Robot Shows Potential for Reducing COPD Readmission Rates

FEBRUARY 28, 2018
Chronic Obstructive Pulmonary Disease (COPD) is a concerning condition for most medical systems. Yes, patient treatment and chronic management are pertinent, but the cost is one area that quickly gets heads turning in business meetings. The fact remains that COPD is a cause of a large number of readmissions that hospitals look to reduce. For some hospitals, this comes down to trying to have patients followup in outpatient clinics quicker or more routinely to identify those that may not be treated well, and others are concentrating on better care coordination and patient education. At the end of the day, medication management therapy is what it all boils down to, and if the patient doesn't take the right meds at the right time, the likelihood of recurrent readmission is on the horizon.
 
Looking outside of the box of standard medical care, a recent pilot study with 60 patients was conducted in New Zealand, looking at a digital health intervention as a tool for those recently discharged to decrease readmission rates.1 The intervention focused on a robot telemedicine service, which is somewhat interesting in several regards.

The iRobi robot (created by Yujin Robot Limited, Korea) has been used in other healthcare settings, but this was the first time for a post-discharge disease management case. The robot was programmed to monitor vitals and metrics associated with COPD (pulse oximetry, heart rate, forced expiration volume, etc.), remind patients to take their medications per their regimen, to perform daily rehabilitation exercises (which the robot would show them via video), provide health education with a focus on COPD, allow them to alert providers if they weren't feeling well, and give metrics on how well they were doing. In many ways it is like many apps on a tablet computer or smartphone. So why the robot? 
 
Well, the issue plaguing digital health and in general technical interventions is behavior change. Adherence to using these devices has been demonstrated as lacking. So, with a robot, the thought is that it is a bit more personalization, having such a unit in the patient home, and would help patients identify more with using it.

So far, the research has shown some promising results. Almost 75% of the subjects in the intervention arm were positive about the robot helping them with medication adherence, education, and companionship, while the remainder didn't like it and wanted it out of their home. Still, 75% is something to work with, and we can always see what facets the 25% had that led them not to like it and to avoid such patients in the future or amend services to help increase utilization.
 
That aside, the clinical outcome is key to whether pursuing this is worth it. Overall, there were no differences in readmission rates between the intervention group using the robot (n=25) versus standard of care. The one positive noted was a higher medication adherence rate for those with the robot and increased rehabilitation exercise.

In one sense, this pilot demonstrates it may help with getting patients to change behavior as wanted by clinicians, but that did not necessarily pan out to lower readmission rates. It could be the trial design, sample, and population at fault here, or just chance. But as a pilot, I am sure others may find some positives here worth further exploration.
 
Reference
  1. Broadbent E, Garrett J, Jepsen N, et al. Using Robots at Home to Support Patients With Chronic Obstructive Pulmonary Disease: Pilot Randomized Controlled Trial. J Med Internet Res 2018;20(2):e45


Timothy Aungst, PharmD
Timothy Dy Aungst, PharmD, is an assistant professor of pharmacy practice at MCPHS University. He graduated from Wilkes University Nesbitt School of Pharmacy and completed a PGY-1 Pharmacy Practice Residency at St. Luke's University Hospital, and then a Clinical Geriatric Fellowship at MCPHS University. He is passionate about the rise of technology in health care and its application to pharmacy. He has published primarily on the role of mobile technology and mHealth, and made multiple national and international presentations on those topics. He blogs at TheDigitalApothecary.com, and you can find him on Twitter @TDAungst.
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