Home telemonitoring of non-invasive ventilation decreases healthcare utilisation in a prospective controlled trial of patients with amyotrophic lateral sclerosis
- Anabela Pinto1,2,
- José Pedro Almeida1,2,
- Susana Pinto2,
- João Pereira3,
- António Gouveia Oliveira4,
- Mamede de Carvalho2,5
- 1Department of Physical Medicine and Rehabilitation, Santa Maria Hospital, Lisbon, Portugal
- 2Neuromuscular Unit, Instituto de Medicina Molecular, Faculty of Medicine, Lisbon, Portugal
- 3Linde Homecare Co, Lisbon, Portugal
- 4Department of Biostatistics, Faculty of Medical Sciences, Universidade Nova de Lisboa, Portugal
- 5Department of Neurosciences, Santa Maria Hospital, Lisbon, Portugal
- Correspondence to Professor A Pinto, Clínica Universitária de Medicina Física e de Reabilitação, Hospital de Santa Maria, Av Professor Egas Moniz, 1649-028 Lisboa, Portugal;
Contributors AP was responsible for the study design, follow-up of the patients (respiratory care and equipments) and supervised data collection, analysis and manuscript preparation. JPA collaborated substantially on data collection, analysis and in the preparation of the manuscript. JP was responsible for the intermediate level of respiratory care, as well as detecting and flagging the alarm signs previously accorded. SP collaborated in the follow-up of patients (neurological care) and was involved in manuscript preparation. AGO was responsible for the statistical procedures, analysis and review, and also provided an important contribution to manuscript preparation. MdC collaborated by obtaining local ethics committee approval, patient informed consent, advising and helping in all phases of the project, including manuscript preparation, and was responsible for the follow-up of patients (neurological care).
- Received 28 January 2010
- Revised 26 April 2010
- Accepted 22 May 2010
- Published Online First 8 September 2010
Background Non-invasive ventilation (NIV) is an efficient method for treating respiratory failure in patients with amyotrophic lateral sclerosis (ALS). However, it requires a process of adaptation not always achieved due to poor compliance. The role of telemonitoring of NIV is not yet established.
Objectives To test the advantage of using modem communication in NIV of ALS patients.
Design Prospective, single blinded controlled trial.
Population and methods According to their residence, 40 consecutive ventilated ALS patients were assigned to one of two groups: a control group (G1, n=20) in which compliance and ventilator parameter settings were assessed during office visits; or an intervention group (G2, n=20) in which patients received a modem device connected to the ventilator. The number of office and emergency room visits and hospital admissions during the entire span of NIV use and the number of parameter setting changes to achieve full compliance were the primary outcome measurements.
Results Demographic and clinical features were similar between the two groups at admission. No difference in compliance was found between the groups. The incidence of changes in parameter settings throughout the survival period with NIV was lower in G2 (p<0.0001) but it was increased during the initial period needed to achieve full compliance. The number of office or emergency room visits and inhospital admissions was significantly lower in G2 (p<0.0001). Survival showed a trend favouring G2 (p=0.13).
Conclusions This study shows that telemonitoring reduces health care utilisation with probable favourable implications on costs, survival and functional status.
Linked articles 212720.
Funding This work was supported by ‘Fundação para a Ciência e Tecnologia’—PIC/IC/82765/2007.
Competing interests None.
Ethics approval The study was approved by the local ethics committee.
Provenance and peer review Not commissioned; externally peer reviewed.