myCOPD Integrated Online System

NHS Innovation Accelerator Fellow: Simon Bourne

Chronic Obstructive Pulmonary Disease (COPD) is a lung disease that is characterised by airflow obstruction or limitation (NHS England, 2012).

COPD is the second most common cause of hospital admissions in the country, costing the NHS over £800m in direct healthcare costs. Studies show that up to 90% of people with COPD do not take their medication correctly due to a combination of poor compliance and poor inhaler technique (Bourbeau & Bartlett, 2008).

 

 

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I have used myCOPD for 9 months, I use it every day. Last year, before using MyCOPD I had 12 exacerbations, this year I have had just 2. I now know when and how to take my medication, when to use my rescue pack and perform my rehab exercises most days.
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COPD kills approximately 25,000 people every year in England and Wales. Recent figures showed that COPD accounted for 4.8% of all deaths in England between 2007 and 2009. It is the fifth biggest killer disease in the UK (NHS England, 2012).

An estimated 3 million people have COPD in the UK. About 900,000 have diagnosed COPD and an estimated 2 million people have COPD which remains undiagnosed (Healthcare Commission, 2006).

COPD is the second most common reason for emergency admission to hospital, accounting for one in eight non-elective admissions, resulting in significant cost to the NHS. COPD kills approximately 23,000 people a year in England alone. Patients who are hospitalised are at particular risk of mortality with one in six people dying during an emergency admission due to COPD, and one in twelve patients dying within three months (Public Health England, 2015).

In the next ten years, £235m could be saved by the NHS if self-management is implemented correctly (Department of Health, 2012). COPD is predicted to be the world’s third largest killer by 2030 (World Health Organisation, accessed online 22.8.17), and the NHS Five Year Forward View (NHS England, 2014) states that it is looking for an expanding set of NHS accredited health apps that patients will be able to use to organise and manage their own health.

The benefits of systematic symptom documentation, explicit care planning, improved inhaler technique, improved adherence and better access to pulmonary rehabilitation, can all be expected to yield improved disease control (https://meridian.wmahsn.org/subdomain/other-innovations/end/node/1804).

myCOPD is an online platform to help people with COPD to manage their condition more effectively. It is available on any device that can connect to the internet and delivers a personalised COPD management system by asking patients a few key questions about their condition.

For people with COPD, it facilitates:

  1. Education and inhaler training
  2. Self-management
  3. Pulmonary rehabilitation
  4. Lifestyle changes
  5. Symptom reporting

For clinicians, it provides:

  1. A dashboard and geographical population map view
  2. An education and patient management suite (to allow monitoring and management of patients remotely, for example, by analysing COPD exacerbations, remotely changing medications and tailoring treatments and support).

myCOPD was designed by Simon Bourne of mymhealth.

mymhealth also have a range of other platforms to help people to manage their conditions including ‘myasthma’ and ‘mydiabetes.’  Platforms for pain management and heart failure will be launched during 2017.

View the video here: https://www.youtube.com/watch?v=e2XclULqRJU

Under the NHS Innovation Accelerator (NIA), there has been a focus on:

  • Refining myCOPD, along with a multi-morbidity platform to include diabetes and asthma (‘myasthma’ and ‘mydiabetes’).
  • Building the evidence base through a large randomised control trial and health economic case
  • Developing website and marketing materials, contacting key people in over 100 clinical commissioning groups, and attending key conferences
  • Building national and international partnerships to support distribution
  • Looking at interoperability with other clinical systems such as EMIS and SystemOne.

The platform claims to correct 98% of inhaler errors without any other clinical intervention and has been shown to deliver the same outcomes as access to a face to face rehabilitation class. In addition, 95% of patients improved their symptom score using myCOPD (North, 2015).

These results were obtained from a service development project that compared the efficacy of myCOPD with a standard face to face NHS service. This took place over a ten month period, with 36 patients having a confirmed diagnosis of COPD. Prior to the intervention, 98% of patients used their inhalers incorrectly. Results showed that 95% of the participants who used the system showed a mean decrease in COPD Assessment Test (CAT) score of 4.5 (P<0.001) and an improvement in inhaler technique. The patient cohort who did not use the system had a mean increase in their CAT score of 2.4 points. By the end of the study, 98% of patients who used the system were using their inhalers correctly, translating as a 95% improvement in CAT scores with no other clinical intervention.

One study has shown that myCOPD is as good as class based pulmonary rehabilitation in a randomised controlled trial (Wilkinson et al, 2017). Further studies have demonstrated that myCOPD improves adherence to medication by 70% (estimated to previously be as low as 8% in many studies) and doubles the rate of recovery of patients hospitalised with COPD exacerbations (Green, 2016; unpublished, see protocol available at https://clinicaltrials.gov/ct2/show/NCT02706600).

The National Institute for Health and Care Excellence (NICE) recommends that patients with COPD are provided with a comprehensive self-management plan which includes high-quality information and educational material about the condition and its management, relevant to the stage of disease (Department of Health, 2010).

NICE (2010) also states that “pulmonary rehabilitation should be made available to all appropriate people with COPD including those who have had a recent hospitalisation for an acute exacerbation”.

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