1. Telehealth Monitoring of People with
COPD – Are We Fostering Self
Management or Service Dependency?
Gill Lewin
Joanna Smith, Kristen De San Miguel,
IFA Conference, Prague, May 2012

2. Background
• Silver Chain, WA. Health and community care provider.
• 40,000+ clients with 50,000+ hospital admissions annually
• Diagnosis of COPD increases risk of admission
• Tested telehealth remote monitoring
Western
Australia
• Two trials with people with COPD

3. Intervention
What is Telehealth Self Monitoring?

4. Daily Measurements

5. Equipment

6. Nurse Monitoring

7. First Study
• Randomised controlled trial
• Telehealth remote monitoring vs Information only
• 40 participants in each group
• Monitored for six months
• Measured: Health Service Use and Quality of Life
• Results promising

8. Hospital Admissions
30
Hospital Admissions COPD Hospital Admissions Not COPD
25
20
17
Number
15
8
10
5 9
8
0
Telehealth Information
Group

9. Days in Hospital
200
180
Hospital LOS COPD Hospital LOS Not COPD
160
140
Number of Days
120
100 162
80
60 85
40
20
21 21
0
Telehealth Information
Group

10. ED Presentations
25
ED Presentations COPD
ED Presentations Not COPD
20
15 6 11
Number
10
12
5 10
0
Telehealth Information
Group

11. Questions…
• Would results be same over winter?
• Were people now dependent on
ongoing monitoring?

12. Second Study
Cross Over Trial
71 Individuals Telehealth Information
completed first study n=36 n=35
Tele-Tele Info-Info
69 recruited into 2nd n=18 n=16
study
Tele-Info Info-Tele
Outcomes monitored for n=17 n=18
further 6 months +
compared to first 6 months

13. Mean Change in Hospitalisations
0,8
0,6
0,4 0,3
Mean Change
0,2
0,3 0,3 0,3
0,1 Other Hosp
0,0
-0,1 -0,2 COPD Hops
-0,2
-0,5
-0,4
-0,6
INFO-INFO INFO-TELE TELE-INFO TELE-TELE
Group

14. Mean Change in Days in Hospital
5,0
0,8
4,0
3,0
Mean Change
2,0 3,9
Other LOS
1,0 1,9
COPD LOS
0,8
0,4
0,0 -0,3
-0,8
-1,2
-1,0
-2,0
INFO-INFO INFO-TELE TELE-INFO TELE-TELE
Group

15. Mean Change in ED Presentations
0,8
0,6
0,4 0,3
Mean Change
0,2 0,4
0,3
0,2
0,1 Other ED
0,0
COPD ED
-0,3
-0,2 -0,4
-0,5
-0,4
-0,6
INFO-INFO INFO-TELE TELE-INFO TELE-TELE
Group

16. Cost Difference
$8 000
$7 000 $7 466
$6 000
$5 000
Cost Difference
$4 000
$3 000
$2 000
$1 000
$1 344
$-
-$46
-$1 000 -$1 448
-$2 000
INFO-INFO INFO-TELE TELE-INFO TELE-TELE
Group

17. Conclusions
• The benefits of telehealth remote monitoring are evident in all
seasons
• Telehealth remote monitoring has an impact on all health service
use – not just COPD related
• The benefits remain even after the monitoring equipment is
removed (if the individual has learned to take notice)
• Telehealth can result in large cost
savings for the health system

18. Acknowledgements
Commonwealth Department of Health and Ageing
State Health Research Advisory Council
Study Participants
Research Colleagues

19. Contact Details
Further information:
glewin@silverchain.org.au