Tele-assistance in Chronic Respiratory Failure Patients: a Randomised Clinical Trial

¹ Divisione di Pneumologia, Fondazione S. Maugeri, IRCCS, Lumezzane (Bs) – Italy
² Divisione di Pneumologia, Fondazione S. Maugeri, IRCCS, Montescano (Pv) – Italy
³ Divisione di Pneumologia, Fondazione S. Maugeri, IRCCS, Cassano delle Murge (Ba) – Italy
⁴ Divisione di Pneumologia, Fondazione S. Maugeri, IRCCS, Veruno (No) – Italy
⁵ Servizio di Telemedicina, Fondazione S. Maugeri, IRCCS, Lumezzane (Bs) – Italy

^* To whom correspondence should be addressed. E-mail: mvitacca{at}fsm.it.

	Abstract

Chronic respiratory patients requiring oxygen or home mechanical ventilation experience frequent exacerbations and hospitalisations with related costs. Strict monitoring and care have been recommended.

The primary aim was to evaluate reduction in hospitalisations and secondarely exacerbations, general practictioner (GP) calls and related cost-effectiveness of tele-assistance (TA) for these patients.

240 patients (101 COPD) were randomized to two groups: intervention group received one year TA program while controls received traditional care

No anthropometric and clinical differences were found between groups both in baseline and in mortality (18% for TA, 23% for controls). As compared with controls, TA group experianced less hospitalizations (-36% p<0.02), less GP urgent calls (-65% p<0.002), less acute exacerbations (-71% p<0.0001). Only COPD patients, as a separate group had more subject free from hospitalizations (p=0.012), emergency room admissions (p=0.0008), urgent GP calls (p=0.013) or exacerbations (p<0.0001). Each patient referred to staff 36±25 times. After deduction of TA costs, the average overall cost per each patient was 33% less than that for usual care.

In chronic respiratory failure patients on oxygen or home mechanical ventilation, a nurse-centred Tele-assistance prevents hospitalizations while it is cost/effective. The COPD group seems to have the bigger advantage from tele-assistance.

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