Table 1

Description of characteristics of included studies

Study, yearNumber of participants, country, settingIntervention studiedMain outcomes of interest
Bourbeau 200312191 participants, Quebec, Canada, participants were recruited by hospital clinic and were recruited if the had been hospitalised at least once in the preceding year for an acute exacerbation of COPDCOPD self-management programme consisting of 1 hour/week teaching delivered to the patient at home for 7 weeks. Supervised by respiratory nurses. Followed by weekly telephone calls for 8 weeks. Then monthly telephone callsMedication profile, spirometry, 6-minute walk test, dyspnoea measurements after exercise, quality of life as measured by the SGRQ, healthcare use (emergency department visits, hospitalisations unscheduled and scheduled general practice, and specialist visits), costs and cost effectiveness
Casas 200613 (Garcia-Aymerich 200722155 participants, Barcelona, Spain, Leuven, Belgium, patients were recruited from two tertiary hospitals immediately following discharge. All patients had been admitted for COPD exacerbation for more than 48 hoursPhysical and social assessment and education were delivered with coordination by a case manager working between hospital and primary care. A web-based call centre facilitated coordination and weekly educational phone calls were made for the first month following dischargeHospital re-admission, quality of life as measured by SGRQ, clinical features of current exacerbation, comorbid conditions, treatment, including concordance and observed skills for inhaling drugs and oxygen, healthcare use, and mortality
Chandler 19901513 adult patients in Kentucky, US with COPD, asthma, or both who were receiving theophylline from pulmonary medicine outpatientsThe intervention group measured their theophylline level at home using a blood spot test, then phoned the clinic for advice on drug dosageLung function at each clinic visit, degree of dyspnoea at each clinic visit, night and day coughing, wheezing and breathlessness were measured on visual analogue scales, drug-related adverse events. Patients' health attitudes and beliefs were assessed using the Krantz Health Opinion Survey and the Multidimensional Health Locus of Control
de Toledo 200614157 participants, in Spain all recruited during their tertiary hospital admission for an exacerbation of COPDVideoconferencing with patients in their own homes supported by a web-based patient record which also supplied education to patients and professionals. Patients had 24-hour access to the multidisciplinary team via a call centreNumber of readmissions, number of visits to emergency department, mortality, acceptability to professionals, patterns of use, equipment, and communication costs
Finkelstein 2004,23 20061668 participants, in Minnesota, US an unspecified number of whom had COPD, congestive heart failure, or chronic wounds. The study took place between the central site and the home environment, where either the patient, or a carer, had to be physically and cognitively able to use the homecare equipmentTwo intervention groups: 1) standard care plus videoconferencing. 2) standard care plus videoconferencing plus physiological monitoring; for example, spirometry for COPDTermination from home care or loss of eligibility for home care, time to discharge to a higher level of care such as a nursing home or hospital, mortality, morbidity patient perception of telehealthcare (Telemedicine Perception Questionnaire), Patient satisfaction Home Care Client Satisfaction Instrument, quality and clinical usefulness of virtual visits, patient use of services, cost for both subjects and service providers
Johnston 200017Patients who had been referred for home health care because they suffered from a chronic condition in Sacramento, California, US via a health insurance organisation. 102 intervention patients, 110 control patients. 29 intervention patients had COPD, 19 control patients had COPD, the other patients had congestive heart failure, stroke, cancer, diabetes or needed wound care. All patients were projected to need two or more visits a weekBoth groups received routine home health care with face-to-face visits and access to telephone contact. However, the intervention group also had a remote videoconferencing system with equipment for testing cardiopulmonary status. This could provide a virtual visit at any time of day or nightUse of services, costs for inpatient and outpatient services, visits to emergency departments, costs for pharmacy services, clinicians, emergency department visits, inpatient treatment, home healthcare costs and videoconferencing costs, patient compliance with medication regimen, patient knowledge about their illness, patient ability to move towards self care, patient satisfaction survey. Results for patients with COPD were not presented as separate from the other illnesses
Nguyen 20081850 patients with moderate to severe COPD (all of whom could use the internet) in San Francisco and Seattle US were assigned to either internet-based dyspnoea management (intervention) or face-to-face dyspnoea management control). Patients were recruited from web and non-web sources, including chest clinic referralsInternet based dyspnoea management focused on education, skills training and ongoing support and was delivered via a hand-held computer. The control intervention delivered the sam econtent using face-to-face methodsDyspnoea with activities of daily living and quality of life as measured with the Chronic Respiratory Questionnaire, exercise behaviour, and exercise performance, COPD exacerbations, self-efficacy and social support, and patient satisfaction
Vitacca 200919240 chronically ill respiratory patients, Lumezzane, Italy all of whom require home oxygen, some were on home mechanical ventilation, 101 had COPD, other reasons for respiratory failure included amyotrophic lateral sclerosis, restrictive chest disease, or other neuromuscular disease. Inclusion criteria: patient had had one hospitalisation for respiratory illness in the previous year. This study was conducted in the home settingThe intervention was a teleassistance programme based on continuous 24-hour on-call service. Patients had pulse oximetry, and modem to transmit through the home telephone line. The teleassistance nurse was available by phone during working hours and out of hours the pulmonologist on duty was contactedReduction in hospitalisations, reduction in urgent GP calls, acute emergency department admissions, also costs after paying for set-up of equipment
Whitten 200720Patients with a diagnosis of COPD and/or congestive heart failure who were prescribed home-healthcare services by their insurer were recruited Michigan, US. Intervention group = 83 patients and control group = 78 patients, The study was conducted in the home settingIntervention was a combination of traditional face-to-face home health care and virtual telemedicine visitsThe Short Form 36, Outcome and Assessment Information Set and patient charts were used to collect outcome data. Qualitative work, in the form of telephone interviews, collected patient perceptions of home telecare services
Wong 20052160 patients with COPD were recruited from an acute care hospital setting, in Hong Kong. The intervention was post-discharge telephone follow-upIntervention was post-discharge telephone follow-up provided by an experienced respiratory nurse. Two phone calls were made in the first 4 weeks after discharge from hospitalSelf-efficacy (a person with high self efficacy feels mor confident about engaging in activities and makes more effort to overcome challenges), as measured by the Chinese Self-Efficacy Scale, number of visits to emergency department, number of hospitalisations, and unscheduled visits by clinicians
  • COPD = chronic obstructive pulmonary disease. SGRQ = St Georges Respiratory Questionnaire.