JMIR Publications

ABSTRACT

Background:

Digital interventions may help reduce exacerbations and increase adherence to the Chronic Obstructive Pulmonary Disease (COPD) action plan by providing opportunities for self-monitoring of symptoms and self-management behaviors, and remote support from a case-manager

Objective:

To compare the impact of a COPD Patient Health Portal (PHP) on action plan adherence during exacerbations vs. usual care. A secondary objective was to evaluate the association between severity of COPD, sociodemographic, and knowledge, self-efficacy, anxiety and depression with adherence to the action plan

Methods:

This trial was a 12-month parallel, 2-arm RCT. Participants recruited from a speciality clinic were assigned to either: (1) COPD PHP with self-monitoring and automated feedback and online communication with a nurse case manager and usual care, or (2) usual care which consisted of self-management support delivered by a nurse case-manager with access to online educational material (Living Well with COPD). Analyses were based on an intent-to-treat analysis. The primary outcome was self-reported adherence to the exacerbation action plan. Secondary outcomes included COPD self-efficacy, HRQL, healthcare utilization, anxiety, depression, technology acceptance (TAM), and PHP use.

Results:

Forty-nine participants were randomized to either intervention ((n=24) or control (n=25). Groups were similar in age, sex, BMI, education, marital status, smoking status, spirometry and GOLD classification. While a greater proportion of intervention participants were adherent to the action plan (47%, 20/43 exacerbations) compared to the control arm (37%, 18 of 48 exacerbations), differences were not statistically significant. Twelve percent of exacerbation in the intervention arm led to the participant contacting a health professional compared to 4% in the control group. The average exacerbation length among individuals who contacted a healthcare professional during the exacerbation and took a medication was significantly lower in the intervention (days=10.6 ± 2.2, n=5) vs. control (29.5 ± 6.4, n=2) group. There was no effect of treatment arm on adherence to action plan at the exacerbation level (OR 1.16, 95% CI 0.44-3.03) nor of GOLD severity group (GOLD 3 vs 2: OR 1.6 and 95% CI 0.5-5.7, GOLD 4 vs 2: OR 1.3 and 95% CI 0.4-4.2) in adjusted models.

Conclusions:

A 12-month PHP intervention did not significantly increase adherence to the exacerbation action plan. There was a trend for those using the PHP to have fewer exacerbations in the first 4 months and with a shorter duration when contacting their HCP resulting in taking medication.