A real-world service evaluation of myCOPD

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A real-world service evaluation of myCOPD

Results of a supported self-management evaluation of COPD patients by Stonehaven Medical Group and Aberdeenshire Health & Social Care Partnership (NHS Grampian).

Kris McLaughlin, Erika Skinner

Stonehaven Medical Group and Aberdeenshire Health & Social Care Partnership designed this test of change evaluation to explore the impact of myCOPD on patient self-management, exacerbations frequency, unscheduled general practice (GP) consultations and hospital admissions.

Chronic Obstructive Pulmonary Disease (COPD) is a common and serious disease of the lungs. Many people in the UK suffer with the disease and it is a leading cause of hospital admissions. Preventing COPD exacerbations and promoting overall wellbeing can be achieved through supportive self-management of disease. However, successful self-management is dependent on the knowledge and skills provided to patients to give them the confidence to make the right decisions about their treatments, use of healthcare services and lifestyle choices. Digital tools can be a useful resource to support patient self-management. The myCOPD app provides structured education, pulmonary rehabilitation, inhaler videos to promote good inhaler technique as well as supportive self-management tools.

This test of change evaluation was conducted in primary care in 2019. At 5 months data was collected to review any outcomes since myCOPD was introduced. Overall, 64 patients agreed to take part with 43 agreeing to an early review. Of these 43, 23 (53.4%) patients who had been given access to myCOPD attended the interim review.

The evaluation involved measuring CAT score, inhaler technique including rescue inhaler usage, healthcare usage and hospital admissions, and patient feedback.

Results identified 4 key outcomes:

     1. An overall improvement in mean CAT score of -2.1 since the start of the study
     2. A mean reduction in rescue inhaler use was observed from 3.17 to 2.13, demonstrating an improvement in symptom control. There was              also an overall improvement in inhaler technique, where good inhaler technique practices increased from 48 to 91%
     3. There was a reduction observed in healthcare usage when comparing patient data prior to myCOPD. Overall, there were 20 (19%) less                unscheduled GP appointments (reduction range of 105 to 85), and hospital admissions dropped from 6 to 0 during this time
     4. Patient feedback showed that the proportion of patients who described their ability to manage exacerbations very well rose from 29 to              55%, and those who felt confident using an inhaler rose from 76 to 90%

This real-world evaluation of myCOPD provides valuable insights into the benefits of using digital health to support self-management. Recent studies have shown that myCOPD can provide patients with an alternative, or adjunct, to their COPD healthcare management. These results reinforce the evidence base from our formal RCTs (EARLY and RESCUE) which showed that using myCOPD improved inhaler technique, reduced CAT score, exacerbations and hospital admissions.

Based on these results, Stonehaven Medical Group, NHS Grampian’s Respiratory Managed Clinical Network canvassed for widespread adoption of myCOPD. This is to be commissioned by the Operation Home First Steering Group who have approved funding to enable rapid deployment of myCOPD during winter 2020/21.
By July 2024 07 Aug, 2024
NHS University College London Hospitals NHS Foundation Trust, part of North Central London ICB, is taking a significant step towards enhancing patient empowerment and optimising disease management. Asthma is a chronic condition that affects millions of people worldwide, often leading to severe health complications if not managed properly. Recognising the critical need for effective self-management tools, NHS University College London Hospitals NHS Foundation Trust has chosen the myAsthma app to provide patients with the resources they need to take control of their health. Dr Kay Roy PhD FRCP, Consultant Respiratory Physician University College London Hospitals NHS Foundation Trust, comments “We are thrilled to introduce myAsthma as a self-management tool to our community. It represents a significant step forward in empowering our patients with asthma to take control of their health. By providing them with personalised support, we believe this tool will greatly improve their quality of life. Additionally, the use of myAsthma in outpatient settings will help triage patients more effectively, ensuring they are seen in a timely manner and appropriately referred for the right investigations and services. Our team is excited to see the positive impact this will have on the asthma population across North Central London ICB." The myAsthma app, part of the my mhealth suite of digital health solutions, is designed to empower patients with comprehensive tools and information to manage their asthma more effectively. Key features include: • Personalised Action Plans: Tailored asthma management plans based on individual patient needs. • Inhaler technique training: Contributing to better health outcomes and reduced risk of exacerbations • Medication Tracking: Reminders and logs to ensure patients take their medication as prescribed. • Symptom tracking: Easy-to-use tools for tracking symptoms and triggers. • Educational Resources: Access to a wealth of information on asthma, helping patients understand their condition and how to manage it. As more NHS partners embrace the my mhealth platform, we're thrilled to witness its growing impact and the positive changes it is bringing to long-term condition care. For more information on this article or other my mhealth projects, please get in touch https://mymhealth.com/contact-us
By The my mhealth data library is an extensive resource designed to support healthcare providers by offering a wealth of information and tools related to COPD and long-term health conditions. 07 Aug, 2024
The my mhealth data library is an extensive resource designed to support healthcare providers by offering a wealth of information and tools related to COPD and long-term health conditions.
By 2nd July 2024 07 Aug, 2024
Permission to use received from Rebecca Fowler View poster
By 5th October 2023 07 Aug, 2024
Charlotte Smith 1 Francesca D’angelo 2 University Hospital of Derby and Burton, Cardiac Rehabilitation Department, Burton Upon Trent, UK. University Hospital of Derby and Burton, Health and Wellbeing Department, Burton, UK To examine the effectiveness of physical activity outcomes using a web-based Cardiac Rehabilitation application compared with a conventional programme or a combination of both. University Hospitals of Derby and Burton NHS Foundation Trust poster presented at the BACPR Annual Conference October 5-6th 2023 Permission to use received from Charlotte Smith
By 5th October 2023 07 Aug, 2024
Francesca D’angelo 1 Charlotte Smith 2 University Hospital of Derby and Burton, Health and Wellbeing Department, Burton, UK University Hospital of Derby and Burton, Cardiac Rehabilitation Department, Burton Upon Trent, UK. To examine the effectiveness of psychological outcomes using a web-based Cardiac Rehabilitation application compared with a conventional programme or a combination of both. University Hospitals of Derby and Burton NHS Foundation Trust poster presented at the BACPR Annual Conference October 5-6th 2023 Poster presented at the BACPR Annual Conference October 5-6th 2023 Permission to use received from Charlotte Smith
By 12 March 2024 07 Aug, 2024
Christopher Duckworth 1 Bethany Cliffe 2. Brian Pickering 1 Ben Ainsworth 2 Alison Blythin 3 Adam Kirk 3 Adam Kirk Thomas M. A. Wilkinson 3,4,5 Michael J. Boniface 1 1 IT Innovation Centre, Digital Health and Biomedical Engineering, University of Southampton, Southampton, UK. 2. School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK my mHealth Limited, London, UK. National Institute for Health Research Applied Research Collaboration Wessex, University of Southampton , Southampton , GB Faculty of Medicine, University of Southampton, Southampton , GB Mobile Health (mHealth) has the potential to be transformative in the management of chronic conditions. Machine learning can leverage self-reported data collected with apps to predict periods of increased health risk, alert users, and signpost interventions. Despite this, mHealth must balance the treatment burden of frequent self-reporting and predictive performance and safety. Here we report how user engagement with a widely used and clinically validated mHealth app, myCOPD (designed for the self-management of Chronic Obstructive Pulmonary Disease), directly impacts the performance of a machine learning model predicting an acute worsening of condition (i.e., exacerbations). We classify how users typically engage with myCOPD, finding that 60.3% of users engage frequently, however, less frequent users can show transitional engagement (18.4%), becoming more engaged immediately ( < 21 days) before exacerbating. Machine learning performed better for users who engaged the most, however, this performance decrease can be mostly offset for less frequent users who engage more near exacerbation. We conduct interviews and focus groups with myCOPD users, highlighting digital diaries and disease acuity as key factors for engagement. Users of mHealth can feel overburdened when self-reporting data necessary for predictive modelling and confidence of recognising exacerbations is a significant barrier to accurate self-reported data. We demonstrate that users of mHealth should be encouraged to engage when they notice changes to their condition (rather than clinically defined symptoms) to achieve data that is still predictive for machine learning, while reducing the likelihood of disengagement through desensitisation. Read more
By 24th October 2023 07 Aug, 2024
Christopher Duckworth 1 Michael J Boniface 1 Adam Kirk 2 Thomas M A Wilkinson 2 3 4 IT Innovation Centre, Digital Health and Biomedical Engineering, University of Southampton, Southampton, UK. my mHealth Limited, London, UK. National Institute for Health Research Applied Research Collaboration Wessex, University of Southampton , Southampton , GB Faculty of Medicine, University of Southampton, Southampton , GB Introduction: The GOLD (Global Initiative for Chronic Obstructive Lung Disease) 2023 guidelines proposed important changes to the stratification of disease severity using the "ABCD" assessment tool. The highest risk groups "C" and "D" were combined into a single category "E" based on exacerbation history, no longer considering symptomology. Purpose: We quantify the differential disease progression of individuals initially stratified by the GOLD 2022 "ABCD" scheme to evaluate these proposed changes. Patients and methods: We utilise data collected from 1529 users of the myCOPD mobile app, a widely used and clinically validated app supporting people living with COPD in the UK. For patients in each GOLD group, we quantify symptoms using COPD Assessment Tests (CAT) and rate of exacerbation over a 12-month period post classification. Results: CAT scores for users initially classified into GOLD C and GOLD D remain significantly different after 12 months (Kolmogorov-Smirnov statistic = 0.59, P = 8.2 × 10-23). Users initially classified into GOLD C demonstrate a significantly lower exacerbation rate over the 12 months post classification than those initially in GOLD D (Kolmogorov-Smirnov statistic = 0.26; P = 3.1 × 10-2; all exacerbations). Further, those initially classified as GOLD B have higher CAT scores and exacerbation rates than GOLD C in the following 12 months. Conclusion: CAT scores remain important for stratifying disease progression both in-terms of symptomology and future exacerbation risk. Based on this evidence, the merger of GOLD C and GOLD D should be reconsidered. Read more
By 15 May 2023 07 Aug, 2024
Alison M. Blythin 1 Jack Elkes 2 Ronie Walter 3 Amber Bhogal 1 Ian Thompson Thomas van Lindholm 1 Matt Smith 1 Trish Gorely 3 Tom M.A. Wilkinson 1,5 Stephen J. Leslie 3,4 and Adam Kirk 1 my mhealth Limited, London, UK Imperial College London Clinical Trials Unit, London, UK University of the Highlands and Islands, SCOTLAND NHS Highlands Cardiology Department, SCOTLAND University of Southampton Faculty of Medicine, UK COVID-19 significantly impacted cardiac rehabilitation (CR) delivery. Service disruption left numerous patients without treatment access. Many healthcare teams made use of digital apps to support CR delivery and patients remotely. This evaluation aimed to analyse digital CR access from the myHeart interactive, cloud-based self-management app during the pandemic. Five NHS secondary care CR services agreed to combine existing anonymised app data between Mar-Oct 2020 for 12-weeks to align as much as possible with traditional CR models. No statistically significant differences were observed across age groups or gender between users who activated myHeart and those who did not. N=314/350 (89.7%) users accessed 5,469 CR videos with N=313/314 (99.7%) accessing 3,606 within the first 6-weeks of activation. No statistically significant differences were observed across gender or age group for education video views. Users with angina only diagnosis accessed more exercise videos than those with other reported diagnoses. Patient user feedback responses showed a statistically significant increase in self-management confidence following myHeart access. myHeart provided remote timely CR during service disruption. This evaluation is the beginning of a journey to understand app usage however further research is needed to fully understand the role digital health can play in the delivery of CR.f your post goes he re. To edit this text, click on it and delete this default text and start typing your own or paste your own from a different source. Read more.
By 11 March 2023 07 Aug, 2024
A.M. Blythin 1, J. Elkes 2 T. van Lindholm 1 A. Bhogal 1 T.M.A. Wilkinson 1 C. Saville 3 A. Kirk 1 Department of Research & Innovation, my mhealth Limited, Bournemouth, UK. School of Public Health, Imperial College Clinical Trials Unit, London, UK. Faculty of Medicine, University of Southampton, Southampton, Hampshire, UK Digital health interventions provide a potential solution to improve diabetes education delivery at population scale, overcoming barriers identified with traditional approaches. This evaluation analysed usage data for people with type 2 diabetes focusing on digital structured diabetes education. Results showed a positive uptake and usage with myDiabetes, with increases in app activity post-COVID. No statistically significant differences were observed between gender or age for those activated. No statistically significant differences observed in education video views across age groups, gender, diabetes treatment type or smoking status. The findings support the use of digital health in the provision of additional support for the delivery of diabetes education. There is potential for increasing diabetes education rates by offering patients a digital option in combination with traditional service delivery which should be substantiated through future research. Read more
By 7 March 2022 07 Aug, 2024
Published in Nature on 7 March 2022 A. Geirhos 1 M. Stephan 2 M. Wehrle 3 et al Sci Rep 12, 3639 (2022). Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Faculty of Engineering, Computer Science and Psychology, Ulm University, Ulm, Germany Department of Rehabilitation Psychology and Psychotherapy, Albert-Ludwigs University Freiburg, Freiburg, Germany Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Faculty of Engineering, Computer Science and Psychology, Ulm University, Ulm, Germany Mobile health applications (MHA) have been found to be a promising technological approach to support self-management. A German study has revealed results from an evaluation of diabetes self-management mobile health applications. The Mobile App Rating Scale (MARS), rated on a 5-point scale, was used for analysis. 120 mobile health apps from the European Google Play Store and the Apple App store were included. Results identified myDiabetes as highest of all 120 evaluated mobile health apps, according to: Quality Concordance with recommended self-management tasks Implementation of persuasive system design principle myDiabetes overall MARS Score = 4.62 Permission to use received from Dr L. B. Sander Read more on Nature
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