COPD service evaluation

Chronic Obstructive Pulmonary Disease (COPD) causes nearly 30,000 deaths and over a million hospital bed days annually in the UK, with the highest prevalence seen in socioeconomically deprived areas. Traditional COPD care is reactive, where disease management is typically optimised once a hospital admission has occurred, This reactive approach results in faster disease progression and poor long-term outcomes.

Effective self-management of COPD can significantly reduce hospital admissions, but face-to-face self-management interventions are resource intensive. Digital self-management tools, like the Lenus Treat COPD product, offer scalable solutions by providing remote access to self-management resources and clinician support.

The benefits of the Lenus COPD support service for users with high-risk COPD have been previously evaluated in the RECEIVER trial (1) which took place in NHS Greater Glasgow and Clyde (NHS GG&C) between September 2019 and August 2021.

Study Objectives

In a recent service evaluation, the outcomes of the service users in NHS GG&C who were onboarded onto the service after recruitment for the trial had been completed were explored. This provided an insight into the outcomes of those onboarded onto the service as part of routine clinical care, including users with lower-risk COPD who were not represented in the trial population. The analysis included patients onboarded onto the support service from May 2020 to October 2022 (n=354). Data was collected from electronic health records, focusing on hospital admissions, bed days, and mortality.

For this evaluation the cohort were stratified into a higher-risk (n=114) and a lower-risk (n=240) cohort based on if each user had had a respiratory related hospital admission in the year prior to onboarding.

Results

This evaluation confirmed a sustained reduction in annual respiratory related admissions and occupied bed days compared to baseline in the two years post-service onboarding for the higher risk cohort who match the inclusion criteria for the RECEIVER cohort. This replicates and builds upon the findings from the RECEIVER trial where a reduction in annual hospital admissions and occupied bed days was seen over one year of follow-up in a higher-risk population. For the higher risk cohort, survival to event (respiratory related admission or death) was comparable to the RECEIVER cohort and compared favourably with the control cohort for the RECEIVER trial analysis. Unsurprisingly survival to first event was higher in users with lower-risk COPD than users with higher-risk COPD, however as events still occurred over follow-up, it is clear that this population is still at risk from adverse events and can benefit from support from digital tools. (Figure 1)

Figure 1. Survival plot visualisation showing time to first respiratory related admission or death for patients onboarded to the Lenus COPD support service in NHS GG&C May 2020 – October 2022. The cohort has been stratified into a higher-risk cohort who all had a respiratory related admission in the year prior to service onboarding (green) and lower-risk cohort who did not have a respiratory related admission in the year prior to service onboarding (blue)

Key Findings

• High-risk patients experienced significant reductions in hospital admissions and bed days over two years.
• The average number of admissions decreased from 1.97 to 0.91 per year.
• Occupied bed days dropped from 12.8 to 8.04 per year.
• Lower-risk patients also showed improved clinical outcomes compared to historical and other reference data.
• The digital platform facilitated continuous patient engagement and remote monitoring.
• These improvements were observed across different risk profiles and demographic groups, confirming the service's effectiveness in reducing healthcare utilisation and improving COPD management.