Effect Of Telemonitoring Research Articles

Effect of telemonitoring on the rate of dropout during home non-invasive ventilation: a retrospective study using a home care provider database

ObjectivesTelemonitoring (TM) of home non-invasive ventilation (NIV) has been shown to facilitate home/outpatient therapy set-up. However, the impact of long-term TM on therapy dropouts, compliance and leak control has not...

Effect of telemonitoring and as-needed patient support on positive airway pressure therapy adherence.

Obstructive sleep apnea (OSA) affects patient health and public welfare. Positive airway pressure (PAP) therapy is the preferred treatment of OSA, but therapy adherence rates remain suboptimal. Current literature demonstrates telemonitoring interventions to support improved PAP therapy adherence. To evaluate the effect of interval telemonitoring of PAP therapy data at 2 and 4 weeks after treatment initiation in patients with moderate-to-severe obstructive sleep apnea with as-needed patient support and troubleshooting by telephone consultation. Ninety-nine participants were enrolled in this study, 50 in the control group and 49 in the intervention group. Data were analyzed using descriptive and inferential statistics using SPSS 28.0 software. The primary outcome of interest was 90-day PAP adherence. Mean PAP adherence scores diverged at 90 days after PAP initiation, with the intervention group having a significantly higher mean score (M = 49.24, SD = 38.18) relative to the control group (M = 36.38, SD = 37.69). Likewise, continued PAP usage at 90 days after therapy initiation diverged between participant groups, with the intervention group having a significantly higher mean score (M = 89.80, SD = 30.58) relative to the control group (M = 72.00, SD = 45.36). The intervention resulted in significantly higher mean PAP adherence and a greater percentage of participants demonstrating continued PAP usage at 90 days after therapy initiation but did not result in a statistically significant increase in what is considered and defined as "good PAP adherence" (adherence of ≥70%). Data-triggered telemonitoring protocols offer supplementary support to patients in need and improve PAP adherence.

Home telemonitoring in heart failure patients and the effect of study design on outcome: A literature review

Introduction A wide range of study designs have been utilized in evaluations of home telemonitoring and these studies have produced conflicting outcomes over the years. While some of the research has shown that telemonitoring is beneficial in reducing all-cause mortality, hospital admission, length of stay in hospital and emergency room visits, other studies have not shown such benefits. This study, therefore, aims to examine several home telemonitoring study designs and the influence of study design on study outcomes. Method Articles were obtained by searching PubMed database with the term heart failure combined with the following terms: telemonitoring, telehealth, home monitoring, and remote monitoring. Searches were limited to randomized controlled trial conducted between year January 1, 2000 and February 6, 2021. The characteristics of the study designs and study outcomes were extracted and analyzed. Result Our review of 34 randomized controlled trials of heart failure telemonitoring did not show any significant influence of study design on reduction in number of hospitalizations and/or decrease in mortality. Studies that were done outside North America (USA and Canada) and studies that selected patients at high risk of re-hospitalization were more likely to result in decreased hospitalization and/or mortality, though this was not statistically significant. All the studies that met our inclusion criteria were from high-income countries and only one study enrolled patients at high risk of re-hospitalization. Conclusion There is a need for more studies to understand why telemonitoring studies in Europe were more likely to reduce hospital admission and mortality compared to those in North America. There is also a need for more studies on the effect of telemonitoring in patients at high risk of hospital readmission.

Examining the effectiveness of telemonitoring with routinely acquired blood pressure data in primary care: challenges in the statistical analysis

BackgroundScale-up BP was a quasi-experimental implementation study, following a successful randomised controlled trial of the roll-out of telemonitoring in primary care across Lothian, Scotland. Our primary objective was to assess the effect of telemonitoring on blood pressure (BP) control using routinely collected data. Telemonitored systolic and diastolic BP were compared with surgery BP measurements from patients not using telemonitoring (comparator patients). The statistical analysis and interpretation of findings was challenging due to the broad range of biases potentially influencing the results, including differences in the frequency of readings, ‘white coat effect’, end digit preference, and missing data.MethodsFour different statistical methods were employed in order to minimise the impact of these biases on the comparison between telemonitoring and comparator groups. These methods were “standardisation with stratification”, “standardisation with matching”, “regression adjustment for propensity score” and “random coefficient modelling”. The first three methods standardised the groups so that all participants provided exactly two measurements at baseline and 6–12 months follow-up prior to analysis. The fourth analysis used linear mixed modelling based on all available data.ResultsThe standardisation with stratification analysis showed a significantly lower systolic BP in telemonitoring patients at 6–12 months follow-up (-4.06, 95% CI -6.30 to -1.82, p < 0.001) for patients with systolic BP below 135 at baseline. For the standardisation with matching and regression adjustment for propensity score analyses, systolic BP was significantly lower overall (− 5.96, 95% CI -8.36 to − 3.55 , p < 0.001) and (− 3.73, 95% CI− 5.34 to − 2.13, p < 0.001) respectively, even after assuming that − 5 of the difference was due to ‘white coat effect’. For the random coefficient modelling, the improvement in systolic BP was estimated to be -3.37 (95% CI -5.41 to -1.33 , p < 0.001) after 1 year.ConclusionsThe four analyses provide additional evidence for the effectiveness of telemonitoring in controlling BP in routine primary care. The random coefficient analysis is particularly recommended due to its ability to utilise all available data. However, adjusting for the complex array of biases was difficult. Researchers should appreciate the potential for bias in implementation studies and seek to acquire a detailed understanding of the study context in order to design appropriate analytical approaches.

Effect of telemonitoring on self-care behaviors among community-dwelling adults with heart failure: a quantitative systematic review protocol.

This systematic review seeks to synthesize evidence to determine the effect of telemonitoring on self-care behaviors of adults with heart failure. There is a high-level body of evidence demonstrating that telemonitoring is an appropriate and effective therapy for many chronic conditions and, specifically, for patients with heart failure. However, the effect of telemonitoring on self-care behaviors in the adult population with heart failure is unknown. This review will include studies on adult participants (18 years and over) diagnosed with heart failure who use telemonitoring in the ambulatory setting. Studies of pediatric heart failure patients, and adult heart failure patients in acute care settings or in a care facility, will be excluded. The search for studies will include English language studies published from 1997. Search terms will include heart failure, telemonitoring, self-care, and outpatient/ambulatory care, and will be used in three key sources: CINAHL, Embase, and PubMed. For the full review, Epistomonikos, ProQuest, PsycINFO, and Web of Science will also be searched. Using inclusion/exclusion criteria, two reviewers will select studies based on a three-step process. Methodological quality will be determined using critical appraisal checklists appropriate to the study design. Data extraction will include populations, study designs and methods, interventions, and outcomes related to self-care behaviors. Pooled studies will allow calculation of meta-analysis, while calculated effect sizes and confidence intervals will inform impact and precision of effect. PROSPERO CRD42019131852.

Telemonitoring in patients with chronic heart failure

Actuality. High risk of hospitalisation and death in patients with heart failure highlight the importance of developing methods to moni‑ tor weight, diuresis, heart rate and other parameters and provide the physicians with an ability to change the therapy immediately ifneeded. The aim of this work is an analysis of clinical trials which investigate telemonitoring in patients with heart failure. Discussion. The Cochrane meta-analysis is also discussed in this work. Main conclusions. Our analysis showed that there is no consistency among trials. Not all trials have demonstrated that telemonitoring can reduce the risk of death and heart failure hospitalisations. Potentials explanations are lack of compliance with systems which didn't include the direct contact between the patient and the caregivers, using parameters with low sensitivity in some of the methods and including of stable patients in some of the studies. It is also seeming that effect of telemonitoring is low in regions with existing programs to treat heart failure.

Effects of tailored telemonitoring on functional status and health-related quality of life in patients with heart failure.

BackgroundFunctional status and health-related quality of life (HRQoL) are important in patients with heart failure (HF). Little is known about the effect of telemonitoring on functional status and HRQoL in that population.Methods and resultsA total of 382 patients with HF (New York Heart Association class 2–4) were included in a randomised controlled trial to investigate the effect of tailored telemonitoring on improving HRQoL and functional status in HF patients. Randomisation was computer-generated with stratification per centre. At baseline and after 12 months, patients’ functional status was determined by metabolic equivalent scores (METS). HRQoL was measured with the EuroQol five dimensions questionnaire (EQ-5D), visual analogue scale (VAS) and Borg rating of perceived exertion scale (Borg). Additional outcome data included number of HF-related outpatient clinic visits and mortality. Telemonitoring was statistically significantly related to an increase in METS after 1 year (regression coefficient 0.318; p = 0.01). Telemonitoring did not improve Borg, EQ-5D or VAS scores after 1 year. EQ-5D [hazard ratio (HR) 0.20, 95% confidence interval (CI) 0.07–0.54], VAS (HR 0.98, 95% CI 0.96–0.99), Borg (HR 1.21, 95% CI 1.11–1.31) and METS (HR 0.73, 95% CI 0.58–0.93) at baseline were significantly associated with survival after 12 months.ConclusionsTailored telemonitoring stabilised the functional status of HF patients but did not improve HRQoL. Therefore, telemonitoring may help to prevent deterioration of exercise capacity in patients with HF. However, because our study is a reanalysis of a randomised controlled trial (RCT), this is considered hypothesis-generating and should be confirmed by adequately powered RCTs.Electronic supplementary materialThe online version of this article (10.1007/s12471-019-01323-x) contains supplementary material, which is available to authorized users.

Telemonitoring in asthma control: a randomized controlled trial

Objective: Telemonitoring seems to be a useful tool for patients’ management. The aim of our project was to test the applicability and potential effects of a 12-month telemonitoring of patients with asthma supported by information and communication technologies. Methods: We included 100 patients with asthma followed in the outpatient pulmonary clinic in a randomized controlled clinical trial. The patients’ data were collected by study questionnaires and lung function tests at the inclusion and at the end of interventional period. In the interventional group, asthma control test (ACT) and peak expiratory flow measurements (PEF) were stimulated to be regularly reported by Short Message Service (SMS). As a response to reported values, the patients automatically received a preformed text or a call from a study nurse in case of detected predefined critical values. Results: The compliance of reporting PEF and ACT values was higher than 80% in 96% of patients. Although we did not detect significant differences in ACT score improvement between the two study groups, we found more prominent improvement of ACT score in the subgroup of patients with two or more exacerbations prior to inclusion in the interventional group, compared to the control group. 40 (78%) patients in the interventional group listed at least one positive effect of telemonitoring on management of asthma. Conclusions: The developed program for home monitoring of patients with asthma was applicable and offered the patients support in managing their disease. Further studies with more selected patients are needed to confirm its usefulness in improving asthma control.

Effect of telemonitoring in the recovery of cataract surgery in elders: Randomized controlled trial

Effect of telemonitoring in the recovery of cataract surgery in elders: Randomized controlled trial

Effects of telemonitoring on glycaemic control and healthcare costs in type 2 diabetes: A randomised controlled trial

Introduction This study examined the effect of a telehealth intervention on the control of type 2 diabetes and subsequent potential cost-savings to the health system. Methods This prospective randomised controlled trial randomised adults with type 2 diabetes to the intervention (diabetes program) or control (usual care) arm. Key eligibility criteria included an HbA1c level of at least 58 mmol/mol (7.5%) without severe or unstable comorbidities. All participants continued their usual healthcare, but participants in the intervention arm received additional diabetes care from a diabetes care coordinator via a home monitor that captured clinical measures. Data collected included biomedical, quality of life measures and healthcare (GP, outpatient and inpatient) costs. The primary outcome was HbA1c collected at baseline and 6 months. Analysis was conducted on a complete case intention-to-treat basis. The healthcare system perspective was taken to calculate the incremental cost per percentage-point reduction in HbA1c. Results Results from 63 participants from each study arm were analysed. HbA1c in the intervention group decreased from a median 68 mmol/mol (8.4%) to 58 mmol/mol (7.5%), and remained unchanged in the control group at median 65 mmol/mol (8.1%) at the 6-month endpoint. The intervention effect on HbA1c change was statistically significant (p = .004). Total healthcare costs in the intervention group, including the intervention costs, were lower (mean $3781 vs. $4662; p < .001) compared with usual care. Discussion There was a clinically meaningful and statistically significant benefit from the telehealth intervention at a lower cost; thus, telehealth was cost-saving and produced greater health benefits compared with usual care.

Model based methods for the analysis of non-stationary effects of telemonitoring as an intervention for the management of chronic conditions at home.

The monitoring of vital signs for the management of chronic conditions at home have been demonstrated in numerous trials to have a positive impact on the patient's healthcare outcomes as well as to reduce hospitalization and improve quality of life. The CSIRO has just completed a two year clinical trial designed to evaluate a large number of qualitative and quantitative outcomes of at home telemonitoring. As preliminary data demonstrates that before and after data is not stationary, a model based BACI (Before-After-Control-Impact) design frequently used in environmental and agricultural yield studies, but rarely in clinical trials, has been developed to model the effects of the intervention on healthcare outcomes over time as well as possible secondary effects associate with environmental and seasonal conditions.

Effects of telemonitoring in cancer patients

Effects of telemonitoring in cancer patients

Perceptions and Experiences of Heart Failure Patients and Clinicians on the Use of Mobile Phone-Based Telemonitoring

BackgroundPrevious trials of heart failure telemonitoring systems have produced inconsistent findings, largely due to diverse interventions and study designs.ObjectivesThe objectives of this study are (1) to provide in-depth insight into the effects of telemonitoring on self-care and clinical management, and (2) to determine the features that enable successful heart failure telemonitoring.MethodsSemi-structured interviews were conducted with 22 heart failure patients attending a heart function clinic who had used a mobile phone-based telemonitoring system for 6 months. The telemonitoring system required the patients to take daily weight and blood pressure readings, weekly single-lead ECGs, and to answer daily symptom questions on a mobile phone. Instructions were sent to the patient’s mobile phone based on their physiological values. Alerts were also sent to a cardiologist’s mobile phone, as required. All clinicians involved in the study were also interviewed post-trial (N = 5). The interviews were recorded, transcribed, and then analyzed using a conventional content analysis approach.ResultsThe telemonitoring system improved patient self-care by instructing the patients in real-time how to appropriately modify their lifestyle behaviors. Patients felt more aware of their heart failure condition, less anxiety, and more empowered. Many were willing to partially fund the use of the system. The clinicians were able to manage their patients’ heart failure conditions more effectively, because they had physiological data reported to them frequently to help in their decision-making (eg, for medication titration) and were alerted at the earliest sign of decompensation. Essential characteristics of the telemonitoring system that contributed to improved heart failure management included immediate self-care and clinical feedback (ie, teachable moments), how the system was easy and quick to use, and how the patients and clinicians perceived tangible benefits from telemonitoring. Some clinical concerns included ongoing costs of the telemonitoring system and increased clinical workload. A few patients did not want to be watched long-term while some were concerned they might become dependent on the system.ConclusionsThe success of a telemonitoring system is highly dependent on its features and design. The essential system characteristics identified in this study should be considered when developing telemonitoring solutions.Key Words

Telemonitoring in Patients with Heart Failure – Lessons from Recent Randomised Multicentre Trials

Home telemonitoring (TLM) has been proposed as an effective tool to reduce cardiac events in patients with chronic heart failure (HF). In contrast to older and more recent meta-analyses, large randomised multicentre trials have failed to demonstrate any positive effect of TLM on HF rehospitalisation and all-cause mortality. However, these negative results do not preclude the potential role of TLM as an effective system for managing patients with HF. In this article, possible explanations for these negative results are presented and discussed, and a new model of TLM, with investments in technology but above all in personnel and organisation, is suggested.

Weight loss in obese patients with type 2 diabetes: Effects of telemonitoring plus a diet combination – The Active Body Control (ABC) Program

AimsWe evaluate the efficacy of the “Active Body Control (ABC) Program” for weight reduction in patients with type 2 diabetes. MethodsThe ABC program combines telemonitoring of the physical activity with a low-calorie diet also preferring carbohydrates with low glycemic indexes. In this 6-month, randomized, clinical trial 35 patients (aged 57±9 years; BMI=35.3±5.7kg/m2) were treated according to the ABC program and 35 control patients (aged 58±7 years; BMI=34.8±5.9kg/m2) received standard therapy. ResultsAfter 6 months the mean weight loss in the intervention group was 11.8kg±8.0kg. Glucose and HbA1c were lowered by respectively 1.0mmol/l and 0.8 percentage points (p=0.000, respectively). The proportion of patients with HbA1c>7% fell from 57% to 26%. Antidiabetic drugs were discontinued in 13 patients (39%) and reduced in 14 (42%). The reduction of costs on medication per patient was €83 in 6 months. In the control group, there were no relevant changes in body weight, laboratory values or drug treatment. ConclusionsThe ABC program effectively lowers body weight, Hb1Ac and antidiabetic drug use in patients with type 2 diabetes.

Telemonitoring of Heart Failure Patients and Their Caregivers: A Pilot Randomized Controlled Trial

Heart failure (HF) is the leading cause of rehospitalization in older adults. The purpose of this pilot study was to examine whether telemonitoring by an advanced practice nurse reduced subsequent hospital readmissions, emergency department visits, costs, and risk of hospital readmission for patients with HF. One hundred two patient/caregiver dyads were randomized into 2 groups postdischarge; 84 dyads completed the study. Hospital readmissions, emergency department visits, costs, and days to readmission were abstracted from medical records. Participants were interviewed soon after discharge and 3 months later about effects of telemonitoring on depressive symptoms, quality of life, and caregiver mastery. There were no significant differences due to telemonitoring for any outcomes. Caregiver mastery, informal social support, and electronic home monitoring were not significant predictors for risk of hospital readmission. Further studies should address the interaction between the advanced practice nurse and follow-up intervention with telemonitoring of patients with HF to better target those who are most likely to benefit.

Telemonitoring of Heart Failure Patients and Their Caregivers: A Pilot Randomized Controlled Trial

Heart failure (HF) is the leading cause of rehospitalization in older adults. The purpose of this pilot study was to examine whether telemonitoring by an advanced practice nurse reduced subsequent hospital readmissions, emergency department visits, costs, and risk of hospital readmission for patients with HF. One hundred two patient/caregiver dyads were randomized into 2 groups postdischarge; 84 dyads completed the study. Hospital readmissions, emergency department visits, costs, and days to readmission were abstracted from medical records. Participants were interviewed soon after discharge and 3 months later about effects of telemonitoring on depressive symptoms, quality of life, and caregiver mastery. There were no significant differences due to telemonitoring for any outcomes. Caregiver mastery, informal social support, and electronic home monitoring were not significant predictors for risk of hospital readmission. Further studies should address the interaction between the advanced practice nurse and follow-up intervention with telemonitoring of patients with HF to better target those who are most likely to benefit.

Hypertension Home Telemonitoring

feedback. With the large number of people experiencing hypertension worldwide and the burden of this medical condition, home blood pressure (BP) telemonitoring has become popular given its potential for reducing cost and improving patient care. This study provides an overview on the current evidence and trends of hypertension telemonitoring, and presents recommendations for future studies in this area. A comprehensive literature search was conducted from 1966 to 2006 on Cochrane Library, ScienceDirect, PubMed, MEDLINE, EMBASE, CINAHL, and PsycINFO using the key words ‘hypertension’, ‘blood pressure’, ‘telemonitoring’, ‘telecare’, ‘telemedicine’, ‘biotelemetry’, ‘telehealth’, and ‘telehomecare’. Fourteen studies involving telemonitoring experiments were found and included in this review, ten of which were conducted in Europe and the US. The studies present evidence on the positive impacts of telemonitoring on patients and their conditions (e.g. significant BP control, better medication adherence, changes in patients’ lifestyle). However, the results of the studies should be considered with caution due to the limitations of study designs. Furthermore, little is known about the effects of telemonitoring on services utilization and only one study demonstrated a detailed cost-effectiveness analysis of this approach. This review presents preliminary evidence on the benefits of telemonitoring as a successful patientmanagement approach. However, at present, limited information exists that would substantiate its effects on the utilization of health services (e.g. office and emergency room visits, hospitalizations) and demonstrate its economic viability. Future studies should examine the effects of mediating variables and the mechanisms through which BP control is achieved. Further research should also incorporate designs that allow more control and investigate its effects over longer time periods with larger diversified samples of patients.