Telehealth and telemedicine in the management of adult patients after hospitalization for COPD exacerbation: a scoping review

Rezende, Lilian Cristina; Ribeiro, Edmar Geraldo; Parreiras, Laura Carvalho; Guimarães, Rayssa Assunção; Reis, Gabriela Maciel dos; Carajá, Adriana Fernandes; Franco, Túlio Batista; Mendes, Liliane Patrícia de Souza; Augusto, Valéria Maria; Silva, Kênia Lara

doi:10.36416/1806-3756/e20220067

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Jornal Brasileiro de Pneumologia

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Sumário

REVIEW AND UPDATE ARTICLE • J. bras. pneumol. 49 (3) • 2023 • https://doi.org/10.36416/1806-3756/e20220067 copy

Telehealth and telemedicine in the management of adult patients after hospitalization for COPD exacerbation: a scoping review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

A substantial number of people with COPD suffer from exacerbations, which are defined as an acute worsening of respiratory symptoms. To minimize exacerbations, telehealth has emerged as an alternative to improve clinical management, access to health care, and support for self-management. Our objective was to map the evidence of telehealth/telemedicine for the monitoring of adult COPD patients after hospitalization due to an exacerbation.

Methods:

Bibliographic search was carried in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, Scopus, Biblioteca Virtual de Saúde/LILACS and Cochrane Library databases to identify articles describing telehealth and telemonitoring strategies in Portuguese, English, or Spanish published by December of 2021.

Results:

Thirty-nine articles, using the following concepts (number of articles), were included in this review: telehealth (21); telemonitoring (20); telemedicine (17); teleconsultation (5); teleassistance (4); telehomecare and telerehabilitation (3 each); telecommunication and mobile health (2 each); and e-health management, e-coach, telehome, telehealth care and televideo consultation (1 each). All these concepts describe strategies which use telephone and/or video calls for coaching, data monitoring, and health education leading to self-management or self-care, focusing on providing remote integrated home care with or without telemetry devices.

Conclusions:

This review demonstrated that telehealth/telemedicine in combination with telemonitoring can be an interesting strategy to benefit COPD patients after discharge from hospitalization for an exacerbation, by improving their quality of life and reducing re-hospitalizations, admissions to emergency services, hospital length of stay, and health care costs.

Keywords:
Pulmonary disease, chronic obstructive; Symptom flare up; Telemedicine; Patient discharge

Database

Search strategy

Scopus
Cochrane Library
Web of Science
PubMed-Medline
CINAHL

(“Pulmonary Disease, Chronic Obstructive” OR “Airflow Obstruction, Chronic” OR “Airflow Obstructions, Chronic” OR “COAD” OR “COPD” OR “Chronic Airflow Obstruction” OR “Chronic Airflow Obstructions” OR “Chronic Obstructive Airway Disease” OR “Chronic Obstructive Lung Disease” OR “Chronic Obstructive Pulmonary Disease” OR “Lung Diseases”) AND (“Telemonitoring” OR “Telemedicine” OR “Remote Consultation” OR “Cell Phone” OR “Mobile Applications”) AND (“Patient Discharge” OR “Hospitalization”)

BVS/LILACS

(“Pulmonary Disease, Chronic Obstructive” OR “Enfermedad Pulmonar Obstructiva Crónica” OR “Doença Pulmonar Obstrutiva Crônica” OR “COAD” OR “COPD” OR “DPOC” OR “Doença Obstrutiva Crônica Pulmonar” OR “Doença Obstrutiva Crônica das Vias Aéreas” OR “Doença Obstrutiva Crônica do Pulmão” OR “Obstrução Crônica do Fluxo Respiratório” OR “Obstrução do Fluxo Respiratório Crônica” OR “Airflow Obstruction, Chronic” OR “Airflow Obstructions, Chronic” OR “Chronic Airflow Obstruction” OR “Chronic Airflow Obstructions” OR “Chronic Obstructive Airway Disease” OR “Chronic Obstructive Lung Disease” OR “Chronic Obstructive Pulmonary Disease” OR “Lung Diseases” OR “Enfermedades Pulmonares” OR “Pneumopatias”) AND (“Telemonitoring” OR “Telemonitorización” OR “Telemonitoramento” OR “Telemedicine” OR “Telemedicina” OR “Remote Consultation” OR “Consulta Remota” OR “Cell Phone” OR “Teléfono Celular” OR “Telefone Celular” OR “Mobile Applications” OR “Aplicaciones Móviles” OR “Aplicativos Móveis”) AND (“Patient Discharge” OR “Alta del Paciente” OR “Alta do Paciente” OR “Alta Hospitalar” OR “Alta do Hospital” OR “Planejamento da Alta” OR “Hospitalization” OR “Hospitalización” OR “Hospitalização”)

Author, country, year	Study design	Professionals responsible for delivering telehealth	Objective of the study	Sample size	Concept	Strategy	Outcomes
Vitacca; et al, Italy, 2018⁸8 Vitacca M, Montini A, Comini L. How will telemedicine change clinical practice in chronic obstructive pulmonary disease?. Ther Adv Respir Dis. 2018;12:1753465818754778. 10.1177/1753465818754778 https://doi.org/10.1177/1753465818754778...	Observational study	Nurse, physician.	To test the feasibility of and patient satisfaction with an advanced care plan for severe COPD patients followed by teleassistance at home for six months, focusing on monitoring patient’s palliative topics by means of a dedicated checklist	N = 10	Telemedicine Teleassistance	Phone call	High level of satisfaction of the service
Ratner et al., USA, 2001¹²12 Ratner D, Louria D, Sheffet A, Fain R, Curran J, Saed N, et al. Wealth from Health: an incentive program for disease and population management: a 12-year project. Lippincotts Case Manag. 2001;6(5):184-204. 10.1097/00129234-200109000-00002 https://doi.org/10.1097/00129234-2001090...	Clinical trial	Nurse, doctor	To describe the Wealth from Health program, which utilizes current and future technologies to help the health care system become a leader in health care delivery and to assist many communities at an affordable cost	N = 78 Intervention vs. control groups^a	Telemedicine Telecommunication	Phone call	Reduction in re-hospitalizations and medical costs Improvement in quality of life
Vontetsianos et al., Greece, 2005¹³13 Vontetsianos T, Giovas P, Katsaras T, Rigopoulou A, Mpirmpa G, Giaboudakis P, et al. Telemedicine-assisted home support for patients with advanced chronic obstructive pulmonary disease: preliminary results after nine-month follow-up. J Telemed Telecare. 2005;11 Suppl 1:86-88. 10.1258/1357633054461697 https://doi.org/10.1258/1357633054461697...	Clinical trial	Nurse, doctor, physiotherapist, social worker, clinical psychologist, dietician, and pharmacist	To evaluate the clinical utility of an advanced system of e-health services in home-based integrated care for patients suffering mainly from COPD	N = 18 Intervention vs. control groups^a	Telehealth Telemedicine	Video call	Reduction in hospitalizations, emergency department visits, and use of health services Improvement in disease knowledge, self-management, and perception of the quality of life Total costs were lower after study period
Finkelstein et al, USA, 2006¹⁴14 Finkelstein SM, Speedie SM, Potthoff S. Home telehealth improves clinical outcomes at lower cost for home healthcare. Telemed J E Health. 2006;12(2):128-136. 10.1089/tmj.2006.12.128 https://doi.org/10.1089/tmj.2006.12.128...	Clinical trial	Nurse	To identify and document the benefits of a telemedicine application compared with standard care for homebound patients receiving home health services after an acute hospitalization for a long-term condition	N = 53 Intervention (n = 35) vs. control (n = 18) groups	Telemedicine Telehomecare Telecommunication	Telemetry/Data sending Video call	Reduction in costs to deliver home healthcare
Vitacca et al., Italy, 2006¹⁵15 Vitacca M, Assoni G, Pizzocaro P, Guerra A, Marchina L, Scalvini S, et al. A pilot study of nurse-led, home monitoring for patients with chronic respiratory failure and with mechanical ventilation assistance. J Telemed Telecare. 2006;12(7):337-342. 10.1258/135763306778682404 https://doi.org/10.1258/1357633067786824...	Observational study	Nurse, doctor	To test the feasibility of telemedicine out of hospital use	N = 45	Telemonitoring Teleassistance Teleconsultation	Telemetry/Data sending	Feasibility of home monitoring
Trappenburg et al., Netherlands, 2008¹⁶16 Trappenburg JC, Niesink A, de Weert-van Oene GH, van der Zeijden H, van Snippenburg R, Peters A, et al. Effects of telemonitoring in patients with chronic obstructive pulmonary disease. Telemed J E Health. 2008;14(2):138-146. 10.1089/tmj.2007.0037 https://doi.org/10.1089/tmj.2007.0037...	Clinical trial	Respiratory nurse, general practitioner, pulmonary physician	To determine the effects of a home-based telemonitoring device, the Health Buddy, on health consumption and HRQoL in patients with moderate to severe COPD	N = 115 Intervention (n = 59) vs. control (n = 56) groups	Telemedicine Telemonitoring	Phone call Message	Reduction in the number of exacerbations and hospitalizations
Cardozo & Steinberg, USA, 2010¹⁷17 Cardozo L, Steinberg J. Telemedicine for recently discharged older patients. Telemed J E Health. 2010;16(1):49-55. 10.1089/tmj.2009.0058 https://doi.org/10.1089/tmj.2009.0058...	Observational study	Nurse, physiotherapist, occupational therapist, social work, and dietician	To evaluate whether case-managed telemedicine as a care delivery system is practical and accepted by elderly patients and could lead to a reduction of costs to the health system, lower emergency care and readmission rates, and provide improved clinical outcomes	N = 851	Telehealth Telemedicine	Telemetry/Data sending	Reduction in re-hospitalizations and emergency visits improvement in disease, knowledge, and quality of life
Sorknaes et al., Denmark, 2011¹⁸18 Sorknaes AD, Madsen H, Hallas J, Jest P, Hansen-Nord M. Nurse tele-consultations with discharged COPD patients reduce early readmissions--an interventional study. Clin Respir J. 2011;5(1):26-34. 10.1111/j.1752-699X.2010.00187.x https://doi.org/10.1111/j.1752-699X.2010...	Clinical trial	Respiratory nurse	To investigate the effect of telemedicine/video consultations between respiratory nurses at the hospital and patients with exacerbated COPD after hospital discharge on early readmissions	N = 100 Intervention (n = 50) vs. control (n = 50) groups	Telecare Telehome Telemedicine Telemonitoring Teleconsultations	Video call Phone call Telemetry/Data sending	Reduction in hospitalizations and median length of stay
Dinesen et al., Denmark, 2012¹⁹19 Dinesen B, Haesum LK, Soerensen N, Nielsen C, Grann O, Hejlesen O, et al. Using preventive home monitoring to reduce hospital admission rates and reduce costs: a case study of telehealth among chronic obstructive pulmonary disease patients [published correction appears in J Telemed Telecare. 2018 Jan;24(1):3]. J Telemed Telecare. 2012;18(4):221-225. 10.1258/jtt.2012.110704 https://doi.org/10.1258/jtt.2012.110704...	Clinical trial	Nurse and general practitioner	To test whether preventive home monitoring of COPD patients would reduce hospital admission rates and hospitalization costs	N = 105 Intervention (n = 57) vs. control (n = 48) groups	Telehealth Telerehabilitation	Telemetry/Data sending Video call	Reduction in admissions during the 10-month follow-up period
Sorknaes et al., Denmark, 2013²⁰20 Sorknaes AD, Bech M, Madsen H, Titlestad IL, Hounsgaard L, Hansen-Nord M, et al. The effect of real-time teleconsultations between hospital-based nurses and patients with severe COPD discharged after an exacerbation. J Telemed Telecare. 2013;19(8):466-474. 10.1177/1357633X13512067 https://doi.org/10.1177/1357633X13512067...	Clinical trial	Nurse	To investigate the effect of daily real-time teleconsultations	N = 100 Intervention (n = 50) vs. control (n = 50) groups	Telemedicine Teleconsultation	Telemetry/Data sending Video call	No significant difference in re-hospitalizations and mortality rate
Bentley et al., England, 2014²¹21 Bentley CL, Mountain GA, Thompson J, Fitzsimmons DA, Lowrie K, Parker SG, et al. A pilot randomised controlled trial of a Telehealth intervention in patients with chronic obstructive pulmonary disease: challenges of clinician-led data collection. Trials. 2014;15:313. 10.1186/1745-6215-15-313 https://doi.org/10.1186/1745-6215-15-313...	Clinical trial	Specialist nurse, specialist physiotherapist, and community matron.	To report the results of a pilot randomized controlled trial of telehealth-supported care within a community-based COPD supported-discharge service	N = 63 Intervention (n = 32) vs. control (n = 31) groups	Telehealth Telemonitoring	Telemetry/Data sending	Reduction in the proportion of hospitalizations and improvement in quality of life
Segrelles Calvo et al., Span, 2014²²22 Segrelles Calvo G, Gómez-Suárez C, Soriano JB, Zamora E, Gónzalez-Gamarra A, González-Béjar M, et al. A home telehealth program for patients with severe COPD: the PROMETE study. Respir Med. 2014;108(3):453-462. 10.1016/j.rmed.2013.12.003 https://doi.org/10.1016/j.rmed.2013.12.0...	Clinical trial	Nurse, pulmonary physician	To assess the efficacy and effectiveness of a home telehealth program for COPD patients with severe airflow obstruction by measuring the number of emergency room visits, number of hospitalizations, length of hospital stay, and mortality	N = 60 Intervention (n = 30) vs. control (n = 30) groups	Telehealth Telemonitoring	Phone call Telemetry/Data sending	Reduction in the number of emergency room visits, number of hospitalizations, length of hospital stays, need for noninvasive ventilation, and number of days to first exacerbation requiring hospitalization
Gottlieb et al., Denmark, 2014²³23 Gottlieb M, Marsaa K, Andreassen H, Strømstad G, Godtfredsen N. Feasibility of a telecare solution for patients admitted with COPD exacerbation: screening data from a pulmonary ward in a university hospital. Eur Clin Respir J. 2014;1:10.3402/ecrj.v1.24193. https://doi.org/10.3402/ecrj.v1.24193 https://doi.org/10.3402/ecrj.v1.24193...	Observational study	Nurse, pulmonary physician	To assess the feasibility of a telehealth care solution when offered in connection with discharge from a pulmonary ward at a university hospital	N = 72	Telecare Telehealth Telemedicine Telehealth care	Video call	No significant difference in re-hospitalizations
Saleh et al., Norway, 2014²⁴24 Saleh S, Larsen JP, Bergsåker-Aspøy J, Grundt H. Re-admissions to hospital and patient satisfaction among patients with chronic obstructive pulmonary disease after telemedicine video consultation - a retrospective pilot study. Multidiscip Respir Med. 2014;9(1):6. 10.1186/2049-6958-9-6 https://doi.org/10.1186/2049-6958-9-6...	Observational study	Specialist respiratory nurse	To assess the impact of telemedicine video consultations on the length of re-admission stays within 6 and 12 months of follow up after telemedicine video-consultations	N = 99	Telemedicine Telemonitoring Tele-video-consultation	Video call	Reduction in the number of patients readmitted due to COPD exacerbations
Davis et al, USA, 2015²⁵25 Davis C, Bender M, Smith T, Broad J. Feasibility and Acute Care Utilization Outcomes of a Post-Acute Transitional Telemonitoring Program for Underserved Chronic Disease Patients. Telemed J E Health. 2015;21(9):705-713. 10.1089/tmj.2014.0181 https://doi.org/10.1089/tmj.2014.0181...	Observational study	Nurse	To determine the feasibility of a transitional care program that integrated mobile health technology and home visits for underserved COPD and chronic heart failure patients and to evaluate preliminary program outcomes related to acute care utilization	N = 149	Telemonitoring	Phone call Interactive voice Telemetry/Data sending	Reduction in re-hospitalizations
Dyrvig et al., Denmark, 2015²⁶26 Dyrvig AK, Gerke O, Kidholm K, Vondeling H. A cohort study following up on a randomised controlled trial of a telemedicine application in COPD patients. J Telemed Telecare. 2015;21(7):377-384. 10.1177/1357633X15572202 https://doi.org/10.1177/1357633X15572202...	Observational study	Nurse	To investigate the effectiveness of a telemedicine intervention in COPD patients during, before, and after an RCT while adjusting for age and gender	N = 11,303	Telemedicine	Video call	Increased risk of re-hospitalizations Reduction in the risk of death
Mierdel & Owen, Canada, 2015²⁷27 Mierdel S, Owen K. Telehomecare Reduces ER Use and Hospitalizations at William Osler Health System. Stud Health Technol Inform. 2015;209:102-108. https://doi.org/10.3233/978-1-61499-505-0-102 https://doi.org/10.3233/978-1-61499-505-...	Observational study	N/R	To evaluate pre- and post-enrollment and post-discharge data captured by the William Osler Health System’s telehomecare host	N = 466	Telehomecare	Phone call Telemetry/Data sending	Reduction in emergency department use, hospitalizations, and mean length of stay
Rosenbek Minet et al., Denmark, 2015²⁸28 Rosenbek Minet L, Hansen LW, Pedersen CD, Titlestad IL, Christensen JK, Kidholm K, et al. Early telemedicine training and counselling after hospitalization in patients with severe chronic obstructive pulmonary disease: a feasibility study. BMC Med Inform Decis Mak. 2015;15:3. 10.1186/s12911-014-0124-4 https://doi.org/10.1186/s12911-014-0124-...	Clinical trial	Nurse, physiotherapist	To assess the feasibility of an individualized home-based training and counseling program via videoconference to patients with severe COPD after hospitalization, including assessment of safety, clinical outcomes, patients’ perceptions, organizational aspects, and economic aspects	N = 50 Intervention vs. control groups^a	Telemedicine Telerehabilitation	Video call	Improvement in the continuity of the rehabilitation program
Chatwin et al., England, 2016²⁹29 Chatwin M, Hawkins G, Panicchia L, Woods A, Hanak A, Lucas R, et al. Randomised crossover trial of telemonitoring in chronic respiratory patients (TeleCRAFT trial). Thorax. 2016;71(4):305-311. 10.1136/thoraxjnl-2015-207045 https://doi.org/10.1136/thoraxjnl-2015-2...	Clinical trial	Study team	To assess the impact of home telemonitoring on health service use and quality of life in patients with severe chronic lung disease	N = 175 Intervention (n = 114) vs. control (n = 61) groups	Telecare Telehealth Telemonitoring Teleassistance	Phone call Telemetry/Data sending	No difference in the median number of days to the first admission Increased hospital admission rate, and home visits Improvement in depression rate No improvement in quality of life
Cordova et al., USA, 2016³⁰30 Cordova FC, Ciccolella D, Grabianowski C, Gaughan J, Brennan K, Goldstein F, et al. A Telemedicine-Based Intervention Reduces the Frequency and Severity of COPD Exacerbation Symptoms: A Randomized, Controlled Trial. Telemed J E Health. 2016;22(2):114-122. 10.1089/tmj.2015.0035 https://doi.org/10.1089/tmj.2015.0035...	Clinical trial	Nurse, pulmonologists	To investigate whether telemedicine-based daily symptom reporting plus optimal medical therapy decreases hospitalizations and COPD-related mortality, as well as the frequency and severity of acute COPD exacerbation symptoms, in high-risk patients	N = 67 Intervention (n = 34) vs. control (n = 33) groups	Telemedicine Telehomecare Teleassistance Telemonitoring	Phone call	Improvement in daily peak flow and dyspnea scores No differences in hospitalization and mortality rates
Fitzsimmons et al., Canada/UK 2016³¹31 Fitzsimmons DA, Thompson J, Bentley CL, Mountain GA. Comparison of patient perceptions of Telehealth-supported and specialist nursing interventions for early stage COPD: a qualitative study. BMC Health Serv Res. 2016;16(1):420. https://doi.org/10.1186/s12913-016-1623-z https://doi.org/10.1186/s12913-016-1623-...	Qualitative study	Nurse, physician	To explore qualitatively the experiences of patients with COPD who had received either a telehealth-supported or a specialist nursing intervention following hospital discharge after an admission for a COPD exacerbation	N = 29	Telehealth	Phone call Telemetry/Data sending	Reduction in home visits by clinicians
Ho et al., Taiwan, 2016³²32 Ho TW, Huang CT, Chiu HC, Ruan SY, Tsai YJ, Yu CJ, et al. Effectiveness of Telemonitoring in Patients with Chronic Obstructive Pulmonary Disease in Taiwan-A Randomized Controlled Trial. Sci Rep. 2016;6:23797.10.1038/srep23797 https://doi.org/10.1038/srep23797...	Clinical trial	Nurse, pulmonologists	To investigate the effectiveness of telemonitoring in improving COPD patient outcomes	N = 106 Intervention (n = 53) vs. control (n = 53) groups	Telehealth Telemonitoring	Phone call Telemetry/Data sending	Increase in the time to first re-hospitalization for COPD exacerbation Reduction in the number of all-cause readmissions and emergency room visits
Ritchie et al., USA, 2016³³33 Ritchie CS, Houston TK, Richman JS, Sobko HJ, Berner ES, Taylor BB, et al. The E-Coach technology-assisted care transition system: a pragmatic randomized trial. Transl Behav Med. 2016;6(3):428-437. 10.1007/s13142-016-0422-8 https://doi.org/10.1007/s13142-016-0422-...	Clinical trial	Nurse	To evaluate the impact of a technology-supported care transition support program on hospitalizations, days out of the community, and mortality	N = 478 Intervention vs. control groups^a	e-coach Telehealth Telemonitoring	Phone call Interactive voice response Telemetry/Data sending	No difference in re-hospitalizations Reduction in length of hospital stay
Vianello et al., Italy, 2016³⁴34 Vianello A, Fusello M, Gubian L, Rinaldo C, Dario C, Concas A, et al. Home telemonitoring for patients with acute exacerbation of chronic obstructive pulmonary disease: a randomized controlled trial. BMC Pulm Med. 2016;16(1):157. 10.1186/s12890-016-0321-2 https://doi.org/10.1186/s12890-016-0321-...	Clinical trial	Nurse, pulmonologist, and general practitioner	To investigate the benefits of a telemonitoring system in managing acute exacerbations in advanced-stage COPD patients to improve their HRQoL and to reduce utilization of healthcare services	N = 334 Intervention (n = 230) vs. control (n = 104) groups	Telehealth Telemonitoring	Phone call Telemetry/Data sending	No significant difference in hospitalizations Reduction in readmission rate for acute exacerbations of COPD or for any cause No significant differences in anxiety and depression No significant difference in HRQoL
Crooks et al., UK, 2017³⁵35 Crooks MG, den Brinker A, Hayman Y, Williamson JD, Innes A, Wright CE, et al. Continuous Cough Monitoring Using Ambient Sound Recording During Convalescence from a COPD Exacerbation. Lung. 2017;195(3):289-294. 10.1007/s00408-017-9996-2 https://doi.org/10.1007/s00408-017-9996-...	Observational study	Study team	To describe a novel monitoring system used to record cough continuously for up to 45 days during acutely exacerbated COPD convalescence	N = 16	Telemonitoring	Telemetry/Data sending	Improvement in early identification of exacerbations
Kargiannakis et al., UK, 2017³⁶36 Kargiannakis M, Fitzsimmons DA, Bentley CL, Mountain GA. Does Telehealth Monitoring Identify Exacerbations of Chronic Obstructive Pulmonary Disease and Reduce Hospitalisations? An Analysis of System Data. JMIR Med Inform. 2017;5(1):e8. 10.2196/medinform.6359 https://doi.org/10.2196/medinform.6359...	Clinical trial	Nurse, doctor	To undertake the first analysis of system data to determine whether telehealth monitoring can identify a COPD exacerbation, giving clinicians an opportunity to intervene with timely treatment and prevent hospital readmission	N = 23	Telehealth	Phone call Telemetry/Data sending	No significant reduction in the re-hospitalizations
Scalvini et al., Italy, 2018³⁷37 Scalvini S, Bernocchi P, Zanelli E, Comini L, Vitacca M; Maugeri Centre for Telehealth and Telecare (MCTT). Maugeri Centre for Telehealth and Telecare: A real-life integrated experience in chronic patients. J Telemed Telecare. 2018;24(7):500-507. 10.1177/1357633X17710827 https://doi.org/10.1177/1357633X17710827...	Observational study	Nurse- and physician-directed	To describe a personal experience at the Centre for Telehealth and Telecare in providing continuity of care for patients with a chronic illness	N = 1,635	Telecare Telehealth Telemedicine Telemonitoring e-health management	Video call Phone call Telemetry/Data sending	Reduction in re-hospitalization rate and costs Improvement in quality of life and patient satisfaction with the service
Barken et al., Norway, 2018³⁸38 Barken TL, Thygesen E, Söderhamn U. Unlocking the limitations: Living with chronic obstructive pulmonary disease and receiving care through telemedicine-A phenomenological study. J Clin Nurs. 2018;27(1-2):132-142. 10.1111/jocn.13857 https://doi.org/10.1111/jocn.13857...	Qualitative study	Nurse	To describe the lived experiences of quality of life among a group of patients living with COPD who had been included in a telemedical intervention after hospitalization for disease exacerbation	N = 10	Telehealth Telemedicine Telemonitoring	Video call Phone call Telemetry/Data sending	Increased accessibility to health care services and improvement in quality of life
Fors et al., Sweden, 2018³⁹39 Fors A, Blanck E, Ali L, Ekberg-Jansson A, Fu M, Lindström Kjellberg I, et al. Effects of a person-centred telephone-support in patients with chronic obstructive pulmonary disease and/or chronic heart failure - A randomized controlled trial. PLoS One. 2018;13(8):e0203031. 10.1371/journal.pone.0203031 https://doi.org/10.1371/journal.pone.020...	Clinical trial	Nurse	To evaluate the effects of person-centered support via telephone in two chronically ill patient groups: COPD and/or heart failure	N = 221 Intervention (n = 103) vs. control (n = 118) groups	Telehealth	Phone call	No significant difference in the composite score consisted of general self-efficacy, re-hospitalization, and death
Soriano et al., Spain, 2018⁴⁰40 Soriano JB, García-Río F, Vázquez-Espinosa E, Conforto JI, Hernando-Sanz A, López-Yepes L, et al. A multicentre, randomized controlled trial of telehealth for the management of COPD. Respir Med. 2018;144:74-81. 10.1016/j.rmed.2018.10.008 https://doi.org/10.1016/j.rmed.2018.10.0...	Clinical trial	Nurse	To clarify the impact of telehealth on outcomes and costs over a 12-month time frame, and in a large sample of COPD patients	N = 169 Intervention (n = 87) vs. control (n = 82) groups	Telehealth Telemonitoring	Phone call Telemetry/Data sending	No significant difference in COPD-related emergency room visits or hospitalizations
Walker et al., Spain, UK, Slovenia, Estonia, and Sweden, 2018⁴¹41 Walker PP, Pompilio PP, Zanaboni P, Bergmo TS, Prikk K, Malinovschi A, et al. elemonitoring in Chronic Obstructive Pulmonary Disease (CHROMED). A Randomized Clinical Trial. Am J Respir Crit Care Med. 2018;198(5):620-628. 10.1164/rccm.201712-2404OC https://doi.org/10.1164/rccm.201712-2404...	Clinical trial	Nurse	To evaluate the efficacy of home monitoring of lung mechanics by the forced oscillation technique and cardiac parameters in older patients with COPD and comorbidities	N = 312 Intervention vs. control groups^a	Telemonitoring	Phone call Telemetry/Data sending	No significant difference in quality of life and hospitalization rate Fewer re-hospitalizations
Bohingamu Mudiyanselage et al., Australia, 2018⁴²42 Bohingamu Mudiyanselage S, Stevens J, Watts JJ, Toscano J, Kotowicz MA, Steinfort CL, et al. Personalised telehealth intervention for chronic disease management: A pilot randomised controlled trial. J Telemed Telecare. 2019;25(6):343-352. 10.1177/1357633X18775850 https://doi.org/10.1177/1357633X18775850...	Clinical trial	Nurse, doctor	To assess the impact of home-based telehealth monitoring on health outcomes, quality of life, and costs over 12 months in patients with diabetes and/or COPD who were identified as being at high risk of hospital readmission	N = 171 Intervention (n = 86) vs. control (n = 85) groups	Telehealth Telemonitoring	Message Video call Phone call	No significant difference in the number of re-hospitalizations Reduction in length of hospital stay Improvement in anxiety, depression, and health literacy Improvement in quality of life at no additional costs
Lyth et al., Sweden, 2019⁴³43 Lyth J, Lind L, Persson HL, Wiréhn AB. Can a telemonitoring system lead to decreased hospitalization in elderly patients?. J Telemed Telecare. 2021;27(1):46-53. 10.1177/1357633X19858178 https://doi.org/10.1177/1357633X19858178...	Observational study	Nurse, doctor	To investigate the effects of the intervention on healthcare costs, number of hospitalizations, and other care required in patients with COPD and heart failure	N = 94 COPD patients (n = 36) and heart failure patients (n = 58)	Telehealth Telemonitoring	Message Telemetry/Data sending	Reduction in hospitalization costs, but total health care costs was not significantly different from the expected costs
Arcilla et al., USA, 2019⁴⁴44 Arcilla D, Levin D, Sperber M. Transitioning Patients to Independence. Home Healthc Now. 2019;37(3):158-164. 10.1097/NHH.0000000000000741 https://doi.org/10.1097/NHH.000000000000...	Clinical trial	Nurse	To prove that the implementation of transitional care interventions in high-risk patients with COPD, heart failure, or diabetes mellitus after hospital discharge can reduce the number of readmissions	N = 102 Intervention vs. control groups^a	Telehealth	Phone call Interactive voice Telemetry/Data sending	Reduction in the number of hospitalizations and 30-day re-hospitalization rates
Bentley et al., UK, 2020⁴⁵45 Bentley CL, Powell L, Potter S, Parker J, Mountain GA, Bartlett YK, et al. The Use of a Smartphone App and an Activity Tracker to Promote Physical Activity in the Management of Chronic Obstructive Pulmonary Disease: Randomized Controlled Feasibility Study. JMIR Mhealth Uhealth. 2020;8(6):e16203. 10.2196/16203 https://doi.org/10.2196/16203...	Randomized feasibility study	Physiotherapist	To determine the feasibility and acceptability of the SMART-COPD intervention for the self-management of physical activity and to explore the feasibility of conducting a future RCT to investigate its effectiveness	N = 63 Intervention (n = 31) vs. control (n = 31) groups	mHealth	Telemetry/Data sending	Feasibility of home monitoring (mHealth shows promise in helping people with COPD self-manage their physical activity levels)
Wang et al., China, 2020⁴⁶46 Wang L, Guo Y, Wang M, Zhao Y. A mobile health application to support self-management in patients with chronic obstructive pulmonary disease: a randomised controlled trial. Clin Rehabil. 2021;35(1):90-101. 10.1177/0269215520946931 https://doi.org/10.1177/0269215520946931...	Clinical trial	Nurse	To investigate the effects of a mobile health smartphone application to support self-management programs on quality of life, self-management behavior, exercising, and smoking cessation behavior in patients with COPD	N = 78 Intervention (n = 39) vs. control (n = 39) groups	Telehealth	Telemetry (Application smartphone)	Improvement in the quality of life and self-management behavior
Leonard et al, USA, 2020⁴⁷47 Leonard R, Forte M, Mehta D, Mujahid H, Stansbury R. The impact of a telemedicine intervention on home non-invasive ventilation in a rural population with advanced COPD. Clin Respir J. 2021;15(7):728-734. 10.1111/crj.13354 https://doi.org/10.1111/crj.13354...	Observational study	Respiratory therapist, pulmonary physician	To investigate the effect of home non-invasive ventilation plus the implementation of a call center following hospitalization for acute exacerbations	N = 20	Telemedicine	Phone call	No significant reduction in the re-hospitalizations Statistically significant difference to adherence to noninvasive ventilation
Marcos et al., Spain, 2020⁴⁸48 Marcos PJ, Represas Represas C, Ramos C, Cimadevila Álvarez B, Fernández Villar A, Fraga Liste A, et al. Impact of a Home Telehealth Program After a Hospitalized COPD Exacerbation: A Propensity Score Analysis. Arch Bronconeumol. 2022;58(6):474-481. 10.1016/j.arbres.2020.05.030 https://doi.org/10.1016/j.arbres.2020.05...	Observational study	Pulmonologist, nurse	To demonstrate if a telemonitoring system after hospital admission for a COPD exacerbation could have a favorable effect in 1-year readmissions and mortality in a real-world setting	N = 843 Intervention (n = 351) vs. control (n = 495) groups	Telehealth Telemedicine Telemonitoring Teleconsultation	Video call Telemetry/Data sending	Reduced mortality and readmission after 12 months
Kooij et al., Netherlands, 2021⁴⁹49 Kooij L, Vos PJE, Dijkstra A, van Harten WH. Effectiveness of a Mobile Health and Self-Management App for High-Risk Patients With Chronic Obstructive Pulmonary Disease in Daily Clinical Practice: Mixed Methods Evaluation Study. JMIR Mhealth Uhealth. 2021;9(2):e21977. 10.2196/21977 https://doi.org/10.2196/21977...	Feasibility study	Pulmonary nurse, pulmonologist	To evaluate the effects of a mobile health and self-management application in clinical practice for recently discharged patients with COPD	N = 39	mHealth	Video call Telemetry/Data sending	Knowledge and coping increased significantly over time No significant changes in recognition and management of symptoms, or adherence to treatment Readmission rate showed that 13% (5/39) of patients were readmitted within 30 days

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[1] Correspondence to: Valéria Maria Augusto. Rua Guianas, 56/201, Sion, CEP 30320-100, Belo Horizonte, MG, Brasil. Tel.: 55 31 3409-9746. E-mail: vmapneumo@gmail.com