JMIR Publications

ABSTRACT

Background:

Mobile health (mHealth) technology is an increasingly recognized and effective method for disease management and has the potential to intervene in pulmonary function, exacerbation risk, and psychological status of patients with chronic obstructive pulmonary disease (COPD).

Objective:

This study aimed to investigate the feasibility of an mHealth-based COPD management system designed for Chinese remote areas with many potential COPD patients but limited medical resources.

Methods:

The system was implemented based on a tailored closed-loop care pathway that breaks the heavy management tasks into detailed pieces to be quantified and executed by computers. Low-cost COPD evaluation and questionnaire-based psychological intervention are the two main characteristics of the pathway. A 6-month prospective observational study at the community level was performed to evaluate the effect of the system. Primary outcomes included changes in peak expiratory flow (PEF) value, quality of life measured by the COPD assessment test (CAT) scale as well as psychological condition. Acute exacerbations, compliance and adverse events were also measured during the study. Compliance was defined as the ratio of the actual frequency of self-monitoring records to the prescribed number.

Results:

A total of 56 patients were enrolled; 39 patients completed the 6-month study. There was no significant difference in the mean PEF value before and after the 6-month period (366.1 +/- 106.7 versus 313.1 +/- 116.6, p = 0.11). Psychological condition significantly improved after 6 months, especially for depression, as measured by the Patient Health Questionnaire-9 scale (PHQ-9) (median 6.0 with interquartile range from 3.0 to 9.0 versus median 4.0 with interquartile range from 0.0 to 6.0, p=0.001). The CAT score after 6-months of intervention was also lower than that at the baseline, and the difference was significant (median 4.0 with interquartile range from 1.0 to 6.0 versus median 3.0 with interquartile range from 0.0 to 6.0, p=0.003). The median overall compliance was 91.1%, with an interquartile range from 67% to 100%. In terms of acute exacerbation, 110 exacerbations were detected and confirmed by healthcare providers (median 2.0 per half year, interquartile range from 1.0 to 5.0). Moreover, 72 adverse events occurred during the study, including 1 death, 19 hositalizations, and 52 clinic visits due to persistent respiratory symptoms.

Conclusions:

We designed and validated a feasible mHealth-based method to manage COPD in remote Chinese areas with limited medical resources. The proposed closed-loop care pathway was effective at the community level. Proper education and frequent communication with healthcare providers may encourage patients’ acceptance and use of smartphones to support COPD self-management. In addition, WeChat might play an important role in improving patient compliance and psychological distress. Further research might explore the effect of such systems on a larger scale and at a higher evidence level.