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Prevalence of educational qualifications and access to information technologies in patients with acute exacerbation of COPD

R. Wijayarathna1,3, E.Suh 1,2,3, S.Mandal1,2,3, N.Hart 1,2,3,4

1Lane Fox Clinical Respiratory Physiology Research Centre, Guy’s & St Thomas’ NHS Foundation Trust, London, UK 2Division of Asthma, Allergy and Lung Biology, King’s College London, UK, 3Lane Fox Respiratory Unit, Guy’s & St Thomas’ NHS Foundation Trust, London, UK

4Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, NIHR Comprehensive Biomedical Research Centre, London, UK

Introduction

Methods

Results Conclusion

Socioeconomic factors are known to influence

clinical outcome in COPD patients, but few

studies have addressed the impact of

educational attainment (1,2).

Furthermore, while there is increasing interest in

the use of telehealth for patients with COPD,

there are few data relating to patients’ access to

the technologies through which telehealth

interventions may be delivered.

We therefore aimed to ascertain the prevalence

of formal educational qualifications and access to

information technologies among patients

hospitalised with acute exacerbation of COPD

(AECOPD).

Clinical and physiological data were

prospectively gathered from consecutive patients

admitted to a metropolitan teaching hospital with

AECOPD between April and December 2013.

Patient data were analysed according to the

possession of educational qualifications, and

access to a personal computer and the internet.

These data suggest there may be difficulties in

implementing the use of telehealth within this

metropolitan COPD population. Only 14% had

access to a computer and the internet.

Patients with no educational qualifications had

worse spirometry at admission, but surprisingly a

lower symptom burden. This may be due to the fact

that those with educational qualifications may have

a greater awareness of the symptoms of an

exacerbation, and therefore present to hospital at

an earlier stage.

While telehealth has great potential to transform

the chronic care in COPD, attention needs to be

paid to individual patients’ levels of education and

familiarity with information technology.

100 patients were admitted with AECOPD (40%

female, age 70.5±9.3years). 51% of patients

lived alone, 38% were current smokers, with

FEV1 0.70±0.39L at admission, and 13% were

on long term oxygen therapy. Median duration of

symptoms prior to admission was 4 days (IQR 1

to 14). Hospital admission frequency 2 (IQR 1 to

6) per year.

Results

Table 1. Characteristics of patients admitted with AECOPD. FEV1:

forced expiratory volume in 1s, NRS: numerical rating scale; CAT:

COPD Assessment Test. *p<0.05 compared with patients with

educational qualifications; **p<0.05 compared with patients with

access to the internet or personal computer.

To determine the proportion of patients with

educational qualifications and those who had

access to information technology at home, and to

establish whether such access was related to

clinical outcomes

Objective

We gratefully acknowledge funding by

the European Union as part of the Advanced Care

Coordination and Telehealth Deployment Project

(ACT) led by Philips, and the Department of

Physiotherapy, Guy’s and St. Thomas’ NHS

Foundation Trust.

Acknowledgements

83% of patients had no educational

qualifications (Figure 1, Table 1), while 86% had

no access to the internet or a personal computer

(Table 1). Women were less likely to have

formal educational qualifications.

Patients with no educational qualifications had a

lower %predicted FEV1 (31.2±23.6% vs.

38.7±20.9%, p<0.05), and were less likely to

have access to information technologies (7% vs.

93%, p<0.05).

Educational Access to personal

qualifications computer or Internet

Yes (n=17)

No (n=83)

Yes (n=14)

No (n=86)

%Male/Female 76/24% 57/43% 57/43% 60/40%

Age (years)69.4 (8.3)

70.6 (9.4)

64.8 (7.7)

71.3 (9.2)**

FEV1 %predicted 38.7 (20.9)

31.2 (23.6)*

23.6 (16.2)

34.9 (24.2)

28 day readmission

18% 13% 0 16%

NRS for dyspnoea (/10)

5.0 (2.0)

3.6 (2.1)

3.8 (1.9)

3.8(2.1)

CAT score (/40) 24 (10.8) 21.8 (10.8) 21 (10) 22 (11)

Length of hospital stay (days)

4.1 (2.9) 6.0 (6.2) 5.0 (7.1) 5.7 (5.6)

Figure 1. Educational qualifications of 100 patients admitted with

AECOPD.Patients with no educational qualifications were

no more likely to be readmitted within 28 days,

and presented with a lower symptom burden on

admission as measured by the numerical rating

scale for dyspnoea (3.6/10 vs. 5.0/10).

Patients with access to the internet or a

computer were significantly younger (Table 1)

and were less likely to be readmitted within 28

days of discharge from hospital (0% vs. 16%).

There was no significant difference in spirometry

or symptoms at admission.

1. Eisner MD, Blanc PD, Omachi TA, et al. Socioeconomic

status, race and COPD health outcomes. J Epidemiol

Community Health 2011;65:26-34.

2. Mannino DM, Buist AS. Global burden of COPD: Risk

factors, prevalence, and future trends. The Lancet;370:765-

773.

References