1. Telehealth Monitoring of People with COPD – Are We Fostering Self Management or Service Dependency? Gill Lewin Joanna Smith, Kristen De San Miguel, IFA Conference, Prague, May 2012

2. Background Silver Chain, WA. Health and community care provider. 40,000+ clients with 50,000+ hospital admissions annually Diagnosis of COPD increases risk of admission Tested telehealth remote monitoring Two trials with people with COPD Western Australia

3. What is Telehealth Self Monitoring? Intervention

4. Daily Measurements

5. Equipment

6. Nurse Monitoring

7. First Study Randomised controlled trial Telehealth remote monitoring vs Information only 40 participants in each group Monitored for six months Measured: Health Service Use and Quality of Life Results promising

8. Hospital Admissions

9. Days in Hospital

10. ED Presentations

11. Questions… Would results be same over winter? Were people now dependent on ongoing monitoring?

12. Second Study Telehealth n=36 Telehealth n=36 Information n=35 Information n=35 Tele-Tele n=18 Tele-Tele n=18 Tele-Info n=17 Tele-Info n=17 Info-Tele n=18 Info-Tele n=18 Info-Info n=16 Info-Info n=16 71 Individuals completed first study 69 recruited into 2 nd study Cross Over Trial Outcomes monitored for further 6 months + compared to first 6 months

13. Mean Change in Hospitalisations

14. Mean Change in Days in Hospital

15. Mean Change in ED Presentations

16. Cost Difference

17. What makes it sustainable? Increased symptom awareness: “I can now recognise when I am a bit short of breath and notice when my oxygen levels are dropping...I recognise that when I am feeling a bit short of breath I should take a rest for a while.” Better symptom management: “I take more notice of things, and take remedial measures if things aren’t right…” Increased understanding: “It has helped me to understand my condition, taught me not to panic and when I should go to the doctors.”

18. Conclusions The benefits of telehealth remote monitoring are evident in all seasons Telehealth remote monitoring has an impact on all health service use – not just COPD related The benefits remain even after the monitoring equipment is removed (if the individual has learned to take notice) Telehealth can result in large cost savings for the health system

19. Acknowledgements Commonwealth Department of Health and Ageing State Health Research Advisory Council Study Participants Research Colleagues

20. Contact Details Further information: glewin@silverchain.org.au