Adherence to an eHealth Self-Management Intervention for Patients with Both COPD and Heart Failure: Results of a Pilot Study

Joanne Sloots; Mirthe Bakker; Job van der Palen; Michiel Eijsvogel; Paul van der Valk; Gerard Linssen; Clara van Ommeren; Martijn Grinovero; Monique Tabak; Tanja Effing; Anke Lenferink

doi:10.2147/COPD.S299598

Adherence to an eHealth Self-Management Intervention for Patients with Both COPD and Heart Failure: Results of a Pilot Study

Int J Chron Obstruct Pulmon Dis. 2021 Jul 15:16:2089-2103. doi: 10.2147/COPD.S299598. eCollection 2021.

Authors

Joanne Sloots¹, Mirthe Bakker¹, Job van der Palen^{1

2}, Michiel Eijsvogel¹, Paul van der Valk¹, Gerard Linssen³, Clara van Ommeren¹, Martijn Grinovero⁴, Monique Tabak^{5

6}, Tanja Effing⁷, Anke Lenferink^{1

8}

Affiliations

¹ Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands.
² Department of Research Methodology, Measurement & Data Analysis, University of Twente, Enschede, the Netherlands.
³ Department of Cardiology, Hospital Group Twente, Almelo and Hengelo, the Netherlands.
⁴ Amiko Digital Health Limited, London, UK.
⁵ eHealth Group, Roessingh Research and Development, Enschede, the Netherlands.
⁶ Department of Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, the Netherlands.
⁷ College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
⁸ Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social sciences, Technical Medical Centre, University of Twente, Enschede, the Netherlands.

Abstract

Background: Chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) often coexist and share periods of symptom deterioration. Electronic health (eHealth) might play an important role in adherence to interventions for the self-management of COPD and CHF symptoms by facilitating and supporting home-based care.

Methods: In this pilot study, an eHealth self-management intervention was developed based on paper versions of multi-morbid exacerbation action plans and evaluated in patients with both COPD and CHF. Self-reporting of increased symptoms in diaries was linked to an automated decision support system that generated self-management actions, which was communicated via an eHealth application on a tablet. After participating in self-management training sessions, patients used the intervention for a maximum of four months. Adherence to daily symptom diary completion and follow-up of actions were analyzed. An add-on sensorized (Respiro^®) inhaler was used to analyze inhaled medication adherence and inhalation technique.

Results: In total, 1148 (91%) of the daily diaries were completed on the same day by 11 participating patients (mean age 66.8 ± 2.9 years; moderate (55%) to severe (45%) COPD; 46% midrange left ventricular function (LVF) and 27% reduced LVF). Seven patients received a total of 24 advised actions because of increased symptoms of which 11 (46%) were followed-up. Of the 13 (54%) unperformed advised actions, six were "call the case manager". Adherence to inhaled medication was 98.4%, but 51.9% of inhalations were performed incorrectly, with "inhaling too shortly" (<1.25 s) being the most frequent error (79.6%).

Discussion: Whereas adherence to completing daily diaries was high, advised actions were inadequately followed-up, particularly the action "call the case manager". Inhaled medication adherence was high, but inhalations were poorly performed. Future research is needed to identify adherence barriers, further tailor the intervention to the individual patient and analyse the intervention effects on health outcomes.

Keywords: chronic conditions; disease management; dry powder inhalers; self-treatment; telemedicine.

MeSH terms

Aged
Electronics
Heart Failure* / diagnosis
Heart Failure* / therapy
Humans
Medication Adherence
Middle Aged
Pilot Projects
Pulmonary Disease, Chronic Obstructive* / diagnosis
Pulmonary Disease, Chronic Obstructive* / drug therapy
Self-Management*
Telemedicine*

Grants and funding

This study was funded by the Pioneers in Health Care Innovation Fund (2016), a cooperation between Medisch Spectrum Twente (hospital), ZiekenhuisGroep Twente (hospital), University of Twente and Saxion Academy, all in The Netherlands. The aim of this fund is to stimulate the introduction of innovative technology in healthcare.