Telemonitoring Of Patients Research Articles

Adapting a home telemonitoring intervention for underserved Hispanic/Latino patients with type 2 diabetes: an acceptability and feasibility study

BackgroundHome telemonitoring is a promising approach to optimizing outcomes for patients with Type 2 Diabetes; however, this care strategy has not been adapted for use with understudied and underserved Hispanic/Latinos (H/L) patients with Type 2 Diabetes.MethodsA formative, Community-Based Participatory Research approach was used to adapt a home telemonitoring intervention to facilitate acceptability and feasibility for vulnerable H/L patients. Utilizing the ADAPT-ITT framework, key stakeholders were engaged over an 8-month iterative process using a combination of strategies, including focus groups and structured interviews. Nine Community Advisory Board, Patient Advisory, and Provider Panel Committee focus group discussions were conducted, in English and Spanish, to garner stakeholder input before intervention implementation.Focus groups and structured interviews were also conducted with 12 patients enrolled in a 1-month pilot study, to obtain feedback from patients in the home to further adapt the intervention. Focus groups and structured interviews were approximately 2 hours and 30 min, respectively. All focus groups and structured interviews were audio-recorded and professionally transcribed. Structural coding was used to mark responses to topical questions in the moderator and interview guides.ResultsTwo major themes emerged from qualitative analyses of Community Advisory Board/subcommittee focus group data. The first major theme involved intervention components to maximize acceptance/usability. Subthemes included tablet screens (e.g., privacy/identity concerns; enlarging font sizes; lighter tablet to facilitate portability); cultural incongruence (e.g., language translation/literacy, foods, actors “who look like me”); nursing staff (e.g., ensuring accessibility; appointment flexibility); and, educational videos (e.g., the importance of information repetition). A second major theme involved suggested changes to the randomized control trial study structure to maximize participation, including a major restructuring of the consenting process and changes designed to optimize recruitment strategies. Themes from pilot participant focus group/structured interviews were similar to those of the Community Advisory Board such as the need to address and simplify a burdensome consenting process, the importance of assuring privacy, and an accessible, culturally congruent nurse.ConclusionsThese findings identify important adaptation recommendations from the stakeholder and potential user perspective that should be considered when implementing home telemonitoring for underserved patients with Type 2 Diabetes.Trial registrationNCT03960424; ClinicalTrials.gov (US National Institutes of Health). Registered 23 May 2019. Registered prior to data collection. https://www.clinicaltrials.gov/ct2/show/NCT03960424?term=NCT03960424&draw=2&rank=1

Follow-up with Telemedicine in Early Discharge for COPD Exacerbations: Randomized Clinical Trial (TELEMEDCOPD-Trial)

The results reported by different studies on telemonitoring in patients with chronic obstructive pulmonary disease (COPD) have been contradictory, without showing clear benefits to date. The objective of this study was to ascertain whether an early discharge and home hospitalization telehealth program for patients with COPD exacerbation is as effective as and more efficient than a traditional early discharge and home hospitalization program. A prospective experimental non-inferiority study, randomized into two groups (telemedicine/control) was conducted. The telemedicine group underwent monitoring and was required to transmit data on vital constants and ECGs twice per day, with a subsequent telephone call and 2 home visits by healthcare staff (intermediate and at discharge). The control group received daily visits. The main variable was time until first exacerbation. The secondary variables were: number of exacerbations; use of healthcare resources; satisfaction; quality of life; anxiety-depression; and therapeutic adherence, measured at one and 6 months of hospital discharge. A total of 116 patients were randomized (58 to each group) without significant differences in baseline characteristics or time until first exacerbation, i.e. median 48 days (pp. 25–75:23–120) in the control group, and 47 days (pp. 25–75:19–102) in the intervention group; p = 0.52). A significant decrease in the number of visits was observed in the intervention versus the control group, 3.8 ± 1 vs 5.1 ± 2(p = 0.001), without significant differences in the number of exacerbations. In conclusion follow-up via a telemedicine program in early discharge after hospitalization is as effective as conventional home follow up, being the cost of either strategy not significantly different.

Quality Assessment of an Integrated Care Pathway Using Telemonitoring in Patients with Chronic Heart Failure and Chronic Obstructive Pulmonary Disease: Protocol for a Quasi-Experimental Study.

BackgroundChronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) often coexist and are associated with a high morbidity and reduced quality of life (QoL). Although these diseases share similarities in symptoms and clinical course, and exacerbations of both diseases often overlap, care pathways for both conditions are usually not integrated. This results in frequent outpatient consultations and suboptimal treatment during exacerbations, leading to frequent hospital admissions. Therefore, we propose an integrated care pathway for both diseases, using telemonitoring to detect deterioration at an early stage and a single case manager for both diseases.ObjectiveThis study aims to investigate whether an integrated care pathway using telemonitoring in patients with combined CHF and COPD results in a higher general health-related QoL (HRQoL) as compared with the traditional care pathways. Secondary end points include disease-specific HRQoL, level of self-management, patient satisfaction, compliance to the program, and cost-effectiveness.MethodsThis is a monocenter, prospective study using a quasi-experimental interrupted time series design. Thirty patients with combined CHF and COPD are included. The study period of 2.5 years per patient is divided into a preintervention phase (6 months) and a postintervention phase (2 years) in which end points are assessed. The intervention consists of an on-demand treatment strategy based on monitoring symptoms related to CHF/COPD and vital parameters (weight, blood pressure, heart rate, oxygen saturation, temperature), which are uploaded on a digital platform. The monitoring frequency and the limit values of the measurements to detect abnormalities are determined individually. Monitoring is performed by a case manager, who has the opportunity for a daily multidisciplinary meeting with both the cardiologist and the pulmonologist. Routine appointments at the outpatient clinic are cancelled and replaced by telemonitoring-guided treatment.ResultsFollowing ethical approval of the study protocol, the first patient was included in May 2018. Inclusion is expected to be complete in May 2021.ConclusionsThis study is the first to evaluate the effects of a novel integrated care pathway using telemonitoring for patients with combined CHF and COPD. Unique to this study is the concept of remote on-demand disease management by a single case manager for both diseases, combined with multidisciplinary meetings. Moreover, modern telemonitoring technology is used instead of, rather than as an addition to, regular care.Trial RegistrationNetherlands Trial Register NL6741; https://www.trialregister.nl/trial/6741International Registered Report Identifier (IRRID)DERR1-10.2196/20571

Blood pressure telemonitoring and remote counseling of hypertensive patients: pros and cons

Home blood pressure monitoring (HBPM) is strongly recommended by current guidelines as an effective out-of-office diagnostic and monitoring tool in patients with hypertension (HTN). However, there are personal, cultural, logistic difficulties owing to low effectiveness of HBPM. These put HBPM at a disadvantage in routine clinical practice. As such, telehealth solutions are of special interest nowadays, particularly blood pressure telemonitoring (BPTM) with or without remote counseling. BPTM might become something of digital assistant in the long-term patients’ follow-up and it fits well into the practice of continuity of medical care. The purpose of this review is to highlight not only the benefits of BPTM, but important discrepancies that may impede its widespread implementation in everyday clinical work. Critical comments address the lack of long-term, high-quality studies, absence of hard clinical outcomes and uncertainty on the best technical performance.

Remote TELEmonitoring and Health Coaching for patients with acute heart failure: results of the TELE-HC randomized trial

Abstract Introduction Patients discharged after acute decompensated heart failure (ADHF) have elevated risk for readmission due to multiple factors including suboptimal behavioral and social support. Telemonitoring interventions have shown inconsistent effectiveness in reducing HF readmissions. Patient-centered health coaching, when combined with telemonitoring, may be a viable model to engage patients in self-care behaviors and enhance patient experiences following acute hospitalization. Purpose This multicenter randomized trial evaluates whether remote telemonitoring combined with health coaching decreases 60 day readmission rates for patients with ADHF when compared to standard of care. Methods Patients with primary or secondary diagnosis of ADHF were consented and randomized prior to hospital discharge to either standard care or intervention of remote telemonitoring and health coaching. Within 2 days of hospital dismissal, intervention patients were onboarded to the remote monitoring platform, which links personal health sensors which collect on-body physiologic measures (ECG, heart rate, respiration rate, and activity via 3-axis accelerometer) with providers through secure mobile communication. A registered nurse was designated as the primary health coach focusing on disease management - including symptom recognition, adherence to treatment strategies, care coordination, medication matters, and problem solving. A social worker and nutritionist were also assigned. The primary outcome was all-cause mortality or readmission within 60 days of hospital dismissal. Statistical analysis included stratified log-rank tests and stratified Cochran-Mantel-Haenszel Chi-square test to account for site-stratified randomization. Results The study was halted due to low rate of subject accrual. Of planned 304 subjects, 143 were randomized between 2015 and 2019 at 6 sites in the United States. Dropout and withdrawal after randomization of 32 subjects (22%) left 112 analyzable for the primary endpoint. Many subject withdrawals after unblinded disclosure of arm allocation were related to treatment assignment. Immediate withdrawal without follow up in these subjects precluded an intention-to-treat analysis. Mean age was 69 years and subjects were more often male (56%) and non-Hispanic white (70%). In per-protocol analysis, using subjects adherent to protocol specified visits (n=112), we observe no difference in the primary outcome (26% among intervention vs 28% among standard care, Figure, p=0.77). There were also no differences among secondary outcomes of overall mortality (2% vs 7%, p=0.20) or composite emergency department visit, hospital admission, or death (35% vs 34%, p=0.85). Conclusions Among patients with heart failure, an intervention of remote telemonitoring and health coaching did not reduce all-cause readmission or mortality. Significant withdrawal rates suggest future studies may need to improve screening and study retention. Figure 1 Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Institutes of Health, National Institute on Aging

A Telemonitoring and Hybrid Virtual Coaching Solution "CAir" for Patients with Chronic Obstructive Pulmonary Disease: Protocol for a Randomized Controlled Trial.

BackgroundChronic obstructive pulmonary disease (COPD) is one of the most common disorders in the world. COPD is characterized by airflow obstruction, which is not fully reversible. Patients usually experience breathing-related symptoms with periods of acute worsening and a substantial decrease in the health-related quality-of-life. Active and comprehensive disease management can slow down the progressive course of the disease and improve patients’ disabilities. Technological progress and digitalization of medicine have the potential to make elaborate interventions easily accessible and applicable to a broad spectrum of patients with COPD without increasing the costs of the intervention.ObjectiveThis study aims to develop a comprehensive telemonitoring and hybrid virtual coaching solution and to investigate its effects on the health-related quality of life of patients with COPD.MethodsA monocentric, assessor-blind, two-arm (intervention/control) randomized controlled trial will be performed. Participants randomized to the control group will receive usual care and a CAir Desk (custom-built home disease-monitoring device to telemonitor disease-relevant parameters) for 12 weeks, without feedback or scores of the telemonitoring efforts and virtual coaching. Participants randomized to the intervention group will receive a CAir Desk and a hybrid digital coaching intervention for 12 weeks. As a primary outcome, we will measure the delta in the health-related quality of life, which we will assess with the St. George Respiratory Questionnaire, from baseline to week 12 (the end of the intervention).ResultsThe development of the CAir Desk and virtual coach has been completed. Recruitment to the trial started in September 2020. We expect to start data collection by December 2020 and expect it to last for approximately 18 months, as we follow a multiwave approach. We expect to complete data collection by mid-2022 and plan the dissemination of the results subsequently.ConclusionsTo our knowledge, this is the first study investigating a combination of telemonitoring and hybrid virtual coaching in patients with COPD. We will investigate the effectiveness, efficacy, and usability of the proposed intervention and provide evidence to further develop app-based and chatbot-based disease monitoring and interventions in COPD.Trial RegistrationClinicalTrials.gov identifier: NCT04373070; https://clinicaltrials.gov/ct2/show/NCT04373070International Registered Report Identifier (IRRID)DERR1-10.2196/20412

Remote Monitoring Empowerment of Patients with IBDs during the SARS-CoV-2 Pandemic.

Once the WHO declared the Sars-CoV-2 pandemic, the world had to reprogram numerous clinical activities, particularly those related to highly disabling diseases such as inflammatory bowel diseases (IBDs). In this study, 1083 IBD patients were assessed, affected by Crohn’s Disease (CD) and Ulcerative Colitis (UC), and subdivided into two groups. The first group included patients who needed treatment in person at the outpatients clinic, while the second group could be tele-monitored because they were able to self-administer therapy. The tele-monitoring was based on telecommunication applications via smartphone, driven by a dedicated clinical control room in the IBD Clinic. The aim of this study was to assess the quality of life (using IBDQ32) of UC patients and tele-monitored CD patients (tele-monitoring group) as compared to those patients who underwent assessment in person in the outpatients clinic (control group). Despite observing a lower number of relapses in the control group than the tele-monitoring group, there were no statistically significant differences between the groups in terms of the IBD32Q scores. Tele-monitoring of patients who are able to self-administer the IBD therapy can be an effective vicarious system as compared to the clinical evaluation in person, that could lead to important changes to avoid the overcrowding of the IBD outpatients clinic, especially during public health crises like the present pandemic.

Value-based approach to blood pressure telemonitoring and remote counseling in hypertensive patients

Purpose Blood pressure telemonitoring and remote counselling (BPTM) improves blood pressure (BP) control in patients with hypertension (HTN). Studies assessing the efficacy of BPTM from a value-based perspective are lacking. We investigated whether BPTM fits all principles of the value-based approach (clinical and economic effectiveness, improvement in patient-reported outcome/experience measures (PROM/PREM)). Materials and methods Two hundred and forty ambulatory patients with uncontrolled HTN were randomised in a 2: 1 manner to BPTM (n = 160, mean age 47 y.o.) and usual care (UC, n = 80; 49 y.o.) with baseline and 3-month follow-up clinic visits. BPTM employed a mobile application (for patients) and a desktop version (for clinician), which allowed communication and exchange of medical data. The main outcomes were changes in office and ambulatory systolic (S) BPs, rate of BP control. The incremental cost-effectiveness ratio (ICER) and incremental cost-utility ratio (ICUR) were evaluated in economic analysis. The MOS SF-36 score was taken as a PROM, and the PEQ score was used as a PREM. Results Larger decreases in office and ambulatory SBPs (–16.8 and −8.9 mm Hg, respectively; p < .05) was achieved in BPTM group while the treatment intensity was equal (2.4 drugs). The ICER 11.1 EUR/–1 mm Hg 24-hour SBP/1 year was 75% effective as per willingness-to-pay threshold. BPTM improved PROM (+2.1 in mean MOS SF-36; p = .04), reduced long-term mortality (+0.11 life years gained), leading to +0.49 quality-adjusted life years (QALYs) gained as compared with UC. The ICUR was 4 169.4 EUR/QALY gained. Patient-reported experience was higher in the BPTM (+10 PEQ, p = .01). The UC group showed minor changes in MOS SF-36 and PEQ (+1.3; +6, respectively; p n.s.). Conclusions Being cost-effective, BPTM incorporates both clinical benefits and patient-perceived value. Larger randomised studies are needed to confirm our findings.

Non-invasive telemonitoring improves outcomes in heart failure with reduced ejection fraction: a study in high-risk patients.

AimsNon‐invasive telemonitoring (TM) in patients with heart failure (HF) and reduced left ventricular ejection fraction (HFrEF) may be useful in the early diagnosis of HF decompensation, allowing therapeutic optimization and avoiding re‐hospitalization. We describe a TM programme in this population and evaluate its effectiveness during a 12 month period.Methods and resultsWe conducted a single‐centre study of patients discharged from hospital after decompensated HF, allocated into three groups: prospective TM programme, prospective HF protocol follow‐up programme (PFP) with no TM facilities, and retrospective propensity‐matched usual care (UC). TM effectiveness was assessed by all‐cause hospitalizations and mortality; HF‐related hospitalization (HFH), days lost to unplanned hospital admissions/death, functional capacity and quality of life (New York Heart Association, Kansas City Cardiomyopathy Questionnaire, 6 min walk test, and plasma N‐terminal pro‐brain natriuretic peptide) were also evaluated. A total of 125 patients were included [65.9 ± 11.9 years, 32% female, left ventricular ejection fraction 27% (21–32)]. TM was similar to PFP regarding effectiveness; TM reduced all‐cause hospitalization and mortality (HR 0.27; 95% CI 0.11–0.71; P < 0.01) and HFH (HR 0.29; 95% CI 0.10–0.89; P < 0.05) as compared with UC. TM reduced the average number of days lost due to unplanned hospital admissions or all‐cause death as compared with PFP (5.6 vs. 12.4 days, P < 0.05) and UC (5.6 vs. 48.8 days, P < 0.01). Impact on quality of life was similar between TM and PFP (P = 0.36).ConclusionsIn patients with HFrEF and recent HF hospitalization, non‐invasive TM reduced 12 month all‐cause hospitalization/mortality and HFH as compared with usual care. TM also reduced the number of days lost due to unplanned hospital admission/death as compared with either an optimized protocol‐based follow‐up programme or usual care.

Tele-Monitoring of Cancer Patients' Rhythms during Daily Life Identifies Actionable Determinants of Circadian and Sleep Disruption.

The dichotomy index (I < O), a quantitative estimate of the circadian regulation of daytime activity and sleep, predicted overall cancer survival and emergency hospitalization, supporting its integration in a mHealth platform. Modifiable causes of I < O deterioration below 97.5%—(I < O)low—were sought in 25 gastrointestinal cancer patients and 33 age- and sex-stratified controls. Rest-activity and temperature were tele-monitored with a wireless chest sensor, while daily activities, meals, and sleep were self-reported for one week. Salivary cortisol rhythm and dim light melatonin onset (DLMO) were determined. Circadian parameters were estimated using Hidden Markov modelling, and spectral analysis. Actionable predictors of (I < O)low were identified through correlation and regression analyses. Median compliance with protocol exceeded 95%. Circadian disruption—(I < O)low—was identified in 13 (52%) patients and four (12%) controls (p = 0.002). Cancer patients with (I < O)low had lower median activity counts, worse fragmented sleep, and an abnormal or no circadian temperature rhythm compared to patients with I < O exceeding 97.5%—(I < O)high—(p < 0.012). Six (I < O)low patients had newly-diagnosed sleep conditions. Altered circadian coordination of rest-activity and chest surface temperature, physical inactivity, and irregular sleep were identified as modifiable determinants of (I < O)low. Circadian rhythm and sleep tele-monitoring results support the design of specific interventions to improve outcomes within a patient-centered systems approach to health care.

Telemonitoring Versus Usual Care for Elderly Patients With Heart Failure Discharged From the Hospital in the United States: Cost-Effectiveness Analysis.

BackgroundTelemonitoring-guided interventional management reduces the need for hospitalization and mortality of patients with chronic heart failure (CHF).ObjectiveThis study aimed to analyze the cost-effectiveness of usual care with and without telemonitoring-guided management in patients with CHF discharged from the hospital, from the perspective of US health care providers.MethodsA lifelong Markov model was designed to estimate outcomes of (1) usual care alone for all postdischarge patients with CHF (New York Heart Association [NYHA] class I-IV), (2) usual care and telemonitoring for all postdischarge patients with CHF, (3) usual care for all postdischarge patients with CHF and telemonitoring for patients with NYHA class III to IV, and (4) usual care for all postdischarge patients with CHF plus telemonitoring for patients with NYHA class II to IV. Model inputs were derived from the literature and public data. Sensitivity analyses were conducted to assess the robustness of model. The primary outcomes were total direct medical cost, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER).ResultsIn the base case analysis, universal telemonitoring group gained the highest QALYs (6.2967 QALYs), followed by the telemonitoring for NYHA class II to IV group (6.2960 QALYs), the telemonitoring for NYHA class III to IV group (6.2450 QALYs), and the universal usual care group (6.1530 QALYs). ICERs of the telemonitoring for NYHA class III to IV group (US $35,393 per QALY) and the telemonitoring for NYHA class II to IV group (US $38,261 per QALY) were lower than the ICER of the universal telemonitoring group (US $100,458 per QALY). One-way sensitivity analysis identified five critical parameters: odds ratio of hospitalization for telemonitoring versus usual care, hazard ratio of all-cause mortality for telemonitoring versus usual care, CHF hospitalization cost and monthly outpatient costs for NYHA class I, and CHF hospitalization cost for NYHA class II. In probabilistic sensitivity analysis, probabilities of the universal telemonitoring, telemonitoring for NYHA class II to IV, telemonitoring for NYHA class III to IV, and universal usual care groups to be accepted as cost-effective at US $50,000 per QALY were 2.76%, 76.31%, 18.6%, and 2.33%, respectively.ConclusionsUsual care for all discharged patients with CHF plus telemonitoring-guided management for NYHA class II to IV patients appears to be the preferred cost-effective strategy.

Methodology for measuring the gap size using a fiber-optic displacement sensor exemplified by a centrifugal blood pump

In order to avoid blood clotting, in the second generation of rotary blood pumps the impeller is suspended without mechanical bearing, using balance of magnetic and hydrodynamic forces. Reaching single tens of microns gap between pump housing and impeller is crucial for level of blood traumatization by the pump. In this paper we would like to present the method of physical measurement of this gap on a running pump with the use of commercial fiber-optic proximity sensor on the example of Polish rotary blood pump ReligaHeart ROT. We also discussed technical requirements of the construction of laboratory stand. Full Text: PDF ReferencesS. Westaby, "Rotary blood pumps as definitive treatment for severe heart failure", Future Cardiol. 9, 2 (2013). CrossRef R. Delgado, M. Bergheim, "HeartMate® II left ventricular assist device: a new device for advanced heart failure", Epert Rev. Med. Devices, 2, 5 (2005). CrossRef M. Ozban, T. Yagdi, C. Engin et al, Transplant proc., 44, 6 (2012). CrossRef A.T. Lanfear, M. Hamandi, J. Fan et al., "Trends in HeartMate 3: What we know so far", J. Card. Surg., 35, 1 (2020). CrossRef Ch. Zengsheng, S. Anqiang, W. Hongyu, "Non-physiological shear stress-induced blood damage in ventricular assist device", Medicine in Novel Technology and Devices, 3 (2019). CrossRef A. M. Robertson, A. Sequeira, R. G. Owens, Rheological models of blood In: L. Formaggia, A. Quarteroni, A Veneziani (eds) Cardiovascular Mathematics (Milano, Springer-Verlag 2009) CrossRef M. Gawlikowski et al., "Necessity of telemonitoring in patients treated by means of cardiac assist systems on the example of Polish rotary blood pump ReligaHeart ROT", Advances in Intelligent Systems and Computing, 925 (2019). CrossRef R. Kustosz, et al., "The tin coating utilisation as blood contact surface modification in implantable rotary left ventricle assist device religaheart ROT", Arch. Matall. Mater., 60, 3 (2015). CrossRef S. S. Patil, A. D. Shaligram, "Analytical study of performance variations of fiber optic micro-displacement sensor configurations using mathematical modeling and an experimental test jig", IJSER, 4, 11 (2013). DirectLink Philtec Application Note, 6, 25 (2017) CrossRef

Impact of a Home Telehealth Program After a Hospitalized COPD Exacerbation: A Propensity Score Analysis

IntroductionCurrently there is lack of data regarding the impact of a home telehealth program on readmissions and mortality rate after a COPD exacerbation-related hospitalization. ObjectiveTo demonstrate if a tele-monitoring system after a COPD exacerbation admission could have a favorable effect in 1-year readmissions and mortality in a real-world setting. MethodsThis is an observational study where we compared an intervention group of COPD patients treated after hospitalization that conveyed a telehealth program with a followance period of 1 year with a control group of patients evaluated during one year before the intervention began. A propensity-score analyses was developed to control for confounders. The main clinical outcome was 1-year all-cause mortality or COPD-related readmission. ResultsThe analysis comprised 351 telemonitoring patients and 495 patients in the control group. The intervention resulted in less mortality or readmission after 12 months (35.2% vs. 45.2%; hazard ratio [HR] 0.71 [95% CI=0.56–0.91]; p=0.007). This benefit was maintained after the propensity score analysis (HR=0.66 [95% CI=0.51–0.84]). This benefit, which was seen from the first month of the study and during its whole duration, is maintained when mortality (HR=0.54; 95% CI=[0.36–0.82]) or readmission (subdistribution hazard ratio [SHR] 0.66; 95% CI=[0.50–0.86]) are analyzed separately. ConclusionTelemonitoring after a severe COPD exacerbation is associated with less mortality or readmissions at 12 months in a real world clinical setting.

SiTe iC: A telemonitoring system for heart failure patients

In the last years, multidisciplinary post-discharge treatment programs, such as telemonitoring, have been promoted as a strategy for Heart Failure (HF) management. However, the distinctive requirements that a telemonitoring system should have, have not been clearly identified. To this aim, the most relevant requirements for telemonitoring of HF patients are derived from evidence-based Clinical Practice Guidelines (CPGs) for HF management. The main objective of this work is to present a prototype of a telemonitoring system for HF patients, named SiTe iC, that has been developed based on the identified requirements, highlighting its design and evaluation.A first prototype of the system was designed and programmed. It consists of an mHealth app for HF patients, a website for physicians who monitor patients, and a server which runs an Application Programming Interface to allow communication between the app and the website.The system was thoroughly assessed through a clinical trial that demonstrates that telemonitoring using SiTe iC actually improves patients self-care when compared to usual care and it has the potential to avoid patient re-hospitalizations.This study demonstrated that the identified functional requirements for telemonitoring systems are relevant. In addition, thanks to SiTe iC, HF patients would take a more active role in their disease management by improving self-care.

Cardio-oncology services during the COVID-19 pandemic: practical considerations and challenges.

Cardio-oncology services during the COVID-19 pandemic: practical considerations and challenges.

Exploring the Use of Telemonitoring for Patients at High Risk for Hypertensive Disorders of Pregnancy in the Antepartum and Postpartum Periods: Scoping Review

BackgroundHigh blood pressure complicates 2% to 8% of pregnancies, and its complications are present in the antepartum and postpartum periods. Blood pressure during and after pregnancy is routinely monitored during clinic visits. Some guidelines recommend using home blood pressure measurements for the management and treatment of hypertension, with increased frequency of monitoring for high-risk pregnancies. Blood pressure self-monitoring may have a role in identifying those in this high-risk group. Therefore, this high-risk pregnancy group may be well suited for telemonitoring interventions.ObjectiveThe aim of this study was to explore the use of telemonitoring in patients at high risk for hypertensive disorders of pregnancy (HDP) during the antepartum and postpartum periods. This paper aims to answer the following question: What is the current knowledge base related to the use of telemonitoring interventions for the management of patients at high risk for HDP?MethodsA literature review following the methodological framework described by Arksey et al and Levac et al was conducted to analyze studies describing the telemonitoring of patients at high risk for HDP. A qualitative study, observational studies, and randomized controlled trials were included in this scoping review.ResultsOf the 3904 articles initially identified, 20 met the inclusion criteria. Most of the studies (13/20, 65%) were published between 2017 and 2018. In total, there were 16 unique interventions described in the 20 articles, all of which provide clinical decision support and 12 of which are also used to facilitate the self-management of HDP. Each intervention’s design and process of implementation varied. Overall, telemonitoring interventions for the management of HDP were found to be feasible and convenient, and they were used to facilitate access to health services. Two unique studies reported significant findings for the telemonitoring group, namely, spontaneous deliveries were more likely, and one study, reported in two papers, described inductions as being less likely to occur compared with the control group. However, the small study sample sizes, nonrandomized groups, and short study durations limit the findings from the included articles.ConclusionsAlthough current evidence suggests that telemonitoring could provide benefits for managing patients at high risk for HDP, more research is needed to prove its safety and effectiveness. This review proposes four recommendations for future research: (1) the implementation of large prospective studies to establish the safety and effectiveness of telemonitoring interventions; (2) additional research to determine the context-specific requirements and patient suitability to enhance accessibility to healthcare services for remote regions and underserved populations; (3) the inclusion of privacy and security considerations for telemonitoring interventions to better comply with healthcare information regulations and guidelines; and (4) the implementation of studies to better understand the effective components of telemonitoring interventions.

Exploring an Innovative Care Model and Telemonitoring for the Management of Patients With Complex Chronic Needs: Qualitative Description Study.

BackgroundThe growing number of patients with complex chronic conditions presents an urgent challenge across the Canadian health care system. Current care delivery models are overburdened, struggling to monitor and stabilize the complex needs of this growing patient population.ObjectiveThis qualitative study aimed to explore the needs and perspectives of patients and members of the care team to inform the development of an innovative integrated model of care and the needs of telemonitoring (TM) for patients with complex chronic conditions. Furthermore, we explored how these needs could be successfully embedded to support this novel model of complex chronic care.MethodsA qualitative description design was utilized to conduct and analyze 29 semistructured interviews with patients (n=16) and care team members (CTM) (n=13) involved in developing the model of care in an ambulatory care facility in Southern Ontario. Participants were identified through purposive sampling. Two researchers performed an iterative thematic analysis using NVivo 12 (QSR International; Melbourne, Australia) to gain insights from examining multiple perspectives of different participants on complex chronic care needs.ResultsThe analysis revealed 3 themes and 13 subthemes, including the following: (1) adequate health care delivery remains challenging for patients with complex care needs, (2) insights into how to structure an integrated care model, and (3) opportunities for TM in an integrated model of care. Participants not only identified continued challenges in accessing and navigating care in a fragmented and disconnected delivery system but also identified the need for more self-management support. Patients and CTM described the structure of an integrated model of care, including the need for a clear referral and triage processes and composing a tight-knit circle of collaborating interdisciplinary providers led by a nurse practitioner (NP). Finally, opportunities for TM in an integrated model of care were identified, including increasing access and communication, the ability to monitor specific signs and symptoms, and building a clinical workflow around TM-enabled care.ConclusionsDespite entrenched health care service delivery models, a new model of care is acutely needed to care for patients with complex chronic needs (CCN). NPs are in a unique position to lead TM-enabled integrated models of care. TM can facilitate frequent and necessary monitoring of patients with CCN with more than one condition in integrated models of care.

HEART FAILURE POST-DISCHARGE TELEMONITORING IN A SAFETY-NET HOSPITAL REDUCES 30-DAY READMISSIONS

Heart failure (HF) readmissions contribute to significant morbidity, mortality, and healthcare costs. Telemonitoring (TM) in post-discharge heart failure patients has been shown to promote early identification of decompensation. We sought to examine the impact of a TM program in a safety-net

Assessment of the clinical efficacy of telemonitoring and distant counseling in patients with uncontrolled hypertension

The aim of the study was to investigate the mathematical correlation of the clinical efficacy of blood pressure telemonitoring and distant counseling (BPTM) in patients in uncontrolled hypertension (HTN). Telehealth tools are widely used in HTN management. However clinical efficacy of such interventions assessed mainly in groups investigated without its populational and attributable impact. Materials and methods. The total of 240 patients were included, then randomized in 2:1 manner to BPTM group (n=160, median age 47 y.o.) and control group (n=80, median age 49 y.o). The user - friendly and secure telehealth software was provided with mobile application (patients) and desktop (doctors) platforms which allowed storage and analysis of self-BP monitoring data and remote consultations. A three - month surveillance was designed with mandatory baseline and final face - to - face visits with the assessment of office systolic BP (oSBP). Mathematical evaluation was based on target SBP rates achieved in comparator groups and included the absolute efficacies (AE), the attributable efficacy (AtE), the relative efficacy (RE) and the population attributable efficacy (PAtE). Results. BPTM group characterized by larger decrease in SBP level compared with controls (-16.8±2.9 mm Hg versus -7.9±3.9 mm Hg; p.

P373 Telemedicine and inflammatory bowel disease: Results of the IBD assistant pilot project

Abstract Background Telemedicine enables proper and immediate monitoring of the patient’s current health state, followed by well-timed and customised treatment. The aim of our study was to assess feasibility and safety of telemonitoring in Czech patients with inflammatory bowel disease (IBD). Furthermore, we wanted to evaluate the impact of telemonitoring on the number of outpatient′s visits and direct health-care cost. Methods We performed randomised controlled study including patients with IBD in stable remission on conventional therapy who were randomised either to telemonitoring (IBDA) or control (CTRL) group and were followed-up for 12 months. All IBDA patients had access to a specific web application which contained a set of questioners assessing disease activity and complications which were filled-in at least every 3 months. Evaluation of clinical activity was accompanied by measurement of faecal calprotectin (FC) at home using CalproSmart test. Individuals in the CTRL group were followed under the standard conditions as other outpatients. Results A total of 131 were included (42% males; 47% with Crohn′s disease) and randomised to IBDA (n = 94) or control group (n = 37). HBI/pMayo activity indexes were not significantly different at baseline (p = 0.636 and p = 0.853) and end of study (p = 0.517 and p = 0.890) in the two groups. Similarly, no significant difference in inflammatory markers (C-reactive protein, FC) was observed in either group (p&amp;gt;0.05). The occurrence of intercurrent infections (0.93 vs. 0.81 cases of infection/patient-year, p = 0.87) or the need for hospitalisations (1 vs. 0) was similar between the groups. The number of outpatient visits was significantly lower in the IBDA than in the CTRL group (median number in IBDA group 0, in the CTRL group 4.2 visits, respectively, p &amp;lt; 0.0001). Telemedicine led to a reduction in the direct annual health-care cost of patient follow-up by ~25% compared with the standard care. Conclusion Results of the first Czech IBD telemedicine study confirm the effectiveness and safety of the telemedicine approach, which led to a reduction in outpatient visits and savings in health-care costs while maintaining a high standard of health care. Acknowledgements: Supported by the IBD-Comfort Endowment Fund.