Self-care behaviours of COPD patients over a 12-month period in the WSD Evaluation

Abstract

Background There is considerable heterogeneity in effectiveness of telehealth interventions for COPD patients quality of life, psychological distress and healthcare utilisation. One potential reason for the variations in results is that some telehealth interventions are not effective in changing patient self-care behaviours. This research focuses on the extent to which providing people with tools to monitor their condition can improve self-care behaviours. Methods The Chronic Obstructive Pulmonary Disease cohort of the Whole Systems Demonstrator Trial is a pragmatic GP clustered RCT evaluating TH in the UK from three regions in England. All patients at a participating GP practice were deemed eligible for inclusion in the study if they were diagnosed with COPD. Findings 447 participants completed baseline and either a short (4 months) or long term (12 months) follow up. There was a trend of improved self-care behaviours, but there were no trial arm differences between telehealth and usual care groups (p>0.05) Discussion Although TH showed minimal benefit in COPD patients who were not preselected to be at increased risk of acute exacerbations, in the longer term follow up, not shorter-term, these improvements could not be explained by self-care behaviours or self-efficacy to perform self-care behaviours. TH is a complex intervention and should be embedded in a service that is evidenced based. Future research should monitor the fidelity of telehealth interventions to assess their internal validity, along with the monitoring of process variables that are sensitive enough to detect changes in the target population for the specific telehealth intervention.