Structured Telephone Support Research Articles

Development of remote person-centred care based on participatory design for people with chronic obstructive pulmonary disease and chronic heart failure -A Randomized Controlled trial.

Background: Person-centred care (PCC) is an approach based on ethical principles. To support operationalization of person-centred ethics in clinical practice a framework was developed by the Gothenburg Centre for Person Centred Care (GPCC). Both chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) are known for their high mortality and severe impact on activities in daily living. Therefore, self-management strategies are crucial to optimize care. Digital solutions have been suggested as a safe option to promote self-management of chronic conditions such as COPD and CHF. However, most digital solutions seem to be lacking the user-perspective in the development of the platform. The project aimed to develop and evaluate a remote PCC based on a participatory design for people with chronic obstructive pulmonary disease and chronic heart failure.
 Method: Public involvement is a cornerstone in PCC. Therefore, this study incorporates a participatory design that assumes that all users; patients, relatives and healthcare professionals (HCPs) are involved in the study design and development of the intervention (remote PCC). Extensive iterative consultations with the users took place during the development and design of the digital platform (7). An advisory group consisting of patient representatives, relatives, HCPs, system-developers and researchers was formed to provide advice and co-design all of the major elements of the study design. This study was a multicenter randomized trial conducted from 2018 through 2020. In total, 222 patients were recruited from nine primary care centers. Patients with a diagnosis of COPD and CHF were eligible. Participants were randomized into either usual care (n=112) or PCC on top of usual care (n=110). The primary endpoint was a composite score of change in general self-efficacy (GSE) and hospitalization or death 6 months after randomization, which was dichotomized into improved and deteriorated/unchanged. In addition, data from the 3-month follow-up were analyzed and a per-protocol analysis of those participants that used the intervention were conducted.
 Results: The patient representatives suggested that the platform should include functionalities such as the possibility of a two-way communication and reliable user-friendly information about their condition. The HCPs contributed with input concerning layout and technical functionalities. The effect study showed no significant between-group differences in the composite score at the 3- and 6 months follow-ups. There was, however, a significant difference between the study groups in the per-protocol analysis at three months (p=0.047). This effect was driven by a change in General Self Efficacy from baseline.
 Conclusion: The participatory designed remote PCC resulted in a generic digital platform in this study, the end-user input in the development process is probably mirrored in the increase in self-efficacy among those that used the platform. PCC by a combined digital platform and structured telephone support seems to be a safe option to support people with CHF and COPD to increase their self-efficacy. This study adds to the knowledge of involving users in the design and development process of interventions. Further research is needed in order to explore how to tailor different components in digital interventions and PCC to each unique patient.

Abstract 13191: Effectiveness of a Telemedicine Intervention in Reducing Heart Failure Hospitalizations in Brazil: A Randomized Clinical Trial

Introduction: Telemedicine interventions (TMI) for heart failure (HF) can reduce hospitalizations and deaths. It is unknown if lower literacy and access to technology in low- and middle-income countries could hamper these positive results. We evaluated if a TMI could reduce HF-related rehospitalizations in HF patients discharged from public hospitals in Brazil compared to usual care. Methods: In a randomized clinical trial (UTN: U1111-1263-9802), patients >30 years, hospitalized due to HF in 6 public hospitals (09/2021 to 06/2022) were randomized before discharge to usual care (n=57) or to a multi-component TMI (n=70). The TMI included a weekly structured telephone support from a nurse to evaluate the daily monitoring of weight, blood pressure and heart rate collected by the patient, assess decompensation signs and treatment adherence barriers, and promote self-care education - including flexible diuretics dosing. The nurse was linked to a cardiologist for teleconsultations, according to pre-defined clinical decision trees. An educational program was also available, including unidirectional messages and two-way messaging in working hours. The primary outcome was HF-related rehospitalizations after 180 days, analyzed by intention-to-treat. Results: Of 127 patients, mean age was 64±11 years, 48% were female, 71% were black/“pardo”, 33% had <4 years of education, and 68% had reduced ejection fraction. At 180 days, HF-related hospitalizations occurred in 18 (26%) patients from the TMI vs. 26 (46%) from the usual care group (RR=0.56, 95%CI 0.34-0.91, p<0.01). Kaplan-Meier curves for the primary outcome are shown in Figure 1 . All-cause death or rehospitalizations (secondary outcome) occurred in 30% of patients in the TMI vs 47% in the usual care group (RR=0.63, CI95% 0.40-0.99, p=0.04). Conclusions: In HF patients discharged from hospitals in Brazil, a TMI reduced HF-related rehospitalizations compared to usual care.

Effects of non-drug interventions on anxiety and depression in patients with heart failure: A systematic review based on Bayesian network meta-analysis

BackgroundTo discuss the effect of non-drug interventions on anxiety and depression in patients with heart failure (HF) through Bayesian network meta-analysis. MethodsRelevant literature was searched from PubMed, Web of Science, Embase and Medline from database establishment to October 2022 by a computer. Next, a screening was performed on randomized controlled trials (RCTs) for the effect of non-drug interventions on anxiety and depression in HF patients, followed by a collection of the related data. This meta-analysis was conducted based on Bayesian network, and the statistical analysis was conducted using R4.2 software. ResultsA total of 23 papers were enrolled into this study. The results of Bayesian network meta-analysis showed that compared with the control group and the structured video conferencing support (SVCS) group, telephone case management (TCM) could effectively reduce the anxiety and depression of HF patients. The ranking results revealed that TCM may be the most effective intervention to lower the risk of depression in HF patients, followed by Tai Chi Chuan and Chi Kung training (TCC) and structured telephone support (STS). ConclusionTCM is the most effective intervention to prevent HF patients from anxiety and depression.

Digital Health Technologies for Post-Discharge Care after Heart Failure Hospitalisation to Relieve Symptoms and Improve Clinical Outcomes.

The prevention of recurrent heart failure (HF) hospitalisations is of particular importance, as each such successive event may increase the risk of death. Effective care planning during the vulnerable phase after discharge is crucial for symptom control and improving patient prognosis. Many clinical trials have focused on telemedicine interventions in HF, with varying effects on the primary endpoints. However, the evidence of the effectiveness of telemedicine solutions in cardiology is growing. The scope of this review is to present complementary telemedicine modalities that can support outpatient care of patients recently hospitalised due to worsening HF. Remote disease management models, such as video (tele) consultations, structured telephone support, and remote monitoring of vital signs, were presented as core components of telecare. Invasive and non-invasive monitoring of volume status was described as an important step forward to prevent congestion-the main cause of clinical decompensation. The idea of virtual wards, combining these facilities with in-person visits, strengthens the opportunity for education and enhancement to promote more intensive self-care. Electronic platforms provide coordination of tasks within multidisciplinary teams and structured data that can be effectively used to develop predictive algorithms based on advanced digital science, such as artificial intelligence. The rapid progress in informatics, telematics, and device technologies provides a wide range of possibilities for further development in this area. However, there are still existing gaps regarding the use of telemedicine solutions in HF patients, and future randomised telemedicine trials and real-life registries are still definitely needed.

The Role of Structured Telephone Support in the Development of Self-care in Comorbid Patients with Chronic Heart Failure

Aim. To research the effect of structured telephone support on the self-care in comorbid patients with chronic heart failure (CHF) over 12 months of follow-up.Material and methods. Self-care was assessed using The Self-care of Heart Failure Index (SCHFI, version 6.2) in 130 patients with CHF II-IV functional class according to NYHA, mean age 63.2±9.6 years old, left ventricular ejection fraction averaged 47.1±11.6%, men (70.8%) and patients with ischemic etiology of CHF (78.5%) prevailed. After fixed simple randomization by the envelope method, the patients were divided into groups of standard (control) and active outpatient follow-up (additional telephone contacts or correspondence using available messengers – structured telephone support). All patients received CHF therapy in accordance with the current Russian clinical guidelines. The indicators evaluated initially and after 12 months of follow-up.Results. Over 12 months, total SCHFI scores increased significantly by 62% in the telephone support group and by 34.7% in the comparison group (p<0.001). A significant maximum improvement in the score was noted in section B of this scale (self-care management) in patients in the telephone support group (by 100%; p<0.001).There was an improvement in the clinical condition and an increase in exercise tolerance in both groups, somewhat more in the telephone support group (p>0.05).However, there were no statistically significant differences in the intake of the main groups of drugs and the achievement of their target dosages (p>0.05).Conclusion. The study found a positive effect of structured telephone support on the self-care and the clinical condition of patients with CHF, although it did not reach the maximum possible acceptable values. Further studies are need to assess the self-care in patients with CHF.

A Quality Improvement Project to Support Post-Intensive Care Unit Patients with COVID-19: Structured Telephone Support.

Background: More than 50% of intensive care unit (ICU) survivors suffer from long-lasting physical, psychosocial, and cognitive health impairments, also called “post-intensive care syndrome” (PICS). Intensive care admission during the COVID-19 pandemic was especially uncertain and stressful, both for patients and for their family. An additional risk of developing symptoms of PICS was feared in the absence of structural aftercare for the patient and family shortly after discharge from the hospital. The purpose of this quality improvement study was to identify PICS symptoms and to support post-intensive care patients and families in the transition from the hospital to the home. Therefore, we offered post-ICU patients and families structured telephone support (STS). Methods: This was a quality improvement study during the 2019 COVID-19 pandemic. A project team developed and implemented a tool to structure telephone calls to identify and order symptoms according to the PICS framework and to give individual support based on this information. We supported post-ICU patients diagnosed with COVID-19 pneumonia and their family caregivers within four weeks after hospital discharge. The reported findings were both quantitative and qualitative. Results: Forty-six post-ICU patients received structured telephone support and reported symptoms in at least one of the three domains of the PICS framework. More than half of the patients experienced a loss of strength or condition and fatigue. Cognitive and psychological impairments were reported less frequently. Family caregivers reported fewer impairments concerning fatigue and sleeping problems and expressed a need for a continuity of care. Based on the obtained information, the ICU nurse practitioners were able to check if individual care plans were optimal and clear and, if indicated, initiated disciplines to optimize further follow-up. Conclusions: The implementation of the STS tool gave insight in the impairments of post-ICU patients. Surprisingly, family caregivers expressed fewer impairments. Giving support early after hospital discharge in a structured way may contribute to providing guidance in the individual care plans and treatment of the early symptoms of PICS (-F).

Usability and feasibility assessment of a smartphone application (Suhriday) for heart failure self-care remote monitoring in an Indian tertiary health care setting: a pilot mixed-methods study

Background/objectivesRemote monitoring as a component of chronic heart failure (CHF) management programmes has demonstrated utility in reducing the risk of rehospitalisation and mortality. There is little evidence on mobile health...

The effectiveness of structured telephone support in the late phase of rehabilitation at home in patients with myocardial revascularization

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Institute of Cardiology Background Nowadays remote monitoring seems to be a promising solution for the surveillance of patients with chronic heart disease. Purpose Assessing the impact of structured telephone support in the late phase of home rehabilitation in patients with myocardial revascularization. Methods The study included 180 patients (mean age- 63.0±0.4 years, 75.6% were men, mean follow up duration- 28.8±0.5 months), discharged after completing the cardiac rehabilitation program after myocardial revascularization by coronary artery bypass grafting (81.7%) or percutaneous coronary angioplasty (18.3%). All subjects were divided into 2 groups. STS-Gr included 84 patients (mean age- 63.2±0.7 years, 69.8%- men, mean follow up- 30.5±1.1 months). In this group remote monitoring was applied through Structured Telephone Support - patients being contacted by telephone regularly with the issuance of recommendations for the correction of treatment and risk factors. Non-STS-Gr included 96 patients (mean age- 62.8±0.5 years, 78% being men, mean follow up- 28.1±0.6 months), who were not remotely monitored. At the discharge from the hospital and at the end of the surveillance, all patients underwent echocardiographycal examination, assessement of NT-proBNP level and evaluation of quality of life by SF-36 questionnaire. Results The two groups of patients were comparable in terms of NYHA functional class of heart failure, cardiovascular and non-cardiovascular comorbidities, type of myocardial revascularization. At the follow up visit, in the general group was observed a significant increase in left ventricular ejection fraction by 4.3% (p<0.05) and a decrease in NT-proBNP level (-935.9±357.7, p<0.05), with similar dynamics in both groups. The rate of cardiovascular (CV) hospitalization in the general group during surveillance was 51.2%. In STS-Gr the CV-hospitalization rate was significantly lower compared to non-STS-Gr (47% vs 61.2%, p <0.01). The mortality rate in the general group was 7.8% and did not differ between STS-Gr and non-STS-Gr (7.5% vs 7.9%). The quality of life of patients in the general group attested a statistically important increase of the physical composite score compared to the initial data (+32.3, p<0.001). The physical composite score did not show significant differences between groups at the end of the study (STS-Gr-188.2±10.2, non-STS-Gr- 194.7±7.3). At the initial stage, the mental composite score was significantly lower in STS-Gr (198.6±14.8 vs 239.6±10.6, p<0.05). In contrast, at the end of surveillance, the mean value of the mental composite score in STS-Gr was higher than in non-STS-Gr (246.4±7.9 vs 224.9±5.7, respectively, p<0.05). Conclusions Structured telephone support has been shown to be effective in reducing the rate of cardiovascular hospitalization and improving the SF-36 mental composite score of patients in the late phase of home rehabilitation after myocardial revascularization, but has not influenced mortality.

Meaningful use of a digital platform and structured telephone support to facilitate remote person-centred care \u2013 a mixed-method study on patient perspectives

BackgroundProcess evaluations are useful in clarifying results obtained from randomised controlled trials (RCTs). Traditionally, the degree of intervention usage in process evaluations is monitored by measuring dose or evaluating implementation fidelity. From a person-centred perspective, such evaluations should be supplemented with patients’ experiences of meaningful use, given that intervention use should be agreed upon between interested parties and tailored to each patient. This study aimed to elucidate patients’ experiences of a remote person-centred care (PCC) intervention by deepening the understanding of, if, how and for whom the intervention contributed to meaningful use.MethodsPatients (n = 86) were recruited from the RCT PROTECT intervention group. A convergent mixed-method approach was implemented. Data were collected in parallel with the ongoing RCT via a survey, including ratings and written comments on meaningful or non-meaningful use. Also, interviews were performed with twelve purposefully selected participants. Descriptive statistics, logistic regression and content analysis were employed. Data sources were integrated in the results.ResultsMost participants rated the overall intervention as meaningful to use, with the telephone support rated as most meaningful. Interviews and written comments showed that patient ratings on meaningful use were explained by four categories: Not in need, Communication deficiency, Benefits in everyday life and A personal boost. Meaningful use of rating symptoms on the digital platform was predicted by living alone (adjusted odds ratio [aOR] = 2.8 P = .044). A diagnosis of chronic obstructive pulmonary disease (COPD) predicted meaningful use of digital platform direct messaging (aOR = 3.5, P = .045). Moreover, having access to direct-dial telephone contact explained meaningful use among participants with low ratings of technical competence (aOR = 3.6, P = .014).ConclusionsThe combined digital platform and structured telephone support could be helpful in identifying preventive actions to maintain health for people diagnosed with COPD and chronic heart failure but tends to be more meaningful for those diagnosed with COPD. Overall, lower adoption of the digital platform was seen compared to telephone support. Shortcomings were noted in the digital platform’s implementation that negatively influences experiences of meaningful use. When used, the intervention proved to be an easily applicable and valued tool to support preventive actions in a person-centred manner.

Performance of an eHealth (NOMHAD) System Comprising Telemonitoring, Telenotification, and Telecoaching for Patients With Multimorbidity: Proof-of-Concept Study.

BackgroundManagement of patients with multiple chronic diseases is a growing public health challenge, especially in rural sectors where access to physicians may be limited. Connected medical devices monitoring vital signs, associated with eHealth program and structured telephone support, may improve complex patient management through early detection of disease complications, positive impact on patients’ health, and health resources consumption optimization.ObjectiveThe aim of this study was to evaluate the technical performance and user experience of the NOMHAD eHealth system in patients with multimorbidity.MethodsThis was a pilot, single-arm, interventional study. Patients with multimorbidity with any combination of chronic heart failure (CHF), chronic obstructive pulmonary disease, and diabetes were followed for 80-100 days using the NOMHAD eHealth system. This system used connected devices telemonitoring symptoms and vital signs (eg, body weight, oxygen saturation, pulse rate, blood pressure, and blood glucose), associated with structured telecoaching and educational support by call center nurses. An overall risk indicator (ORI) was automatically computed after each data teletransmission. The ORI was color coded; green indicated no action required; yellow, orange, and red (low to high priority, respectively) generated telenotifications and indicated to the nurses the need for a telecoaching action. Each ORI was calculated by combining 7 clinical stability system indicators based on symptom questionnaires and vital signs. Technical accuracy of the system was assessed by comparing system-generated ORIs with ORIs recalculated from raw data. Ease of use, usefulness, satisfaction, and acceptability of the system were assessed through patient adherence to self-assessments, and through self-administered questionnaires to patients, call center nurses, and physicians.ResultsA total of 23 patients were enrolled in this study and participated between April 2016 and March 2017 at 5 study centers in France. All patients were successfully equipped and evaluable for analysis. Mean age was 68.5 (SD 10.4) years and most patients were men (n=20). The most common multimorbidity was CHF + diabetes (n=15), followed by patients with all 3 diseases (n=5). Mean effective follow-up was 78.7 (SD 24.2) days. The system generated 6263 ORIs, as several ORIs could be generated on a single day for any patient. Overall system sensitivity was 99.2% (95% CI 98.9-99.4) and overall specificity was 91.3% (95% CI 87.7-94.1). Most patients (20/23, 87%) were satisfied with the system and agreed that it helped them to better understand and manage their diseases, and 19/23 (83%) valued the nurse regular contacts. Nurses and physicians were generally satisfied with the system and considered it useful. All users indicated they would agree to long-term use of the system.ConclusionsThis study provides evidence that the NOMHAD eHealth system is accurate, acceptable, informative, and feasible for patients with multimorbidity, supporting further investigation of its clinical benefits.Trial RegistrationAgence Nationale de Sécurité du Médicament et des Produits de Santé 2015-A01106-43; https://ictaxercb.ansm.sante.fr/Public/index.php

Effects of Person-Centered Care Using a Digital Platform and Structured Telephone Support for People With Chronic Obstructive Pulmonary Disease and Chronic Heart Failure: Randomized Controlled Trial.

BackgroundChronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) are characterized by severe symptom burden and common acute worsening episodes that often require hospitalization and affect prognosis. Although many studies have shown that person-centered care (PCC) increases self-efficacy in patients with chronic conditions, studies on patients with COPD and CHF treated in primary care and the effects of PCC on the risk of hospitalization in these patients are scarce.ObjectiveThe aim of this study is to evaluate the effects of PCC through a combined digital platform and telephone support for people with COPD and CHF.MethodsA multicenter randomized trial was conducted from 2018 to 2020. A total of 222 patients were recruited from 9 primary care centers. Patients diagnosed with COPD, CHF, or both and with internet access were eligible. Participants were randomized into either usual care (112/222, 50.5%) or PCC combined with usual care (110/222, 49.5%). The intervention’s main component was a personal health plan cocreated by the participants and assigned health care professionals. The health care professionals called the participants in the intervention group and encouraged narration to establish a partnership using PCC communication skills. A digital platform was used as a communication tool. The primary end point, divided into 2 categories (improved and deteriorated or unchanged), was a composite score of change in general self-efficacy and hospitalization or death 6 months after randomization. Data from the intention-to-treat group at 3- and 6-month follow-ups were analyzed. In addition, a per-protocol analysis was conducted on the participants who used the intervention.ResultsNo significant differences were found in composite scores between the groups at the 3- and 6-month follow-ups. However, the per-protocol analysis of the 3-month follow-up revealed a significant difference in composite scores between the study groups (P=.047), although it was not maintained until the end of the 6-month follow-up (P=.24). This effect was driven by a change in general self-efficacy from baseline.ConclusionsPCC using a combined digital platform and structured telephone support seems to be an option to increase the short-term self-efficacy of people with COPD and CHF. This study adds to the knowledge of conceptual innovations in primary care to support patients with COPD and CHF.Trial RegistrationClinicalTrials.gov NCT03183817; http://clinicaltrials.gov/ct2/show/NCT03183817

Effects of remote monitoring of patients with heart failure based on smartphone application in the context of the COVID-19 pandemic in the Kyrgyz Republic

Abstract Background Patients with CHF were the most vulnerable during the COVID-19 pandemic. Given to reduce hospitalizations and outpatient appointments, remote monitoring of CHF patients using a mobile application in response to the COVID-19 pandemic has proven particularly relevant, providing continuous specialized medical care and ensuring social distancing. Purpose To study the clinical effectiveness of the implementation of a mobile application for remote monitoring of patients with CHF compared with standard practice during the COVID-19 pandemic in a mountainous country. Methods ERICA-HF is a randomized, controlled, open-label study. Were included patients with verified CHF III FC (NYHA) with randomization to the main group of remote monitoring of patients using a mobile application + standard treatment (n=200) or to the control group on standard outpatient follow-up at the place of residence (n=100), for 12 months. The assessment of the clinical course of CHF is carried out on the basis of clinical indicators that allow assessing the current state of patients, depending on the quantitative assessment of deviations above or below the threshold values, consisting of seven points: shortness of breath, position in bed, heartbeating, edema, weight, blood pressure, heart rate, which the patient fills twice a week, with the possibility of automatically notifying the doctor and the patient. The application is equipped with two-way feedback in the form of structured telephone support and online chat. Quality of life assessment according to the Minnesota Living With Heart Failure Questionnaire, the ability to self-control according to the scale EHFScBS_9. The primary outcome is the percentage of unplanned rehospitalizations for HF decompensation, quality of life, mortality from CHF. The main secondary outcomes are cost-effectiveness and adherence to treatment. Results During the COVID-19 pandemic, 209 patients on remote monitoring with CHF from all regions (63% men, age 65±11 years) were observed by coordinating cardiologists, 24 of them got sick with COVID-19, 7 received hospital treatment due to the development of HF decompensation, pneumonia and respiratory failure, 3 died of pneumonia. 9 participants dropped out of the study due to Internet traffic interruptions. 95% of patients noted high compliance, confidence, gave a positive assessment and use of the mobile application. Conclusion Remote monitoring using a mobile application was an effective means of managing patients with CHF in socially isolation. This suggests that remote monitoring using a smart phone can be a good alternative to outpatient practice, which we have demonstrated in the context of the COVID-19 pandemic. Also, the relatively low cost can greatly facilitate the implementation of remote monitoring programs using a mobile application. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): National center of cardiology and internal medicine named after academician M. Mirrakhimov

Patient Perspectives on Innovative Telemonitoring Enhanced Care Program for Chronic Heart Failure (ITEC-CHF): Usability Study.

BackgroundTelemonitoring enables care providers to remotely support outpatients in self-managing chronic heart failure (CHF), but little is known about the usability and patients’ willingness to engage with this technology.ObjectiveThis study aims to evaluate feedback from patients with CHF following participation in the Innovative Telemonitoring Enhanced Care program for CHF (ITEC-CHF) study.MethodsThe telemonitoring intervention consisted of three components: remote weight monitoring, structured telephone support, and nurse-led collaborative care. Participants were provided with electronic weighing scales (W550; ForaCare), and a computer tablet (Galaxy Tab A; Samsung). They were asked to weigh themselves on the provided scales daily. Telemonitoring was integrated with a personal assistance call service and a nurse care service according to their workflows in usual care. Feedback on the usability of ITEC-CHF was collected via survey from study participants following 6 months of receiving telemonitoring care for their body weight. Survey responses were provided on a 5-point Likert scale and through open-ended questions to determine participants’ perceived benefits and barriers to using ITEC-CHF.ResultsA total of 67 participants (49/67, 73% male), with a mean age of 69.8 (SD 12.4) years completed the survey. The majority of participants agreed or strongly agreed that the ITEC-CHF program was easy to use (61/67, 91%), easy to navigate (51/65, 78%), useful (59/65, 91%), and made them feel more confident in managing their weight (57/67, 85%). Themes related to participants’ perceptions of telemonitoring included increased support for early intervention of clinical deterioration, improved compliance to daily weighing, a sense of reassurance, and improved self-care and accountability, among others.ConclusionsITEC-CHF was rated highly on usability and was well accepted by users as part of their routine self-management activities. Participants were willing to use telemonitoring because they perceived a broad spectrum of benefits for CHF management.Trial RegistrationAustralian New Zealand Clinical Trial Registry ID ACTRN 12614000916640; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366691.

Effects of person-centred care via telephone on self-efficacy in patients with chronic obstructive pulmonary disease: Subgroup analysis of a randomized controlled trial.

AimTo evaluate the effects of PCC in the form of structured telephone support on self‐reported cardiac self‐efficacy in patients with COPD.MethodsWe enrolled 105 patients, aged ≥50 years, admitted to hospital and diagnosed with COPD from January 2015 to November 2016. The patients received usual care or PCC via telephone added to usual care. The Swedish Cardiac Self‐Efficacy Scale comprising three dimensions (control symptoms, control illness and maintain functioning) was used as outcome measure. Data was collected at baseline, and at 3‐ and 6‐month follow‐ups.ResultsAt both the 3‐ and 6‐month follow‐ups, the intervention group improved significantly more than the control group in the control illness dimension (p = .012 and p = .032, respectively). No differences were found in the other two dimensions.ConclusionsPCC in the form of structured telephone support increases patients’ confidence in managing their illness and may be a feasible strategy to support patients in their homes.

Becoming more of an insider: A grounded theory study on patients' experience of a person-centred e-health intervention.

The aim was to explore the experiences of a person-centred e-health intervention, in patients diagnosed with chronic obstructive pulmonary disease (COPD) or chronic heart failure (CHF). Grounded theory was applied to gather and analyse data. The study is part of a research project evaluating the effects of person-centred care (PCC) using a digital platform and structured telephone support for people with COPD or CHF recruited from nine primary care units in Sweden. Twelve patients from the intervention group were purposefully selected in accordance with the initial sampling criteria. The intervention was delivered through a digital platform and telephone support system for 6 months. The intervention relied on person-centred ethics operationalised through three core PCC components: patient narratives, partnership and shared documentation. A core category was formulated: Being welcomed through the side door when lacking the front door keys. The core category reflects how a PCC intervention delivered remotely provides access to mutual and informal meetings at times when professional contacts were desired to support patient self-management goals. According to patients' wishes, family and friends were seldom invited as care partners in the e-health context. A PCC intervention delivered remotely as a complement to standard care in a primary care setting for patients diagnosed with COPD or CHF is a viable approach to increase patients' access and involvement in preventive care. The e-health intervention seemed to facilitate PCC, strengthen patients' position in the health service system and support their self-management.

A transitional care intervention for hypertension control for older people with diabetes: A cluster randomized controlled trial.

To evaluate the effect of a nurse-coordinated hospital-initiated transitional care programme on hypertension control for older people with diabetes in China. A cluster randomized controlled trial. A total of 10 wards (clusters) of four acute care hospitals participated in the trial. They were randomly assigned to the intervention group or the control group. A total of 270 participants (135 in each group) were recruited from these wards. Data were collected between June 2016 - June 2017. Participants in the intervention group received a 6-month hospital to home transitional care programme coordinated by discharge nurses and community nurses. The programme comprised self-management education, lifestyle changes, individualized medication treatment, structured telephone support, and primary care visits. Outcomes were measured at baseline, and 3months and 6months from the baseline. The mean age was 70.9 (SD 5.8) years and 55% of participants were men. The intervention group demonstrated a statistically significant decrease in mean systolic blood pressure of 10.7mmHg and mean diastolic blood pressure of 4.1mmHg compared with the control group. The findings also demonstrated significant improvements in HbA1c, hypertension knowledge, diabetes knowledge, treatment adherence, quality of life, hospital readmission, and emergency department visits in the intervention group compared with the control group. However, no significant differences in adverse events were observed between the two groups. A hospital-initiated and nurse-coordinated transitional care intervention improves hypertension control and reduces hospital readmissions for older people with diabetes. Lack hospital to home transitional care for hospitalized older people with hypertension and diabetes can result in high readmission rates and emergency department visits. A hospital-initiated and nurse-coordinated transitional care intervention built on collaboration between acute care hospitals and community health centres results in improved hypertension control and reduced readmissions for older people with diabetes and other chronic conditions. An integrated and well-coordinated care services between acute care hospitals and community health centres can strengthen the primary care approach to supporting self-management of hypertension, diabetes, and other ageing-associated health conditions for community-dwelling older people. The trial was registered with the Australia New Zealand Clinical Trials Registry (ID: ACTRN12617001352392).

Person-centred care by a combined digital platform and structured telephone support for people with chronic obstructive pulmonary disease and/or chronic heart failure: study protocol for the PROTECT randomised controlled trial

BackgroundA core feature of chronic obstructive pulmonary disorder (COPD) and chronic heart failure (CHF) is that symptoms may change rapidly because of illness progression. Thus, these chronic conditions are associated...

Structured telephone support programs in chronic heart failure may be affected by a learning curve.

The efficacy of a telephone support program in chronic heart failure has been questioned particularly when considering short-term follow-up. This study is aimed to assess the impact of the HeartNetCare telephone support program in chronic heart failure within 18 months of observation and to verify a possible effect of a learning-to-care curve on outcome. We retrospectively compared a cohort of 269 chronic heart failure patients included in HeartNetCare program with 200 patients receiving usual care as a control group. All-cause death and hospitalization for heart failure or implantation of left ventricular assist device were the primary composite outcome. Secondary endpoints were the changes in left ventricular ejection fraction and in New York Heart Association (NYHA) functional class. Outcome data were also analyzed in relation to the time of enrollment from program initiation. At baseline, HeartNetCare group showed lower ejection fraction and higher NYHA class. At the follow-up, 59 HeartNetCare patients (21.9%) and 49 usual care patients (24.5%) reached the primary endpoint (P = 0.51). After 18 months of follow-up, HeartNetCare patients improved ejection fraction and NYHA class compared with the usual care patients (P < 0.001). We also observed that the HeartNetCare patients enrolled after 12 months from the initiation of the program had a more favorable outcome in primary endpoint compared with controls. These results indicate that the long-term impact of a structured telephone support program might be able to positively influence symptoms and reduce events in chronic heart failure. These appreciable effects where more evident after an initial period essential for completing the learning-to-care curve.

Structured Telephone Support Intervention: Improved Heart Failure Outcomes.

BackgroundPresently, 6.5 million Americans are living with heart failure (HF). These patients are expected to follow a complex self-management regimen at home. Several demographic and psychosocial factors limit patients with HF in following the prescribed self-management recommendations at home. Poor self-care is associated with increased hospital readmissions. Under the Affordable Care Act, there are financial implications related to hospital readmissions for hospitals and programs such as the Program of All-Inclusive Care for the Elderly (PACE) in Pinellas County, Florida. Previous studies and systematic reviews demonstrated improvement in self-management and quality of life (QoL) in patients with HF with structured telephone support (STS) and SMS text messaging.ObjectiveThis study aimed to evaluate the effects of STS and SMS on self-care, knowledge, medication adherence, and QoL of patients with HF.MethodsA prospective quality improvement project using a pre-post design was implemented. Data were collected at baseline, 30 days, and 3 months from 51 patients with HF who were enrolled in PACE in Pinellas County, Florida. All participants received STS and SMS for 30 days. The feasibility and sustained benefit of using STS and SMS was assessed at a 3-month follow-up.ResultsA paired t test was used to compare the mean difference in HF outcomes at the baseline and 30-day follow-up, which demonstrated improved HF self-care maintenance (t 49=0.66; P=.01), HF knowledge (t 49=0.71; P=.01), medication adherence (t 49=0.92; P=.01), and physical and mental health measured using Short-Form-12 (SF-12; t 49=0.81; P=.01). The results also demonstrated the sustained benefit with improved HF self-care maintenance, self-care management, self-care confidence, knowledge, medication adherence, and physical and mental health (SF-12) at 3 months with P<.05 for all outcomes. Living status and social support had a strong correlation with HF outcomes. Younger participants (aged less than 65 years) performed extremely well compared with older adults.ConclusionsSTS and SMS were feasible to use among PACE participants with sustained benefits at 3 months. Implementing STS and SMS may serve as viable options to improve HF outcomes. Improving outcomes with HF affects hospital systems and the agencies that monitor and provide care for outpatients and those in independent or assisted-living facilities. Investigating viable options and support for implementation will improve outcomes.

The Galaxy Plot: A New Visualization Tool for Bivariate Meta-Analysis Studies.

Funnel plots have been widely used to detect small-study effects in the results of univariate meta-analyses. However, there is no existing visualization tool that is the counterpart of the funnel plot in the multivariate setting. We propose a new visualization method, the galaxy plot, which can simultaneously present the effect sizes of bivariate outcomes and their standard errors in a 2-dimensional space. We illustrate the use of the galaxy plot with 2 case studies, including a meta-analysis of hypertension trials with studies from 1979-1991 (Hypertension. 2005;45(5):907-913) and a meta-analysis of structured telephone support or noninvasive telemonitoring with studies from 1966-2015 (Heart. 2017;103(4):255-257). The galaxy plot is an intuitive visualization tool that can aid in interpreting results of multivariate meta-analysis. It preserves all of the information presented by separate funnel plots for each outcome while elucidating more complex features that may only be revealed by examining the joint distribution of the bivariate outcomes.