contacts Calls
28 Motive for contacts made NB: the study exempted prior education on self-care in COPD. Only allowed 2 x 1hour sessions on digital literacy Digital literacy/ technical problems health Social support Digital literacy/ Technical problems
29 Time invested in patient support 12 months Total time Spent in contact with patient Average 1 minute day per patient Total time Spent monitoring Via plataform All users Average: 5 mins/ Day Exc adverse events
30 Motives for Contacts made-annual
31 Results Daily PROs
32 Other Daily PROMs to be evaluated by end of study (June 4th evaluation) Alerts and follow-up by educator % bronquial hygiene Rescue Inhaler use/frequency O2 for individuals Average daily exercise compared to recommended levels Nº days no exercise Well-being of patients related to their illness
33 Results Partial results from 3rd evaluation
34 CAT Results IMPACT of COPD in Patients quality of life: Interval of results: 0-40 <10: Low impact 10-20: Medium Impact 20-30: High Impact > 30: Very High Impact
35 Results: SGRQ-symptoms
36 Results: SGRQ-activity
37 Results: SGRQ-impacts
38 Results: SGRQ-total score Results closer to 0% indicate better Quality of Life than those closer to 100%
39 Results: Visual Analogue Scale EUROQOL-5D ( quantitive measure of health) Visual Analogue Scale Self-rated health : 100 is the best imaginable health state 0 worst imaginable health state
40 Results: CAP- Respiratory Physiotherapy Adherence p Control 55,1 (17,4) Intervention 64,8 (5,0) 0,028 31,4 (11,0) 38,2 (4,1) 0,018 23,7 (6,6) 26,6 (2,9) 0,098 CAP_Physio Tot PERCEPTION patient ADHERENCE physio therapy technique
41 Conclusions Carrying out an m-health integrated care program in patients with COPD produces significant improvements in Adherence, their Quality of Life and their own perception of improvement.
42
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