Patients' and Health Care Professionals' Perspectives on Remote Patient Monitoring in Chronic Obstructive Pulmonary Disease Exacerbation Management: Initiating Cocreation.

Abstract

Background: Chronic obstructive pulmonary disease (COPD) exacerbations cause physiological and psychological distress, affecting overall health and quality of life. Early diagnosis of exacerbations is crucial for preserving lung function, preventing hospitalizations, and reducing health care costs. While remote patient monitoring (RPM) offers the potential for early exacerbation detection, challenges remain in recognizing symptoms in a timely manner. A noninvasive breath analysis device is under development to monitor patients with COPD and detect exacerbations before symptoms arise by measuring breath biomarkers through volatile organic compounds. This study encompassed the initial cocreation phase to align the use of the breath analysis device and corresponding care process with current COPD exacerbation management and user needs.

Objective: We aimed to explore perspectives on COPD care processes, exacerbation management, and RPM in the Netherlands through 3 objectives: (1) identify stakeholders in COPD exacerbation care, (2) understand existing COPD care, and (3) explore stakeholder experiences and expectations regarding RPM in COPD care.

Methods: Following the Center for eHealth Research and Disease Management Roadmap, 4 research activities were conducted between March 2024 and September 2024 for the initial cocreation phase: (1) desk research, (2) interviews, (3) project group meeting, and 4) coanalysis focus group. Desk research involved reviewing literature and COPD (exacerbation) care guidelines. Semistructured interviews (N=34) were conducted with 18 patients, 14 health care professionals (HCPs), 1 caregiver, and 1 hospital policy adviser. Topics included COPD diagnosis, exacerbation management, stakeholder roles in COPD care, and RPM experiences or expectations. The project group meeting between interviews and the focus group verified interim findings and guided the focus group content. In total, 6 patients participated in a coanalysis focus group to review interview quotes on exacerbations and RPM. The framework method was used to analyze the interviews and the focus group through abductive coding.

Results: Seven key stakeholders were identified in COPD care, patients, pulmonologists, general practitioners, nurse practitioners, nurse specialists, physiotherapists, and informal caregivers. We observed a lack of uniformity in COPD care, exacerbation management, and information provision across HCPs. Patients reported struggling to recognize exacerbations. Although patients with experience in RPM reported positive experiences, they questioned the added value in early detection of exacerbations. Those without RPM experience were receptive to its use for symptom tracking but were concerned about reduced in-person care and overreliance on data. HCPs reported seeing value in RPM for between-visit monitoring and efficiently allocating resources but stressed the need for clear guidelines and noted barriers, such as language proficiency and technology usability.

Conclusions: This study highlights the opportunities to improve COPD care and optimize exacerbation management with RPM. Future research should refine RPM processes, balance objective data with patient-reported symptoms, enhance communication among HCPs and with patients, provide clear exacerbation management guidelines, and ensure inclusivity.