Telemedicine helping people manage their COPD at home

As the disease progresses, loss and weakening of muscle mass is often the result of inactivity. Thus, many patients with moderate COPD have significantly weaker muscles than healthy people of the same age. Bone calcification (osteoporosis) is a frequent sequelae of COPD. Heart disease and lung cancer also frequently occur among patients with COPD. This simultaneous occurrence of multiple diseases (multi-disease) makes it impossible to achieve a sufficiently effective result for the patient, even with optimal pharmacological treatment.

Patients receive the following:

• A tablet (a small portable screen) and measuring equipment. Patients need to measure their oxygen saturation, heart rate, blood pressure and weight each week.
• A thorough guide on how to use the equipment and take measurements.
• Questions about the status of the illness that are entered on the device (tablet).

The measurements are sent wirelessly from the device/tablet to health professionals in the municipality or hospital.

The purpose of the national dissemination of telemedicine to support treatment for citizens with COPD is to contribute to the potential positive effects on both health and social economy. This includes, for example, individual citizens with COPD understanding and acting on their own symptoms in order to achieve increased quality of life, satisfaction, safety and fewer and/or shorter subsequent consultations, admissions and re-admissions.

Implementation and dissemination of the telemedical solution for citizens with COPD is a local responsibility and is organised into five regional programmes, one for each region and associated municipalities and general practitioners. With anchoring in the Health Agreements, regions and municipalities are jointly responsible for the implementation and for ensuring progress and gain realisation in the process.

The dissemination is organized nationally with a common public portfolio management group and a joint secretariat, which is responsible for sharing knowledge across the regional programs and for following up on the distribution.

As a starting point for the implementation, four national prerequisite projects have been initiated, which will strengthen the economic, professional and technical basis for dissemination. These will deliver: health professional guidelines, including inclusion criteria and organisation of professional content; national it-infrastructure; models for service and logistics; business case with calculations based on research data from TeleCare Nord.

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From this, there must be a clear plan for measurements, frequency of checks, who the responsible contact persons are and a plan for the further course.

Consent must be obtained for telemedicine-supported treatment and the transmission of contact data to partners. The responsible healthcare practitioner is obliged to record all relevant information regarding information and consent, including disclosure of health information, etc.

It is important to know who is responsible for starting the treatment, This is usually the municipality but can also be the hospital.

It is recommended that the following criteria are met in order for citizens with COPD to be included in telemedicine-supported treatment of their disease:

• Diagnosis of COPD is via spirometry, etc.
• The user has multiple symptoms (based on MRC> 3 or CAT> 10) and two or more exacerbations or admissions for COPD in the previous year or FEV1 <50% of the expected), and/or the user requires oxygen treatment.
• The user is already receiving treatment or is motivated to receive treatment.
• The user has a permanent resident and general practitioner in the region (this may be deviated from locally by agreement). 
• The patient is interested in participating – in relation to the technical set-up and health professional content – and is expected to be able to understand and act on their own measured values in the long term.

The GP regularly assesses the degree of the patient's illness and general condition, as well as any concurrent diseases. In this respect, telemedicine measurements can be an important supplement. Thus, it will be of benefit to the citizen to take their tablet containing measurement data when visiting the doctor. It is also important that there is continuous communication between the municipality and the general practice and vice versa with information on/evaluation of the course, including changes in treatment.

Continuous follow-up of effects is crucial for the patient and should be systematic and cross-sectoral, to ensure that the patient is not using the solution if it is not beneficial to them.

As a starting point, the existing agreements on communication routes and standards in the health service will be used, including agreements on admission, discharge, etc. There may also be a need to establish new workflows and new forms of communication practice. In this respect it is recommended that workflows and communication practices are established that support the collaboration between sectors and actors, thereby providing a coherent course for the patient.

Results from TeleCare Nord show that as many as 71% of citizens experience greater security when using telemedicine and 26% state that they experience a higher degree of freedom as they can carry out the measurements themselves. The results also show that telemedicine contributes to citizens' understanding and mastering of their own illness. 61% of citizens responded that they experienced increased control of their disease as telemedicine enables them to respond to disease exacerbations and they then become more aware of the symptoms.