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Effectiveness of tele-monitoring by patient severity and intervention type in chronic obstructive pulmonary disease patients: a systematic review and meta-analysis
Hong Y, Lee SH
International Journal of Nursing Studies 2019 Apr;92:1-15
systematic review

BACKGROUND: Chronic obstructive pulmonary disease is a major burden on healthcare systems worldwide. Tele-monitoring has recently been used for management of chronic obstructive pulmonary disease patients. OBJECTIVES: We analyzed the effect of tele-monitoring on chronic obstructive pulmonary disease patients and performed subgroup analysis by patient severity and intervention type. DESIGN: Systematic review. DATA SOURCE: Electronic databases including OVID-Medline, OVID-Embase, and the Cochrane Library. REVIEW METHODS: We conducted a meta-analysis of randomized controlled trials published up to April 2017. Three databases were searched, two investigators independently extracted data and assessed study quality using risk of bias. RESULTS: Out of 1,185 studies, 27 articles were identified to be relevant for this study. The included studies were divided by intervention: 15 studies used tele-monitoring only, 4 studies used integrated tele-monitoring (pure control), and 8 studies used integrated tele-monitoring (not pure control). We also divided the studies by patient severity: 16 studies included severely ill patients, 8 studies included moderately ill patients, and 3 studies did not discuss the severity of the patients' illness. Meta-analysis showed that tele-monitoring reduced the emergency room visits (risk ratio 0.63, 95% confidence interval 0.55 to 0.72) and hospitalizations (risk ratio 0.88, 95% confidence interval 0.80 to 0.97). The subgroup analysis of patient severity showed that tele-monitoring more effectively reduced emergency room visits in patients with severe versus moderate disease (risk ratio 0.48, 95% confidence interval 0.31 to 0.74; risk ratio 1.28, 95% confidence interval 0.61 to 2.69, retrospectively) and hospitalizations (risk ratio 0.92, 95% confidence interval 0.82 to 1.02; risk ratio 1.24, 95% confidence interval 0.57 to 2.70, retrospectively). The mental health quality of life score (mean difference 3.06, 95% confidence interval 2.15 to 3.98) showed more improved quality of life than the physical health quality of life score (mean difference -0.11, 95% confidence interval -0.83 to 0.61). CONCLUSIONS: Tele-monitoring reduced rates of emergency room visits and hospitalizations and improved the mental health quality of life score. Integrated tele-monitoring including the delivery of coping skills or education by online methods including pulmonary rehabilitation is recommended to produce significant improvement. This application of integrated tele-monitoring (the delivery of education, exercise etc. in addition to tele-monitoring) is more useful for patients with (very) severe chronic obstructive pulmonary disease than those with moderate disease. Tele-monitoring might be a useful application of information and communication technologies, if the intervention includes the appropriate intervention components for eligible patients. Further studies such as large size randomized controlled trials with sub-group by patient severity and intervention type is needed to confirm these finding.
With permission from Excerpta Medica Inc.

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