Results from the 10 included trials
| Study, year | Quality of life | Emergency department visits | Hospitalisations | Deaths | Drop outs | Patient satisfaction | Costs | Other outcomes |
|---|---|---|---|---|---|---|---|---|
| Bourbeau 200312 | On the SGRQ, QoL life improved with mean difference, –4.00 (95% CI = –8.31 to 0.31) where negative change is improving | There were fewer emergency department visits for the intervention group with an OR of 0.40 in comparison with the control group | There were fewer hospitalisations for the intervention group with an OR of 0.47 in comparison with the control group | There were 5 deaths out of % patients among the intervention group and 9 deaths out of 95 patients in the control group. OR 0.53 (95% CI = 0.17 to 1.63) | 26 patients dropped out after randomisation, 1 was lost to follow up, and 11 found the burden of evaluation to be too great | Total per–patient cost of self management was US$3778: mostly accounted for by the case manager's salary. Each case manager supervised 14 patients and there was no significant difference between costs for the two arms | The differences from baseline lung function across the groups were not significantly different for either of the measures of FEV1 or FVC | |
| Casas 200613,29 | On SRGQ, QoL improved with mean difference –11.60 (95% CI = –21.11 to –2.09) | There were fewer hospitalisations for the intervention group with an OR of 0.40 in comparison with the control group | There were 12 deaths out of 65 patients in the intervention group and 14 deaths out of 90 patients in the control group. OR 1.23 (0.46 to 1.75) | After randomisation 35 patients were excluded from the trial = 35%: 26 deaths, 2 cases of cancer, 3 changed address, and 4 patients moved to palliative care | Differences from baseline lung function increased more in the usual care group but not significantly (P = 0.6) | |||
| Chandler 199015 | No hospitalisations | 2 patients due to moving and financial reasons | No comparisons were statistically significant between the groups | Home theophylline measuring kit (Acculevel) cost US$15, (1990) in comparison with routine measurement (>US$30) or physician visit (>US$25), other costs to be calculated include: clinician time, follow-up visits and long- distance telephone calls | Symptomology was measured by visual analogue scale, there was no significant difference between groups. FEV1 decreased by a greater amount over the study in the control group (P>0.05) | |||
| de Toledo 200614 | Significant reduction in emergency department attendance OR 0.47 (95% CI = 0.24 to 0.89 | Significant reduction in hospitalisations OR 0.50 (0.29 to 0.85) | No significant difference in deaths. 14 patients died in the intervention group of 67 and 15 patients died in the control group of 90 | Cost of the equipment: €36,469, cost of communications: €1656, 1 day hospitalisation for COPD costs €220. The reduction in hospitalisations will pay for the system by 1 year. 157 patients | ||||
| Finkelstein 2004,23 200616 | No statistically significant difference in mortality across the groups | Home care client satisfaction instrument scores were significantly higher for patients who had experienced virtual visits | Breakdown of costs according to type of interaction. Virtual visits cost an average US$22.11, monitoring visits, US$33.11; and face-to-face visits, US$48.27 due to nurse and travel time | Discharge to a higher level of care (nursing home or hospital): 42% of control participants, 21.4% of video care participants and 15% of telemonitoring participants | ||||
| Johnston 200017 | Reported that mean number of visits per patient was 1.79 for intervention patients and control patients 1.53 | Results are not given separately for different conditions | Over 95% of both groups said that they agreed or strongly agreed with statements made pertaining to patient satisfaction. There was no difference between the groups | Total mean cost of patients in the control group was US$2674 (standard deviation [SD] 6313) and in the intervention group US$1948 (SD 3681) note large SDs | ||||
| Nguyen 200818 | Groups were compared using the Chronic Respiratory Questionnaire | Only one patient attended the emergency department | 50 patients were randomised, 39 remained after 6 months, 5 control patients dropped out, 7 intervention patients 4 of whom were unable to access the website | Satisfaction scores for both arms were similar: 2.7 and 2.6. | ||||
| Vitacca 200919 | Marked reduction in emergency department visit in intervention arm OR 0.07 (95% CI = 0.02 to 0.21) | Reduction in hospitalisations, however CIs cross the line of no-effect OR 0.61 (95% CI = 0.24 to 1.53) | No significant difference for deaths (COPD deaths are not reported separately) | 111 patients were excluded because of reduced cognitive status, insufficient family cultural requisites or refusal | ICU admission accounted for almost 50% of the total costs of hospitalisation in both groups. Mean overall cost per COPD intervention patient was more than 50% cheaper than for the control group | COPD patients and tracheostomised patients requested the most assistance for ventilation. Fewer exacerbations were experienced by patients using teleassistance | ||
| Whitten 200720 | Interviews were conducted with 49 patients who were overall very satisfied with the telehealthcare programme. | Data of patients with COPD and CHF were analysed together | ||||||
| Wong 200521 | There was a greater mean number of visits per patient in the control group: OR 0.17 | There was no significant difference between the telephone and the control group in hospitalisation rates at 3 months P= 0.182 | 4 patients refused to answer the second wave of questions and had their answers replaced by the group mean | |||||
CHF = chronic heart failure. COPD = chronic obstructive pulmonary disease. CRQ = Chronic Respiratory Questionnaire. FEV1 = forced expiratory volume in 1 second. FVC = forced vital capacity. ICU = intensive care unit. OR = odds ratio. QoL = quality of life. RR = relative risk. SGRQ = St George’s Respiratory Questionnaire. US$ = United States dollars. Є = Euros.