eVita COPD; Patient Centered Care through eHealth Solutions

The number of patients in need of COPD management is increasing.
Self-management may help to provide accessible health care but costs are high
due to ineffective health care processes. Evidence based improvements of
efficiency and quality in health care processes and in clinical outcomes have
been reported for online automated monitoring systems (patient portals).
However, sustainable realization in daily practice stays behind. Insights in
optimal implementation methods in large real-life primary care populations are
needed for successful integration in practice.

The main aim is to investigate clinical effects of different implementation
methods of online supported self-management for COPD patients in primary care.
Secondary objectives include effects on well-being, health care use and actual
use of the portal. Differences in users* satisfaction will be investigated as
tertiary goals. Patient characteristics will be investigated as determinants
for actual use of the portal.

This study encludes a parallel cohort design. The clinical effects will be
measured according to interrupted time series (ITS) design.

Participants who wish to start with self-management will be supported with an
online platform for group A and B, called eVita COPD patient platform. This
platform enables patients to manage their own health and disease. The COPD
platform is integrated in a patient platform (eVita platform) for chronic
diseases (diabetes, heart failure and COPD) that is developed by health care
professionals, ICT professionals and (COPD) patients. Patients in group A and B
will be randomly divided in 2 subgroups after inclusion. Patients in subgroup
A1 and B1 will be individually supported to use the online patient portal by an
account manager in face-to-face (A1) or telephone contacts (B1). Subgroups A2
and B2 will not receive additional support from an account manager. For COPD
patients in group C a more simple portal will be provided by Saltro Diagnostic
Centre, with basic information of COPD and individualized test results.

General Practitioners in the three primary care cooperations that will
parcticipate in this study provide COPD care since many decades. The care
programs are grounded on evidence based national guidelines and have received
objective quality labels. Professionals of the primary care cooperations are in
control of the safety of all patients on daily base: deviations in CCQ,
medication or other determinants are automatically and daily sent to the
professionals to guarantee safety of all patients. Comparable self-management
programs are broadly accepted and being used by other professionals without
report of adverse events, despite lack of evidence based support.

For research goals, patients are asked to fill in questionnaires every three
months during a period of 15 months. The questionnaires will be provided online
and take between 10-20 minutes to complete. After replying the first and last
set of questionnaires, participants will receive gift cards (¤30 in total) as a
reward. This study is important as current care processes can be improved in
favor of patients by its results.

Patients who do not wish to start with self-management continue to receive
regular care. Participants are free to withdraw from the study any moment
without specification of reasons. This will not affect continuity of care.
Furthermore, professionals within the cooperations can decide to withdraw
subjects from the study for urgent medical reasons.