COPD
TELEHEALTH/CARE
PROJECT
Project Objectives:
1. Electronic COPD Patient Record to
track & record information across the
integrated pathway
2. Interactive Voice Response (IVR)
System to provide early indication of
COPD exacerbation
3. Develop the role of Care Managers to
provide early intervention of a COPD
exacerbation
4. Promote Supported Self-care
Patient Eligibility:
• FEV1 < 50% &/or MRC ≥ 3
• Patients with previous hospital
admission due to COPD (&/or)
• Patient with > 2 exacerbations
requiring prednisolone in the last 12
months
UPDATE REPORT AS OF 22ND SEPT 2009
DOUGLAS
MOTHERWELL (1)
MOTHERWELL (2)
LARKHALL
(joined 15/09/08)
(joined 27/10/08)
(joined 24/11/08)
(joined 05/03/09)
Total no. of patients
7
7
17
6
Total no. of patients
withdrawn
3
3
0
2
Total no. of alerts
43
62
122
39
Outcomes
DN Phone Call
34
49
110
29
Mistake
5
1
0
1
Increased Inhaler
2
0
19
0
Antibiotic
11
7
14
4
Steroids
2
7
9
3
District Nurse visit
3
3
0
6
Referred for GP
appointment
6
1
7
0
GP Home Visit
1
1
4
0
Hospital Admission
1
5 (same person)
2 (same person)
2
Initial Outcomes:
1.
2.
3.
4.
Electronic COPD Patient Record

System integration still barrier
Interactive Voice Response (IVR) System

Working well

Patient responding to system

Supporting self-care
Develop the role of Care Managers

Training achieved

Increased knowledge & skills

Increased disease management

Increased confidence
Promote Supported Self-care

Patients initiating self-care

Early initiation of medications

Increased self-management & control

Reduction in admissions
Questions?