JMIR Publications

ABSTRACT

Background:

Self-management interventions, supported by mobile apps, can improve COPD patients’ management over their disease and may decrease hospital admissions. However, not all patients qualify and systematic, comprehensive information on implementation- and compliance related aspects of mobile self-management apps is lacking. As there is a tendency to target digital services to patients in stable phases of disease, it is especially relevant to focus on use in broad clinical practice for patients recently discharged from hospital.

Objective:

To evaluate the effects of a mobile self-management app in clinical practice for recently discharged COPD patients on application use, self-management, anxiety and depression, technology acceptance, patients’ and health care professionals’ satisfaction and hospital readmissions.

Methods:

Usability testing with COPD patients was used to improve the application. Subsequently, patients were provided with the app, containing an 8 week self-management program including lung exacerbation action plan, education, questionnaires, and video consultation. Adult patients, with doctor-diagnosed COPD, access to a mobile device and proficiency of the Dutch language were included during hospital admission. Questionnaires were completed at baseline, after 8 and 20 weeks on self-management (Partners in Health Scale), technology acceptance (UTAUT model) and patients’ and nurses’ satisfaction. Use was assessed using log data, and readmission rates were extracted from the EMR.

Results:

Overall, 76% of patients had to be excluded from participation; half of those because of lack of digital skills and/or access to a mobile device. The COPD app was opened an average of 3.4 (SD2.6) times per week, but use decreased over time. Patients read the information most often during the first week, especially on relevant COPD aspects (74%) and physical activity (62%). The self-management element ‘knowledge and coping’ increased significantly over time (P=.04). However, no effects on anxiety and depression were found. Patients rated the COPD app with a 7.7 (1.7) and were positive about the information. Nurses rated the application with a 6.3 (1.2), and expressed concerns about workload. Preliminary evidence about readmissions rate showed that 13% of patients was readmitted within 30 days, and 21% within 8 weeks, compared to respectively 14% and 22 % in a pre/research cohort.

Conclusions:

The use of a mobile self-management app after hospital discharge seems only feasible for small number of COPD patients. Patients were satisfied about the service, but use decreased over time and a significant relation with use was only found with knowledge and coping. Health care professionals expressed concerns about increased workload. Tailored interventions, patient support and active adoption by professionals are important elements to ensure successful mHealth interventions. Therefore, future research on digital self-management interventions in clinical practice should focus on including more difficult subgroups of target populations, on a multidisciplinary approach, technology related aspects (such as acceptability) and finetuning its adoption in clinical pathways.