Patients with chronic obstructive pulmonary disease (COPD) are often hospitalised with acute exacerbations. This is a common cause of emergency admission to hospital and costs the NHS nearly £2 billion a year. Nearly half of patients are discharged within 3 days of admission but a quarter of patients are readmitted within 30 days of discharge. To further complicate COPD management, nearly three quarters of patients have additional comorbidities and the prevalence of comorbid conditions increases with more advanced disease. Intervening on hospitalised patients could be ideal timing to support the hospital-to-home pathway in preventing readmission.
Using the EDGE system, patients can complete symptom diaries, measure their oxygen saturation levels and pulse daily, and wear a physical activity monitor, with all output monitored remotely by a clinical team, who are alerted to sustained, abnormal values. Personalised videos encouraging good inhaler technique and self-care facilitate engagement with the device. Patient feedback indicates that using the system is acceptable to patients and healthcare teams.
We previously successfully developed the system with patients in the community and we have subsequently moved to identifying patients with COPD in hospital to allow linkage of data from hospital and the support tool around admission for acute exacerbations. As of 2019-20, the study was exploring the feasibility of recruiting from a hospital setting and the system’s acceptability to patients and healthcare professionals.
2021 update: As a result of the COVID-19 pandemic, all hospital-based study recruitment was halted. The sudden and urgent need to put ‘everything online’ meant that the EDGE2 study changed direction and has become a vital tool in the remote management of patients with COPD. Working closely with the respiratory team at the John Radcliffe Hospital, we have revised the study considerably and are now recruiting patients once again from the team’s ‘virtual wards’. I am leading the qualitative work with patients and healthcare professionals, exploring the acceptability and implementation-potential of the system in the challenging context of emerging from a pandemic.
Newhouse, N., Whelan, M.E., & Farmer, A. COVID-19: Needs-led implementation and the immediate potential of remote monitoring. BJGP Open 19 May 2020; bjgpopen20X101093.
Armitage, L., Lawson, B.K., Whelan, M. E., & Newhouse, N. Paying SPECIAL consideration to the digital sharing of information during the COVID-19 pandemic and beyond. BJGP Open 28 April 2020; bjgpopen20X101072.