Authors (including presenting author) :
Lam WTR (1), TSUI TS (1), LAU WLC (1), CHAN YL (1)
Affiliation :
(1) Occupational Therapy Department, Kowloon Hospital
Introduction :
Tele care to support our patients had been increasingly essential during the COVID-19 pandemic situations. There are about 300 patients with various medical diseases discharged from the hospitals in Kowloon Central Cluster (KCC) and recruited to occupational therapist (OT) care in the community under integrated care and discharge support (ICDS) program yearly. More than 30% of ICDS patients referred to OT were suffered from chronic lung disease and some of them required home oxygen therapy devices support. However, some patients may suffer from over / under dose of oxygen therapy due to change of symptoms and some non-oxygen user may encounter a problem of desaturation after discharge.
This project aims at using remote monitoring device for patients with respiratory disease to monitor their SpO2 level in daily livings and provide further intervention according to their performance
Objectives :
Through the remote monitoring device, we aimed at:
1. Providing prompt intervention to patients by early detection of symptoms, such as exertional or nocturnal desaturation
2. Facilitating prescribed O2 compliance monitoring and providing more fine adjustment of O2 regime
3. Facilitate OT to train patients on pacing, activity scheduling and healthy lifestyle by tailor made to their real-life situation
Methodology :
Data collection period was from February 2022 to January 2023.
Case selection criteria includes: 1) Cases under management by occupational therapist in KCC ICDS services, 2) with the need of SpO2 monitoring in daily living tasks, 3) accessibility of technical equipment including smart phone with Bluetooth and internet connection for remote monitoring by patient / caregiver
Result & Outcome :
11 patients (7 males and 4 females, 73 to 93 years old) were selected to use the remote monitoring devices in this program. Their principal diagnosis of respiratory disease included: asthma, bronchitis, bronchiectasis, pneumonia, COPD and COVID-19. In which 9 of them were current home oxygen user. For the application of remote monitoring devices, 7 cases needed caregiver support for the application of the devices, while 4 of them can apply the devices with smart phone connection on their own. Their ADL performance were charted by BI-100 score, with the range from 35 to 100.
The remote monitoring devices enhanced our support to patients' clinical needs. 9 cases (82%) used the device for home oxygen monitoring in daily livings. 10 cases (91%) performed overnight oximetry with the device. 1 case (9%) was early detected for the need of oxygen therapy by the device. More precise home oxygen regime was recommended for 2 cases (18%) with the use of device. And 1 case (9%) used the device for lifestyle monitoring.
The results indicated from the remote monitoring enhanced our OT case managers in oxygen titration in 8 cases (73%). 2 cases (18%) were suggested to have advanced follow up in SOPD. 4 cases (36%) were advised in lifestyle rescheduling. 8 cases (73%) needed OT to activate further oxygen therapy compliance program. There was no unplanned admission episode for all cases 28 days after application of the remote monitoring devices.
Conclusion:
The remote monitoring devices can provide more data on patient's SpO2 level in daily livings. It allows good visual cues with immediate feedback on SpO2, which further reinforces home O2 compliance and facilitates lifestyle rescheduling. Occupational therapist can analyze the data in an effective way and provide immediate and individualized intervention for patients. OT can also take an active role in initiating O2 monitoring and performing overnight oximetry. The device allows better support for patients without home O2 therapy and provide earlier identification on the need of home O2.
