Exploring the potential opportunities and challenges associated with remote care for chronic obstructive pulmonary disease

What are we aiming to find out?

A priority during the pandemic was to reduce social contact especially for older people and those with long-term conditions that put them at risk. Healthcare shifted to remote delivery (via websites, video link, smartphone, telephone) and some are predicting that remote consultations will continue even after the pandemic. As restrictions are gradually being eased it is timely to consider whether remote consulting is acceptable, and perceived as appropriate for the care of older patients with moderate to very severe chronic obstructive pulmonary disease (COPD) who often also have other multiple physical and psychological conditions. Many of these patients are from socially deprived communities and reliance on remote consultations may increase inequalities. In contrast, those with severe disease who are housebound may welcome remote care.

Care in COPD could be discussion of self-management plans, assessing symptoms, education on COPD and its treatment, medications/inhaler use, remote pulmonary rehabilitation, smoking cessation advice, need for other types of services and mental health support. Little is known about the experiences of patients accessing and using this range of care remotely nor the experience of health care professionals providing care remotely to people with complex healthcare problems

Our aims are to find out from:

patients with COPD and their carers, their views and experiences of remote care to meet different needs, to understand what worked well, what were the challenges and how their experience of care could be improved.

health care professionals, their views and experiences of providing different types of care remotely, to understand what worked well, what were the challenges and how their experience of providing care could be improved.

In addition, we have recently finished a large study called TANDEM, which tests whether a personalised, one-to-one talking therapy (discussions) with a trained respiratory professional over a 6 to 8 week period improves both the emotional and/or physical health of patients with moderate to very severe COPD and symptoms of anxiety and depression. Because of the pandemic, some patients recruited at the end of the study had to be offered discussions remotely than face to face as originally intended.

Our third aim is to find out from:

patients and professionals, their views on whether a new, face to face, talking treatment called TANDEM could also be offered as a remote option to patients with moderate to very severe COPD and symptoms of anxiety and/or depression, and how this could be done.

How will this study benefit patients, professionals and services either directly or in the longer term?

Benefits to patients

This work could help to create more opportunities to access care remotely according to patients’ needs and preferences, ensuring a mode of care delivery that is appropriate suitable and acceptable to them

Benefits to NHS services and professionals

This work will:

raise awareness of the challenges patients may face in accessing care remotely

support healthcare services in deciding whom to offer a choice of telephone, video or in-person consultation, and

identify ways of improving availability, accessibility and quality of care of care to people with COPD

This study will also help us to decide whether and how the TANDEM treatment might be offered via a remote option.

Why does this research need to be done now?

The prevalence of COPD is increasing. The progression of COPD leads to many patients living with one or more long-term conditions, this can contribute to poor mental health and wellbeing, which can lead to poor health outcomes. The cost of COPD care to the NHS is £1.9 billion each year. The pandemic has forced many NHS services to switch to remote delivery to provide care and there is increasing debate about its ongoing and future delivery. Currently, this mode of delivery may not be reaching its full potential, in part due to poor understanding of how to achieve this and how to adapt remote delivery to ensure best possible care. This study offers opportunity to improve care provision and reduce health inequalities.

What design and methods have we chosen and why?

We will conduct an interview study involving:

patients and carers of patients with moderate to very severe COPD, poor mental health and/or additional physical long term conditions.

health care professionals who provide COPD care remotely

These interviews will help our understanding of their experiences, why problems are happening, offer insights into challenges and how challenges might be overcome in ways that are acceptable to them.

We will carry out interviews with 12-15 patients, 6-8 carers of patients with COPD and 12-15 health care professionals. Interviews will be conducted by telephone or another acceptable option.

How will the findings be communicated and to whom?

Summary in a newsletter to study participants

Presentation of findings to British Lung Foundation’s (BLF) Support Groups via the BLF Public Involvement Manager and BLF Group Support Officer

Presentation and report for NHS services and professionals

Project report to funder.

Academic papers and conference presentations to reach other researchers.

Amount awarded: £41,414