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Chronic obstructive pulmonary disease
Original article
Randomised crossover trial of telemonitoring in chronic respiratory patients (TeleCRAFT trial)
  1. M Chatwin1,
  2. G Hawkins1,
  3. L Panicchia1,
  4. A Woods1,
  5. A Hanak1,
  6. R Lucas1,
  7. E Baker2,
  8. E Ramhamdany3,
  9. B Mann3,
  10. J Riley1,
  11. M R Cowie1,
  12. A K Simonds1
  1. 1NIHR Respiratory and Cardiology Biomedical Research Units, Royal Brompton & Harefield NHS Foundation Trust, London, UK
  2. 2Department of Basic Medical Sciences, St Georges Hospital, London, UK
  3. 3Department of Respiratory Medicine, West Middlesex University Hospital, Isleworth, Middlesex, UK
  1. Correspondence to Professor A K Simonds, NIHR Respiratory Biomedical Research Units, Royal Brompton & Harefield NHS Foundation Trust, Sydney St, London SW36NP, UK; a.simonds{at}rbht.nhs.uk

Abstract

Objective To assess the impact of home telemonitoring on health service use and quality of life in patients with severe chronic lung disease.

Design Randomised crossover trial with 6 months of standard best practice clinical care (control group) and 6 months with the addition of telemonitoring.

Participants 68 patients with chronic lung disease (38 with COPD; 30 with chronic respiratory failure due to other causes), who had a hospital admission for an exacerbation within 6 months of randomisation and either used long-term oxygen therapy or had an arterial oxygen saturation (SpO2) of <90% on air during the previous admission. Individuals received telemonitoring (second-generation system) via broadband link to a hospital-based care team.

Outcome measures Primary outcome measure was time to first hospital admission for an acute exacerbation. Secondary outcome measures were hospital admissions, general practitioner (GP) consultations and home visits by nurses, quality of life measured by EuroQol-5D and hospital anxiety and depression (HAD) scale, and self-efficacy score (Stanford).

Results Median (IQR) number of days to first admission showed no difference between the two groups—77 (114) telemonitoring, 77.5 (61) control (p=0.189). Hospital admission rate at 6 months increased (0.63 telemonitoring vs 0.32 control p=0.026). Home visits increased during telemonitoring; GP consultations were unchanged. Self-efficacy fell, while HAD depression score improved marginally during telemonitoring.

Conclusions Telemonitoring added to standard care did not alter time to next acute hospital admission, increased hospital admissions and home visits overall, and did not improve quality of life in chronic respiratory patients.

Trial registration number NCT02180919 (ClinicalTrials.gov).

  • COPD Exacerbations
  • Respiratory Infection

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/thoraxjnl-2015-207045

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