Chronic Obstructive Pulmonary Disease

The telemonitoring of Patients with Chronic Obstructive Pulmonary Disease (COPD) aims to promote the continuous monitoring of patients in order to improve their quality of life and observe health gains, using a patient-centered approach and the establishment of community partnerships.

Chronic obstructive pulmonary disease is an obstructive lung disease characterized by chronic and only partially reversible airway limitation and destruction of lung tissue. It originates from a significant inflammatory response to the inhalation of irritants such as, for example, tobacco. It is a progressive disease that has no cure, since the lesions it causes in the lungs do not regress and current treatments are only able to delay the loss of function. This progression also contributes to a lower tolerance to effort by the patient, which leads to a progressive withdrawal from normal activity.

COPD is a multisystemic disease, in which comorbidities play an important role.

The leading cause of COPD is smoking.

Frequent inhalation of certain types of environmental or occupational pollution can also cause inflammation of the respiratory tract, weakening the mucosa and contributing to the onset of the disease.

The hereditary deficiency of a protein called alpha 1-antitrypsin may also be associated with the occurrence of COPD.

In the case of COPD, the monitored parameters (though these may vary depending on the patient), include:

According to Sociedade Portuguesa de Pneumologia (SPP), it is estimated that in Portugal:

Around

30%

of the Portuguese population

suffers from chronic respiratory diseases, such as COPD

which are responsible for

20%

of hospital admissions

and are a cause of disability, which is reflected in

4 million days

of work/school activities

This pathology represents the

5th cause of death

in Portugal (2,4%)

and its annual direct costs are around

240 M€

Objectives

Raise the quality of health services provided to citizens, making them feel continuously accompanied in their disease
Reduce the use of Health Services through the timely detection of acute symptoms, in order to prevent hospital admissions, with a consequent reduction in costs and improvement in the prognosis of patients
To proactively and continuously follow the fluctuations of each patient's condition, allowing a constant follow-up and a timely reaction, postponing as much as possible the worsening of the syndrome

Contribute to Proximity Health, guaranteeing easy access between the patient and the health care provider
Improving quality of life, with an impact on both patients and carers
Contribute to Health Literacy, particularly in the aged population, promoting the active role of the citizen/patient in the management of his/her disease

Results

Economics

Social

Clinicians

Metodology

1. Patient signalling

In Hospital or PHC and clinical and social assessment by multidisciplinary team (medical team and nursing team) confirmation of compliance with inclusion criteria

2. Patient Integration

In the telemonitoring programme by giving informed consent

3. Training/training the patient and carer in the necessary procedures

Telemonitoring and configuration of equipment for remote monitoring, i.e. measuring vital parameters and communicating them to the clinical teams

4. Parameterisation of limit values based on each patient's profile

Individual intervention algorithms, example of alerts to be considered oximetry, axillary temperature, blood pressure (this definition will be left to the medical team's discretion)

5. Initiation of the procedure for remote patient monitoring

From home (usually operated by the carer) by default, daily measurements of biometric signals take place and data is recorded electronically (e.g. mobile phone via Bitalino)

6. Alert signals, via the Desktop application

Through the desktopapplication, existing in the Hospital, based on the data recorded by the patient/caregiver from home, alert signals are identified by the monitoring central of the installed platform, allowing immediate action by the dedicated team (first line nursing team, with medical support if necessary).

a. Telephone contact with patient/caregiver for any corrections to patient treatment or monitoring failures

b. Priority referral of the patient, via notification, for external consultation or emergency consultation, in cases where necessary

c. If it occurs, the electronic prescription avoids the need for the patient to go to the hospital in cases of medication review