Reduced use of healthcare services and increased social activities in COPD patients offered a telehealth service based on the Epital Care Model: “A pragmatic step-wedge controlled trial” (Preprint)

Abstract

Many healthcare systems confront considerable strain attributable to an escalating prevalence of older adults living longer leading to an increased number of people with chronic conditions. Concomitantly the numbers of trained professionals in the healthcare workforce is not keeping up with the increased numbers of people with chronic conditions. In this context, increased digitalization is considered one way to mitigate many of the challenges, but it remains to be documented whether this is of benefit to COPD patients. The Epital Care Model (ECM) constitutes a proactive and data-centric treatment paradigm that leverages patient-reported outcome data and 24/7 telehealth service to facilitate early detection of deteriorating conditions among patients with chronic diseases (1). This approach aims to reduce and address exacerbations early, thereby averting the need for extensive and resource-intensive interventions. It is noteworthy that the Epital frontline service is delivered by trained and certified staff consisting of students from health educations and not by health care professionals.

This clinical controlled trial was conducted to investigate the impact of the virtual component of the ECM framework in COPD on healthcare resource utilization and participants mental wellbeing and social activities.

A pragmatic step-wedged design was employed, involving the random allocation of 184 patients into either an intervention group (n=92) or a control group (n=92), with equitable distribution across four general practice clinics in Denmark. Participants were examined at an 8-month (T1) follow-up and 12-month (T2) follow-up. Healthcare service utilisation and participants’ social activity were assessed and compared using Poisson regression. Mental wellbeing was assessed by comparing the scores on the WHO-5 wellbeing index using an unpaired t-test.

A significant reduction of healthcare utilization associated with COPD was found in the intervention group at T2, with reduced hospital admissions (56%), general practitioner visits (78%), on-call doctor consultations (73%), emergency room visits (49% reduction), and outpatient attendances (60% reduction) compared to the control group. Further, there was a significant increase in social activities (p< 0.01) and travel activities abroad (p< 0.01) at T2 in the intervention group, but no difference was found in well-being (WHO-5 index) between the two groups

The study highlights the value of the ECM virtual care model in COPD management, offering a potential solution to healthcare workforce shortages and resource constraints as it leads to both a significantly reduced use of healthcare services and at the same time introduces a new kind of workforce to complement the existing workforce. Further research using this model in other chronic conditions and other healthcare systems is warranted based on these findings.

No trial registration has been performed. The protocol is available from: https://epital.com/temokap-protokol-2/