Electronic inhaler monitoring and healthcare utilization in chronic obstructive pulmonary disease

Introduction The effect of electronic inhaler monitoring (EIM) on healthcare utilization in chronic obstructive pulmonary disease (COPD) has not been studied. We hypothesized that the use of EIM in conjunction with a disease management program reduces healthcare utilization in patients with COPD. Methods This is a retrospective pre- and post-analysis of a quality improvement project. Patients with COPD and high healthcare utilization (>= one hospitalization or emergency room visit during the year prior to enrolment) were provided with electronic monitoring devices for monitoring controller and rescue inhaler utilization for one year. Patients were contacted when alerts were triggered, indicating suboptimal adherence to controller inhaler or increased use of rescue inhalers, potentially signalling an impending exacerbation. Healthcare utilization was assessed pre- and post-monitoring, with each subject serving as his/her own control. Results Patients with COPD and high healthcare utilization (n = 39) were recruited. Mean EIM duration was 280.5 (+/- 120.6) days. The mean age was 68.6 (+/- 9.9) years, FEV1 (mean forced expiratory volume in one second) was 1.1 (+/- 0.4) L, and mean Charlson Comorbidity index was 5.6 (+/- 2.7). Average adherence was 44.4% (28.4%). Compared with the year prior to enrolment, EIM was associated with a reduction in COPD-related healthcare utilization per year (2.2 (+/- 2.3) versus 3.4 (+/- 3.2),p = 0.01). Although there was a reduction in all-cause healthcare utilization, this was not statistically significant (3.4 (+/- 2.6) versus 4.7 (+/- 4.1),p = 0.06). Discussion EIM in conjunction with a disease management program may play a role in reducing healthcare utilization in COPD patients with a history of high healthcare utilization.