BREATHING BETTER AT HOME: A NEW APPROACH TO TECHNOLOGY ENABLED CHRONIC DISEASE MANAGEMENT

• Published in: Canadian journal of respiratory therapy : CJRT = Revue canadienne de la thérapie respiratoire : RCTR Vol. 55; p. 52
• Main Authors: Engel, K, Cheung, A, Stamenova, V, Yang, R, Shaw, J, Shafai, R, Bhattacharyya, O
• Format: Journal Article
• Language: English
• Published: Ottawa The Canadian Society of Respiratory Therapists 01.01.2019
• Subjects: Chronic obstructive pulmonary disease; Disease management; Emergency medical care; Respiration
• ISSN: 1205-9838; 2368-6820

INTRODUCTION: It is estimated that Chronic Obstructive Pulmonary Disease (COPD) affects 2.6 million Canadians and is costing the healthcare system 1.5 billion annually. Funded by the Office of the Chief Health Innovation Strategist through a Health Technologies Fund, the Breathing Better at Home (BBH) initiative aims to relieve this economic and social burden. The BBH initiative is a single-center randomized controlled trial evaluating three different strategies (Standard Care [SC], Self-Monitoring [SM], Remote Monitoring [RM]) for the management of COPD. This initiative provides valuable insight into the feasibility of a technology enabled self-monitoring program. Evaluation of these management strategies in relation to Hospital Admissions (HA), Emergency Department (ED) visits, Length of Stay (LOS), and workload will provide a useful framework for the development of future chronic disease self-management programs. METHODS: Enrollment of 122 patients, to be followed for 6 months, was completed in September 2018 with patients divided into three study arms. The SC arm is routinely followed by a respirologist in the COPD clinic. Patients in the SM and RM arms are given technology to monitor their vital signs and COPD symptoms as well as a comprehensive action plan that directs care. The RM arm is supervised by a Respiratory Therapist (RT) who contacts patients weekly. The SM arm is not monitored and there is no clinician-initiated contact. In the event of any clinical issues, patients in the RM and SM arms are encouraged to contact the RT during regular business hours and after hours their family doctor or ED. Validated tools including the St. George's Respiratory Questionnaire, the Bristol COPD Knowledge Questionnaire, Partners in Health Index, as well as self-reported ED visits, HA, and LOS are assessed at baseline, 3 and 6 months. CONCLUSION: Independently, self-management and remotemonitoring solutions have been associated with lower ED rates and reduced HA. These solutions may not be sustainable or have limited potential for spread and scale. The BBH initiative will be completed March 2019 with preliminary data expected to be available in early 2019. It is anticipated that this data will support the hypothesis that a technology enabled self-monitoring program is both feasible and safe. This talk will describe the research methodology, current findings and future initiatives being considered at MSH for technology enabled self-management.