Harnessing technology helps people with COPD self manage their condition

The need for better self management

Managing COPD costs the NHS more than £1bn each year. However, treatment is complex, with different inhalers needing to be used in different ways. Compliance with treatment is often extremely low, leading to poor outcomes and wasted prescribing. For this reason, improving self management for patients with COPD is a key priority for the NHS. It’s been estimated that the NHS could save £235m over the next 10 years if self management support is implemented correctly for this patient group.

‘NICE has developed national guidance which recommends people with COPD should be given an individualised and comprehensive self management plan, but until now there hasn’t been a national solution for the delivery of this. Instead individual trusts and CCGs are spending thousands developing their own solutions,’ explains Mal North, a COPD nurse specialist and Project Manager for HealthQuest Solutions.

HealthQuest were funded by the Health Foundation’s Shine 2012 programme to develop their idea for a national solution to COPD self management. The company was formed by COPD specialists who had all worked together on previous Shine projects at University Hospital Southampton. The team felt that setting up as a separate enterprise would free them up to develop their innovation faster as they wouldn’t be restricted by NHS IT systems.

Finding a suitable solution

HealthQuest began their project in 2012, developing a web-based system which patients can access at home, plus an innovative holdall bag to store inhalers and self management materials.

Patients can log in to the website and access personalised tools and information to help them manage their disease. This includes a self management plan advising them how they should manage their medication depending on their symptoms, and useful tools such as local five-day weather, pollen and pollution forecasting. It also contains educational materials and practical resources such as exercise programmes and anxiety management videos.

‘Traditionally self management comes on an A4 sheet of paper, but myCOPD is a living record, constantly updated and much more meaningful to people. Patients like that clinicians can monitor the site, and notifications can be sent to a next of kin or to health care teams to flag up if someone is feeling unwell,’ explains Mal.

Dramatic improvements in condition management

A group of 36 COPD patients were recruited to help test the system over a three month period. Each patient’s inhaler technique and symptom scores were evaluated before and after the testing phase.

The results were impressive. Patients’ symptoms scores (measured on a scale of 0-40 using the COPD Assessment Tool) improved significantly compared to controls, improving by a mean of 4 points, with some patients improving by up to 10. ‘This is a greater improvement than is generally achieved by most pharmaceutical interventions,’ says Mal.

Much of the improvement was down to patients learning to take their medication correctly. At the start of the project 98% of the test group demonstrated several critical errors when using their inhalers, however by the end of the project these patients had recognised these errors and had corrected them.  

‘The inhaler technique videos helped patients to identify what they were doing wrong, and providing the videos online made it easy for people to learn at their own pace and watch as many times as they needed to,’ Mal explains.

Feedback about the holdall bags has also been positive, with patients using them when admitted to hospital to transport their medication, reducing the need for extra prescribing.

Spreading the benefits

‘Seeing the impact myCOPD has had on patients has been great,’ says Mal. ‘It’s really helped people take control of their condition, and some have made amazing changes. They generally feel better and say they can do more.

‘It makes us very enthusiastic about scaling this work up so that we can see more people improving their condition the way these patients have.’

HealthQuest estimate that the myCOPD self management system can be provided to CCGs for under £20 per patient, less than the cost of a one month supply of most COPD inhalers.

The team now plan to test myCOPD on a larger scale and are hoping to partner with several CCGs and hospital trusts to help trial the solution more extensively. They are also continuing to develop the product, adding a new myCOPD dashboard where the patients’ daily symptoms and alerts can be made accessible to practice nurses, GPs and community providers, enabling remote monitoring.