Increasing COPD Care with Telehealth

Telehealth services can increase rural residents' access to COPD care when they otherwise would experience barriers to accessing specialty respiratory care due to distance. Patients can review and improve many self-management practices with their primary care provider or a respiratory therapist via telehealth. For example, patients can accomplish the following through video appointments:

• Discuss their self-management plan with their provider
• Review how to accurately use an inhaler, practice, and receive feedback on proper use
• Upon presentation of a COPD exacerbation, describe their symptoms to a provider to determine whether they should go to the emergency department or if they can manage it themselves, such as by taking emergency antibiotics
• Engage in a follow-up visit with a patient navigator

Digital connectivity has increased treatment options for patients in hard-to-reach areas. For example, online programs can facilitate participation by rural residents. A study of an internet-based walking program for patients with COPD suggests that remote options can help recruit hard-to-reach residents, such as those living in rural or remote areas.

Telehealth can also be used to advance patient education. The University of Virginia is developing a series of educational videos on a variety of topics about COPD management that patients can access through a low-bandwidth platform. Local providers will determine the video topics to respond to local needs; education may focus on smoking cessation, pulmonary rehabilitation, and comorbidities like lung cancer and sleep apnea. This telehealth program allows patients to learn about different components of their diagnosis regardless of their distance from a specialty care provider.

Telehealth reimbursement is currently limited in comparison to services provided in person and varies by state and type of insurance, but there are increased efforts to expand reimbursement policies and increase access to telehealth services. In May 2019, the Better Respiration through Expanded Access to Tele-Health (BREATHE) Act was introduced to the U.S. Congress. This bill would allow respiratory therapists to deliver care management services via telehealth to select Medicare beneficiaries with COPD.

It is important to note that not all rural residents may have the technological capacity to take advantage of telehealth services. In addition, some components of COPD treatment inherently require in-person visits, like lung function measurement or physical pulmonary rehabilitation activities. Nonetheless, telehealth is a promising approach for certain components of COPD treatment that warrants further exploration.

For more information, please see RHIhub's Rural Telehealth Toolkit and Telehealth and Health Information Technology in Rural Healthcare topic guide.

Resources to Learn More

How Telemedicine is Transforming Treatment in Rural Communities
Document
Discusses the role of telemedicine and in-home monitoring of patients with chronic conditions such as COPD to increase contact with their care team and avoid hospitalizations.
Author(s): Ripton, J.T. & Winkler, S.
Date: 4/2016

Using Video Telehealth to Facilitate Inhaler Training in Rural Patients with Obstructive Lung Disease
Document
A study of telehealth inhaler training sessions for rural patients comparing techniques and reporting patient satisfaction.
Author(s): Locke, E., Thomas, R., Woo, D., Nguyen, E., Tamanaha, B., Press, V., Reiber, G., Kaboli, P., & Fan, V.
Citation: Telemedicine and e-Health, 25(3)
Date: 3/2019