Enabling people with COPD to take control of their condition through a mobile app

Background:

Pulmonary rehabilitation is an education and exercise programme, typically delivered in a group setting, which improves quality of life in people living with Chronic Obstructive Pulmonary Disease (COPD). Powys as an area is large and rural, with a scattered population, posing significant challenges in delivering such a service.

Additionally, some patients are unable to access the service in a group due to other factors such as anxiety, work and family commitments or experience challenges maintaining a self-management approach when completing a Pulmonary Rehabilitation programme, for example due to motivation or exacerbations of their condition.

Aims:

The project aimed to implement a web-based digital application called myCOPD into the Pulmonary Rehabilitation Service in Powys Teaching Health Board. This provided a unique opportunity for participants to access an online rehabilitation programme and education package to complement group-based programmes. When registered, the product provides a lifetime licence for the user.

The project aligns with the principles of prudent healthcare in that it reduces variation – providing online access to a programme for those who are unable to attend a group-based rehabilitation programme. This also enables the programme to provide ongoing support following discharge.

This approach gives participants the option to live well with a chronic health condition, without the requirement of a healthcare professional to deliver all the information.

Challenges:

Challenges included the information governance of the project, due to the introduction of General Data Protection Regulations, which required registration and consent processes to be rewritten. To do this, the project team worked closely with their industry partner My mHealth.

Introduction of the app posed challenges relating to changes in practice and processes for clinical and administrative staff. This required collaborative working with the team to redesign the clinical pathway, utilising a shared decision-making booklet and supported by training from My mHealth.

Initial sign-up was difficult for participants who had low confidence in using digital technology. This was approached using behavioural change principles, such as making sign-up and use of the product Easy, Accessible, Social and Timely (EAST).

Outcomes:

The key benefits realised from the project are evident in terms of resource efficiency. The myCOPD app allows participants to access an online Pulmonary Rehabilitation programme alongside a group programme or as a stand-alone experience. Opportunity costing revealed that delivering a programme with proposed remote support was £352, versus £1781 to place a person through group Pulmonary Rehabilitation.

Of the participants who signed up to the app, two chose to use it without attending the group, reporting equivalent health outcomes to the group programme.

The feedback from focus groups with patients was that using the app regularly was difficult without clinician support, however many reported that the benefit could be seen but would require consistent use.

Next steps

The project was trialed with a small number of participants in Powys. The next steps for the programme are to evaluate how patients engage with the product through ongoing focus groups, and learn from this to see whether the wider functions of the application can be introduced to other parts of the Respiratory Service in Powys.

Based on preliminary data, implementation of the product may be suited to primary care at the point of diagnosis to encourage a self-management approach from the outset.

There are opportunities to apply this to other long-term conditions applications provided by My mHealth within Powys.