JMIR Publications

ABSTRACT

Background:

Individuals diagnosed with chronic obstructive pulmonary disease (COPD) live with the burden of progressive life-threatening condition that is often accompanied by anxiety and depression. The severity of the condition is usually considered from a clinical perspective, and characterized according to the GOLD classification of severity that focuses on increasing symptoms and exacerbations (A through D) whereas information about perceived health or ability to manage the condition are rarely objectively included.

Objective:

To evaluate three patient-reported outcome measurements (PROMs) to understand how these can be used to report on individuals living with COPD supported by an innovative digitally assisted solution – the Epital, that aims to increase patient’s understanding and management of their condition to improve their wellbeing.

Methods:

A total of 93 individuals with COPD were enrolled. At entry and after six and twelve months, heiQ, HLQ and SF-36 PROMs were collected. The scores of the 19 PROM dimensions were related to COPD severity i.e. GOLD risk factor group, pulmonary function at entry and number of exacerbations over a three month period.

Results:

Only three dimensions showed significant differences between GOLD risk factor groups; heiQ3. Emotional distress (D and C, p<0.05), heiQ5. Constructive attitudes and approaches (D and C, p<0.01) and SF36 Physical health (D and A, p<0.001; D and B p<0.01), indicating more distress, poorer attitudes and poorer health status with increasing severity. heiQ3. Emotional distress was higher in group C than the other groups indicating less distress for this group. A similar pattern was seen in the SF36 Mental health score. As expected, pulmonary function (FEV1) was negatively associated with the severity of the condition (GOLD risk factor group) FEV1 was associated with increased heiQ2. Positive and active engagement in life (p<0.05), decreased heiQ3. Emotional distress (p<0.05), increased heiQ5. Constructive attitudes and approaches (p<0.001), increased heiQ8. Health service navigation (p<0.05), and also increased in SF36 Physical health (p<0.001). Furthermore, there was a negative association between FEV1 and HLQ 3. Actively managing my health (p<0.05). Only HLQ 8. Ability to find good health information was independently associated with reduced number of contacts over three months. After six months we observed an increase of heiQ 6. Skills and technical acquisition and a reduction in in heiQ 3. Emotional distress. The latter effect persisted after twelve months as did heiQ 4. Self-monitoring and insight had also increased. HLQ 3. Actively managing my health decreased after six and twelve months.

Conclusions:

The examined PROMs provides health professionals with new insights into individual’s ability to understand and manage their condition. In contrast to the Gold severity index, the PROMs did not predict number of contacts to a 24/7 available response and coordination center.