Table 3

Results from the 10 included trials

Study, yearQuality of lifeEmergency department visitsHospitalisationsDeathsDrop outsPatient satisfactionCostsOther outcomes
Bourbeau 200312On the SGRQ, QoL life improved with mean difference, –4.00 (95% CI = –8.31 to 0.31) where negative change is improvingThere were fewer emergency department visits for the intervention group with an OR of 0.40 in comparison with the control groupThere were fewer hospitalisations for the intervention group with an OR of 0.47 in comparison with the control groupThere 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 greatTotal 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 armsThe differences from baseline lung function across the groups were not significantly different for either of the measures of FEV1 or FVC
Casas 200613,29On 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 groupThere 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 careDifferences from baseline lung function increased more in the usual care group but not significantly (P = 0.6)
Chandler 199015No hospitalisations2 patients due to moving and financial reasonsNo comparisons were statistically significant between the groupsHome 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 callsSymptomology 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 200614Significant reduction in emergency department attendance OR 0.47 (95% CI = 0.24 to 0.89Significant 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 90Cost 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 200616No statistically significant difference in mortality across the groupsHome care client satisfaction instrument scores were significantly higher for patients who had experienced virtual visitsBreakdown 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 timeDischarge 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 200017Reported that mean number of visits per patient was 1.79 for intervention patients and control patients 1.53Results are not given separately for different conditionsOver 95% of both groups said that they agreed or strongly agreed with statements made pertaining to patient satisfaction. There was no difference between the groupsTotal mean cost of patients in the control group was US$2674 (standard deviation [SD] 6313) and in the intervention group US$1948 (SD 3681) note large SDs
Nguyen 200818Groups were compared using the Chronic Respiratory QuestionnaireOnly one patient attended the emergency department50 patients were randomised, 39 remained after 6 months, 5 control patients dropped out, 7 intervention patients 4 of whom were unable to access the websiteSatisfaction scores for both arms were similar: 2.7 and 2.6.
Vitacca 200919Marked reduction in emergency department visit in intervention arm OR 0.07 (95% CI = 0.02 to 0.21)Reduction in hospitalisations, however CIs cross the line of no-effect OR 0.61 (95% CI = 0.24 to 1.53)No significant difference for deaths (COPD deaths are not reported separately)111 patients were excluded because of reduced cognitive status, insufficient family cultural requisites or refusalICU admission accounted for almost 50% of the total costs of hospitalisation in both groups. Mean overall cost per COPD intervention patient was more than 50% cheaper than for the control groupCOPD patients and tracheostomised patients requested the most assistance for ventilation. Fewer exacerbations were experienced by patients using teleassistance
Whitten 200720Interviews were conducted with 49 patients who were overall very satisfied with the telehealthcare programme.Data of patients with COPD and CHF were analysed together
Wong 200521There was a greater mean number of visits per patient in the control group: OR 0.17There was no significant difference between the telephone and the control group in hospitalisation rates at 3 months P= 0.1824 patients refused to answer the second wave of questions and had their answers replaced by the group mean
  • CHF = chronic heart failure. COPD = chronic obstructive pulmonary disease. CRQ = Chronic Respiratory Questionnaire. FEV1 = forced expiratory volume in 1 second. FVC = forced vital capacity. ICU = intensive care unit. OR = odds ratio. QoL = quality of life. RR = relative risk. SGRQ = St George’s Respiratory Questionnaire. US$ = United States dollars. Є = Euros.