P199 Sustained patient use and improved outcomes with a COPD digital service. (11th November 2022)

• Record Type: Journal Article
• Authors: Taylor, AJ; Cushing, A; Dow, M; Anderson, J; McDowell, G; Lua, S; Manthe, M; Padmanabhan, S; Burns, S; McGinness, P; Lowe, DJ; Carlin, C
• Is Part Of: Thorax. Volume 77(2022)Supplement 1
• Page Start: A188
• Page End: A188
• Publication Date: 2022-11-11
• Subjects: Chest -- Diseases -- Periodicals; Thorax; Chest -- Diseases; Periodicals; Periodicals; 617.54
• DOI: 10.1136/thorax-2022-BTSabstracts.333
• Languages: English
• ISSNs: 0040-6376

Abstract

Abstract : Background: Digital solutions offer the opportunity to improve accessibility and uptake of strategies that improve clinical outcomes for people with COPD. LenusCOPD has been co-designed to enable digital transformation of COPD services for proactive preventative care. A patient-facing progressive web application, clinician dashboard and support website integrates patient-reported outcomes (PROs), self-management resources, structured clinical summary, wearable and home NIV data with asynchronous patient-clinician messaging. We commenced the implementation-effectiveness observational cohort RECEIVER trial in September 2019 to explore the feasibility and utility of this application alongside routine care (NCT04240353 ). The primary endpoint was the sustained patient usage and secondary endpoints including admissions, mortality, exacerbations, service workload and quality of life. We paused recruitment in March 2021and provided LenusCOPD as routine care in the 'DYNAMIC-SCOT' COVID-19 response service scale-up. Methods: 83 RECEIVER trial participants and 142 DYNAMIC-SCOT participants had completed minimum 1 year follow-up when we censored data on 31st August 2021. We established a control cohort with 5 patients matched per RECEIVER participant from de-identified contemporary routine clinical data held with NHS Greater Glasgow & Clyde Safe Haven. Findings: Sustained patient app utilisation was noted in both cohorts, with an average of 3.5 PRO submissions per person per week. Median time to admission or death was 43 days in control, 338 days in RECEIVER and 400 days in the sub-cohort of DYNAMIC-SCOT participants who had had a respiratory-related admission in the preceding year ( figure 1 ). The 12-month risk of admission or death was 74% in control patients, 53% in RECEIVER and 47% in the DYNAMIC-SCOT sub-cohort participants. LenusCOPD service users had a greater reduction in annual admission and occupied bed day rates compared to control patients, with a median of 2.5 community-managed COPD exacerbations per patient per year and stable quality of life scores during follow up. Patient-clinician messaging workload was manageable. Interpretation: A high proportion of people continued to use the co-designed LenusCOPD application during extended follow-up. Outcome data supports scale-up of this digital service transformation. Qualitative evaluations into participant's perceived benefits of the app are ongoing, along with formation of risk prediction models using AI-based algorithms. Please refer to page A215 for declarations of interest related to this abstract.