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      Global use, utility, and methods of tele-health in COPD: a health care provider survey

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          Abstract

          Introduction

          Advances in technology offer various solutions that might help optimize the care provided to patients living with chronic non-communicable diseases such as chronic obstructive pulmonary disease (COPD). However, the efficacy of tele-health in COPD is still controversial. Despite this, there appears to be widespread adoption of this technology.

          Aim

          To explore the international use of tele-heath for COPD, to assess the perceptions of clinicians employing tele-health in COPD, and to summarize the techniques that have been used by health care providers to personalize alarm limits for patients with COPD enrolled on tele-health programs.

          Methods

          A cross-sectional survey consisting of 15 questions was distributed and advertised to health care professionals worldwide. Questions were designed to cover five different aspects of tele-health in COPD: purpose of use, equipment type, clinician perceptions, variables monitored, and personalization of alarm limits.

          Results

          A total of 138 participants completed the survey from 29 different countries. As high as 59% of the participants had ever used tele-health for COPD, and 33% still provided tele-health services to patients with COPD. Tele-health was most commonly used for baseline monitoring, with 90% believing it to be effective. The three most commonly monitored variables were oxygen saturation, heart rate, and the use of rescue medication.

          Conclusion

          Twenty-nine different countries use tele-health for managing COPD and therefore there is widespread international use of tele-health in COPD. The majority of providers thought tele-health was effective despite evidence to the contrary.

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          Most cited references 20

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          Telehealthcare for chronic obstructive pulmonary disease: Cochrane Review and meta-analysis.

          Chronic obstructive pulmonary disease (COPD) is common. Telehealthcare, involving personalised health care over a distance, is seen as having the potential to improve care for people with COPD. To systematically review the effectiveness of telehealthcare interventions in COPD to improve clinical and process outcomes. Cochrane Systematic Review of randomised controlled trials. The study involved searching the Cochrane Airways Group Register of Trials, which is derived from the Cochrane Central Register of Controlled Trials, MEDLINE, embase, and CINAHL, as well as searching registers of ongoing and unpublished trials. Randomised controlled trials comparing a telehealthcare intervention with a control intervention in people with a clinical diagnosis of COPD were identified. The main outcomes of interest were quality of life and risk of emergency department visit, hospitalisation, and death. Two authors independently selected trials for inclusion and extracted data. Study quality was assessed using the Cochrane Collaboration's risk of bias method. Meta-analysis was undertaken using fixed effect and/or random effects modelling. Ten randomised controlled trials were included. Telehealthcare did not improve COPD quality of life: mean difference -6.57 (95% confidence interval [CI] = -13.62 to 0.48). However, there was a significant reduction in the odds ratios (ORs) of emergency department attendance (OR = 0.27; 95% CI = 0.11 to 0.66) and hospitalisation (OR = 0.46; 95% CI = 0.33 to 0.65). There was a non-significant change in the OR of death (OR = 1.05; 95% CI = 0.63 to 1.75). In COPD, telehealthcare interventions can significantly reduce the risk of emergency department attendance and hospitalisation, but has little effect on the risk of death.
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            Using a mobile health application to support self-management in COPD: a qualitative study.

            Telehealth shows promise for supporting patients in managing their long-term health conditions, such as chronic obstructive pulmonary disease (COPD). However, it is currently unclear how patients, and particularly older people, may benefit from these technological interventions.
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              • Article: not found

              Alarm fatigue: a patient safety concern.

              Research has demonstrated that 72% to 99% of clinical alarms are false. The high number of false alarms has led to alarm fatigue. Alarm fatigue is sensory overload when clinicians are exposed to an excessive number of alarms, which can result in desensitization to alarms and missed alarms. Patient deaths have been attributed to alarm fatigue. Patient safety and regulatory agencies have focused on the issue of alarm fatigue, and it is a 2014 Joint Commission National Patient Safety Goal. Quality improvement projects have demonstrated that strategies such as daily electrocardiogram electrode changes, proper skin preparation, education, and customization of alarm parameters have been able to decrease the number of false alarms. These and other strategies need to be tested in rigorous clinical trials to determine whether they reduce alarm burden without compromising patient safety.
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                Author and article information

                Journal
                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                COPD
                copd
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove
                1176-9106
                1178-2005
                01 August 2019
                2019
                : 14
                : 1713-1719
                Affiliations
                [1 ]UCL Respiratory, University College London , London, UK
                [2 ]Department of Respiratory Care, King Faisal University , Al Ahsa, Saudi Arabia
                [3 ]Department of Respiratory Care, Jazan University , Jazan, Saudi Arabia
                [4 ]Department of Respiratory Care, Prince Sultan Military College of Health Sciences , Dhahran, Saudi Arabia
                Author notes
                Correspondence: Ahmed M AlrajehRoyal Free Hospital, UCL Respiratory Medicine , Rowland Hill Street, LondonNW3 2PF, UKTel +44 207 794 0500 ext 34301Fax +44 207 317 7561Email rmhaaa2@ 123456ucl.ac.uk
                Article
                202640
                10.2147/COPD.S202640
                6682175
                © 2019 Alrajeh et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Figures: 3, Tables: 1, References: 31, Pages: 7
                Categories
                Original Research

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