Adherence to an eHealth Self-Management Intervention for Patients with Both COPD and Heart Failure: Results of a Pilot Study

Abstract

Joanne Sloots,1 Mirthe Bakker,1 Job van der Palen,1,2 Michiel Eijsvogel,1 Paul van der Valk,1 Gerard Linssen,3 Clara van Ommeren,1 Martijn Grinovero,4 Monique Tabak,5,6 Tanja Effing,7 Anke Lenferink1,8 1Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands; 2Department of Research Methodology, Measurement & Data Analysis, University of Twente, Enschede, the Netherlands; 3Department of Cardiology, Hospital Group Twente, Almelo and Hengelo, the Netherlands; 4Amiko Digital Health Limited, London, UK; 5eHealth Group, Roessingh Research and Development, Enschede, the Netherlands; 6Department of Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, the Netherlands; 7College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; 8Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social sciences, Technical Medical Centre, University of Twente, Enschede, the NetherlandsCorrespondence: Joanne SlootsDepartment of Pulmonary Medicine, Medisch Spectrum Twente, Koningsplein 1, Enschede, 7512 KZ, the NetherlandsTel [phone]Email [email protected]: Chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) often coexist and share periods of symptom deterioration. Electronic health (eHealth) might play an important role in adherence to interventions for the self-management of COPD and CHF symptoms by facilitating and supporting home-based care.Methods: In this pilot study, an eHealth self-management intervention was developed based on paper versions of multi-morbid exacerbation action plans and evaluated in patients with both COPD and CHF. Self-reporting of increased symptoms in diaries was linked to an automated decision support system that generated self-management actions, which was communicated via an eHealth application on a tablet. After participating in self-management training sessions, patients used the intervention for a maximum of four months. Adherence to daily symptom diary completion and follow-up of actions were analyzed. An add-on sensorized (Respiro®) inhaler was used to analyze inhaled medication adherence and inhalation technique.Results: In total, 1148 (91%) of the daily diaries were completed on the same day by 11 participating patients (mean age 66.8 ± 2.9 years; moderate (55%) to severe (45%) COPD; 46% midrange left ventricular function (LVF) and 27% reduced LVF). Seven patients received a total of 24 advised actions because of increased symptoms of which 11 (46%) were followed-up. Of the 13 (54%) unperformed advised actions, six were “call the case manager”. Adherence to inhaled medication was 98.4%, but 51.9% of inhalations were performed incorrectly, with “inhaling too shortly” (< 1.25 s) being the most frequent error (79.6%).Discussion: Whereas adherence to completing daily diaries was high, advised actions were inadequately followed-up, particularly the action “call the case manager”. Inhaled medication adherence was high, but inhalations were poorly performed. Future research is needed to identify adherence barriers, further tailor the intervention to the individual patient and analyse the intervention effects on health outcomes.Keywords: telemedicine, chronic conditions, self-treatment, disease management, dry powder inhalers

Keywords

• telemedicine
• chronic conditions
• self-treatment
• disease management
• dry powder inhalers;