JMIR Publications

ABSTRACT

Background:

Chronic obstructive pulmonary disease (COPD) is a common, costly, and incurable respiratory disease effecting 1.2 million people in the UK alone. Acute COPD exacerbations requiring hospitalisation place significant demands on health services, and the incidence of COPD in poor, remote, and rural populations is up to twice that of cities.

Objective:

MyCOPD is a commercial digital health self-management technology designed to improve COPD outcomes and mitigate demands on health services. In this pragmatic real world feasibility study, we evaluated myCOPD use and clinical effectiveness at reducing hospitalisations, inpatient bed days, and other NHS resource use

Methods:

MyCOPD engagement and NHS resource use was monitored for up to one year after myCOPD activation and compared against health service use in the year prior to activation. 113 participants from predominantly remote and rural communities were recruited via community-based care settings including scheduled home visits, outpatient appointments, pulmonary rehabilitation, and phone or group appointments. There was no predetermined age, disease severity, geographical, or socioeconomic inclusion or exclusion criteria.

Results:

Eighty nine out of 113 participants activated myCOPD (78.8%), with 56% (50/89) doing so on the day of enrolment and 90% (80/89) within 1 month. There was no correlation between participant enrolment, activation, or myCOPD engagement and either age, socioeconomics, rurality, or COPD severity. Most active participants used at least 1 myCOPD module and entered their symptom scores at least once (88.7%, 79/89 people). A subgroup (15/89 participants; 16.9%) recorded their symptom scores very frequently (>once ever 5 days), 14 of whom also used 4 or 5 myCOPD modules. Overall there were no differences in hospital admissions, inpatient bed days, or other health service use before or after myCOPD activation, apart from a modest increase in home visits. Subgroup analysis did however identify a trend towards reduced inpatient bed days and hospital admissions for those participants with very high myCOPD usage.

Conclusions:

Our results suggest that neither age, wealth, nor geographic location represent significant barriers to using myCOPD. This finding may help mitigate perceived risks of increased health inequalities associated with the use of digital health technologies as part of routine care provision. Despite high levels of activation, myCOPD did not reduce overall demands on health services such as hospital admissions or inpatient bed days. Subgroup analysis did however suggest that very high myCOPD usage was associated with a moderate reduction in NHS resource use. Thus, although our study does not support implementation of myCOPD to reduce health service demands on a population wide basis, our results do indicate that highly engaged patients may derive benefits.