Real-World Comparison of Telemonitoring Versus Conventional Care in Patients With Chronic Obstructive Pulmonary Disease and Those With Asthma-Impact on Clinical Outcomes and Patient Characteristics: Retrospective Cohort Study

Abstract

Background: Chronic obstructive pulmonary disease (COPD) and asthma belong to the most common chronic diseases and their incidence continues to rise. Many patients experience exacerbations leading to hospitalization, impacting quality of life and straining health care systems. Telemonitoring emerged as a substitute for outpatient clinic visits, aiming to intervene early and prevent hospitalization. However, studies evaluating telemonitoring are conducted in controlled settings and may not fully reflect real-world conditions. Real-world evidence is needed to understand how telemonitoring functions in routine clinical practice.

Objective: This study aims to describe and compare patient characteristics and clinical outcomes of patients with COPD or asthma who received telemonitoring versus conventional care based on real-world data.

Methods: An observational cohort study with retrospective data collection was conducted with data from newly diagnosed patients with COPD or asthma who received telemonitoring or conventional care with up to 1-year follow-up. Outcomes included patient characteristics, COPD- or asthma-related hospitalizations, emergency department visits, exacerbations, and outpatient clinic visits. The telemonitoring intervention involves a mobile app where patients weekly complete the Asthma Control Questionnaire or the Clinical COPD Questionnaire, allowing nurses to intervene if scores indicate deterioration. The app serves as a substitute for outpatient clinic visits for patients with COPD, while patients with asthma use it as a complement to these visits.

Results: The study included 614 patients in conventional care and 96 patients in telemonitoring. Telemonitoring users are younger, predominantly female, rarely current smokers, and have fewer comorbidities. More patients with asthma used telemonitoring than patients with COPD. Patients using telemonitoring showed more moderate exacerbations (incidence rate ratio [IRR] 2.15, 95% CI 1.16-3.98; P=.02). Although telemonitoring users experienced fewer hospitalizations, this was not significant after adjusting for confounders (IRR 0.68, 95% CI 0.15-3.11; P=.62). Telemonitoring users had more telephone and screen-to-screen consultations (IRR 7.16, 95% CI 5.47-9.36; P<.001), but outpatient clinic visits remained consistent across both groups (IRR 1.19, 95% CI 0.88-1.62; P=.27).

Conclusions: Patient characteristic differences and clinical outcome differences were identified between telemonitoring and conventional care. Although telemonitoring facilitated earlier initiation of treatment, it did not lead to fewer hospital or outpatient clinic visits. More insight is needed into factors influencing participation in telemonitoring to better serve current users and improve accessibility for nonusers. Patients should be provided with additional guidance on effectively using the communication channels offered by telemonitoring. This may encourage them to use these methods instead of attending outpatient clinic visits. Additionally, when implementing telemonitoring, it is essential to critically evaluate and redesign care processes to prevent unnecessary health care use.

Keywords: asthma; chronic obstructive pulmonary disease; mHealth; pulmonary disease; pulmonary disease, chronic obstructive; real-world evidence; telemedicine; telemonitoring.