Telemonitoring Program Research Articles

Evaluating the Impact of a Blood Pressure Remote Telemonitoring Program (BP Connect)

Background: The prevalence of hypertension is around 30-45% among the general population. Hypertension contributes to 1 out of 7 deaths in the United States and approximately 70% of persons who have a first heart attack or stroke. Timely treatment and optimal management of hypertension is associated with substantial reductions in stroke incidence (35-40%), myocardial infarction (20-25%), and heart failure (>50%). Additionally, remote monitoring with active intervention by medical professionals (telemonitoring) improves drug compliance and increase the target blood pressure (BP) achievement rate.

Telemonitoring in fasting individuals with Type 2 Diabetes Mellitus during Ramadan: A prospective, randomised controlled study

We determined the impact of a remote blood glucose telemonitoring program with feedback in type 2 diabetes mellitus patients fasting during Ramadan compared to conventional self-monitoring method. A twelve-week cluster randomised study, with 85 participants who wish to fast for at least 15 days during Ramadan was conducted. Self-measurement and transmission of blood glucose results were performed six times daily during Ramadan. Results were transmitted to a secure website for review with feedback from case manager if necessary. The control group received usual care. The main outcome was the number of participants experiencing hypoglycaemia during Ramadan and at the end of the study. During Ramadan, the number of participants reporting hypoglycaemia was significantly lower in the telemonitoring group [Odds ratio (OR): 0.186, 95% confidence interval: 0.04–0.936; p = 0.04]. Similarly, the proportion of participants reporting symptomatic hypoglycaemia at the end of the study was significantly lower in the telemonitoring group (OR: 0.257, 95% CI: 0.07–0.89; p = 0.03). A reduction of 1.07% in glycated haemoglobin levels was observed in the telemonitoring group compared to 0.24% in the control group (p < 0.01). Overall, telemonitoring was a useful adjunct to reduce the risk of hypoglycaemia during Ramadan with no deterioration in glycaemic control

Scalable Telemonitoring Model in Cloud for Health Care Analysis

Telemonitoring model is health observations model that going to surveillance patients remotely. Telemonitoring model is suitable for patients to avoid high operating expense to get Emergency treatment. Telemonitoring gives the path for monitoring the medical device that generates a complete profile of patient’s health through assembling essential signs as well as additional health information. Telemonitoring model is relying on four differential modules which is capable to generate realistic synthetic electrocardiogram (ECG) signals. Telemonitoring model shows four categories of chronic disease: pulmonary state, diabetes, hypertension, as well as cardiovascular diseases. On the other hand, the results of this application model recommend facilitating despite of their nationality, socioeconomic grade, or age, patients observe amid tele-monitoring programs as well as the utilization of technologies. Patient’s multiple health status is shown in the result such as beat-to-beat variation in morphology and timing of the human ECG, including QT dispersion and R-peak amplitude modulation. This model will be utilized to evaluate biomedical signal processing methods that are utilized to calculate clinical information from the ECG.

4144A telemonitoring program for primary and secondary prevention of cardiovascular disease

4144A telemonitoring program for primary and secondary prevention of cardiovascular disease

Management of continuous positive airway pressure treatment compliance using telemonitoring in obstructive sleep apnoea.

Continuous positive airway pressure (CPAP) is an effective treatment for obstructive sleep apnoea (OSA), but treatment compliance is often unsatisfactory. This study investigated the efficacy and cost-effectiveness of telemonitoring for improving CPAP compliance.100 newly diagnosed OSA patients requiring CPAP (apnoea-hypopnoea index >15 events·h-1) were randomised to standard management or a telemonitoring programme that collected daily information about compliance, air leaks and residual respiratory events, and initiated patient contact to resolve issues. Clinical/anthropometric variables, daytime sleepiness and quality of life were recorded at baseline and after 3 months. Patient satisfaction, additional visits/calls, side-effects and total costs were assessed.There were no significant differences between the standard and telemedicine groups in terms of CPAP compliance (4.9±2.2 versus 5.1±2.1 h·night-1), symptoms, clinical variables, quality of life and unwanted effects. Telemedicine was less expensive than standard management (EUR123.65 versus EUR170.97; p=0.022) and was cost-effective (incremental cost-effectiveness ratio EUR17 358.65 per quality-adjusted life-year gained). Overall patient satisfaction was high, but significantly more patients rated satisfaction as high/very high in the standard management versus telemedicine group (96% versus 74%; p=0.034).Telemonitoring did not improve CPAP treatment compliance and was associated with lower patient satisfaction. However, it was more cost-effective than traditional follow-up.

Telemedical Care and Monitoring for Patients with Chronic Heart Failure Has a Positive Effect on Survival

Telemedical care and monitoring programs for patients with chronic heart failure have shown beneficial effects on survival in several small studies. The utility in routine care remains unclear. We evaluated a large-sized telemedicine program in a routine care setting, enrolling in total 2,622 patients (54.7 percent male, mean age: 73.7years) with chronic heart failure. We used reimbursement data from a large statutory health insurance and approached a matched control analysis. In a complex propensity score matching procedure, 3,719 suitable controls (54.2 percent male, mean age: 74.5years) were matched to 1,943 intervention patients (54.1 percent male, mean age: 74.4years). The primary endpoint of our analysis was survival after 1year. Analyses revealed a higher survival probability among subjects of the intervention group compared to controls group after 1year (adjusted OR: 1.47, CI 95 percent: 1.21-1.80, p<.001) and 2years (adjusted OR: 1.51, CI 95 percent: 1.28-1.77, p<.001), respectively. The probabilities to survive after 1 and 2years were significantly increased in the intervention group. Our findings confirm previous results of controlled trials and importantly indicate that patients with chronic heart failure may benefit from telemonitoring programs in routine care.

AB004. A home telemonitoring program for patients with idiopathic pulmonary fibrosis and combined pulmonary fibrosis and emphysema

AB004. A home telemonitoring program for patients with idiopathic pulmonary fibrosis and combined pulmonary fibrosis and emphysema

Intervention for Diabetes with Education, Advancement and Support (IDEAS) study: protocol for a cluster randomised controlled trial.

BackgroundThe high market penetration of mobile phones has triggered an opportunity to combine mobile technology with health care to overcome challenges in today’s health care setting. Although Malaysia has a high Internet and mobile penetration rate, evaluations of the efficacy of incorporating this technology in diabetes care is not common. We report the development of a telemonitoring coaching system, using the United Kingdom (UK) Medical Research Council (MRC) framework, for patients with type 2 diabetes mellitus.MethodsThe Intervention for Diabetes with Education, Technological Advancement and Support (IDEAS) study is a telemonitoring programme based on an empowerment philosophy to enable participants to be responsible for their own health decision and behaviour. An iterative cycle of development, piloting, and collating qualitative and quantitative data will be used to inform and refine the intervention. To increase compliance, the intervention will be designed to encourage self-management using simple, non-technical knowledge. The primary outcomes will be HbA1c, blood pressure, total cholesterol, and quality of life and diabetes self-efficacy. In addition, an economic analysis on health service utilisation will be collected.DiscussionThe mixed-method approach in this study will allow for a holistic overview of using telemonitoring in diabetes care. This design enables researchers to understand the effectiveness of telemonitoring as well as provide insights towards the receptiveness of incorporating information technology amongst type 2 diabetes patients in a community setting.Trial registrationClinicalTrials.gov NCT02466880 Registered 2 June 2015.

A Remote Medication Monitoring System for Chronic Heart Failure Patients to Reduce Readmissions: A Two-Arm Randomized Pilot Study.

BackgroundHeart failure (HF) is a chronic condition affecting nearly 5.7 million Americans and is a leading cause of morbidity and mortality. With an aging population, the cost associated with managing HF is expected to more than double from US $31 billion in 2012 to US $70 billion by 2030. Readmission rates for HF patients are high—25% are readmitted at 30 days and nearly 50% at 6 months. Low medication adherence contributes to poor HF management and higher readmission rates. Remote telehealth monitoring programs aimed at improved medication management and adherence may improve HF management and reduce readmissions.ObjectiveThe primary goal of this randomized controlled pilot study is to compare the MedSentry remote medication monitoring system versus usual care in older HF adult patients who recently completed a HF telemonitoring program. We hypothesized that remote medication monitoring would be associated with fewer unplanned hospitalizations and emergency department (ED) visits, increased medication adherence, and improved health-related quality of life (HRQoL) compared to usual care.MethodsParticipants were randomized to usual care or use of the remote medication monitoring system for 90 days. Twenty-nine participants were enrolled and the final analytic sample consisted of 25 participants. Participants completed questionnaires at enrollment and closeout to gather data on medication adherence, health status, and HRQoL. Electronic medical records were reviewed for data on baseline classification of heart function and the number of unplanned hospitalizations and ED visits during the study period.ResultsUse of the medication monitoring system was associated with an 80% reduction in the risk of all-cause hospitalization and a significant decrease in the number of all-cause hospitalization length of stay in the intervention arm compared to usual care. Objective device data indicated high adherence rates (95%-99%) among intervention group participants despite finding no significant difference in self-reported adherence between study arms. The intervention group had poorer heart function and HRQoL at baseline, and HRQoL declined significantly in the intervention group compared to controls.ConclusionsThe MedSentry medication monitoring system is a promising technology that merits continued development and evaluation. The MedSentry medication monitoring system may be useful both as a standalone system for patients with complex medication regimens or used to complement existing HF telemonitoring interventions. We found significant reductions in risk of all-cause hospitalization and the number of all-cause length of stay in the intervention group compared to controls. Although HRQoL deteriorated significantly in the intervention group, this may have been due to the poorer HF-functioning at baseline in the intervention group compared to controls. Telehealth medication adherence technologies, such as the MedSentry medication monitoring system, are a promising method to improve patient self-management,the quality of patient care, and reduce health care utilization and expenditure for patients with HF and other chronic diseases that require complex medication regimens.Trial RegistrationClinicalTrials.gov NCT01814696; https://clinicaltrials.gov/ct2/show/study/NCT01814696 (Archived by WebCite® at http://www.webcitation.org/6giqAVhno)

Investigating telemonitoring practice: a proposed work-applied methodology

Purpose Diabetes is regarded as a global epidemic with 382 million people globally suffering from diabetes. It also has major implications on patients’ quality of life. There are also high cost of treatment associated with diabetes for both patient and healthcare provider. Telemonitoring represents an excellent technology opportunity to redefine health care delivery. Using technology for home-based care promises the ability to deliver more cost effective care whilst also enhancing quality of care and patient satisfaction. The paper aims to discuss these issues. Design/methodology/approach The current research aims to contribute to the methodological design of action research projects in their use to implementation health technologies such as telemonitoring. In particular, it seeks create a model which can be used to demonstrate the efficacy of the use of the action research method as a viable alternative to the traditional randomised control trials methodology currently employed in healthcare. Findings The paper contributes towards the methodological design to investigate the area of practice making use of the telemonitoring programme within a Victorian Health Services Network using action research. Originality/value It intends to address the research problem of the low utilisation of telemonitoring within Monash Health as a whole, and more specifically within the diabetes unit. In this context the research intends to utilise the benefits of telemonitoring to improve clinical outcomes of patients by increasing insulin stabilisation. It is also intended the research organisation benefits by increased efficiency by decreasing clinical workforce time spent on managing patient insulin data.

Structure, process, and outcomes of care in a telemonitoring program for patients with type 2 diabetes.

BackgroundUsing Donabedian’s structure-process-outcomes (SPO) framework, this descriptive, exploratory study examined the structure of a telemonitoring program in a population of patients with type 2 diabetes (T2D), the process of nurse–patient telephonic interactions, and patients’ clinical outcomes.MethodsSecondary data analysis was conducted using data from 581 patients who participated in a home telemonitoring program for 12 months. Three point-biserial and six Pearson correlations were estimated to determine how patient demographics related to clinical characteristics. Mixed model regressions were conducted predicting hemoglobin A1c (HbA1c), systolic blood pressure (SBP), and diastolic blood pressure (DBP) levels at 6, 9, and 12 months based on the frequency of contact in the earlier 3 months. Analysis of variances were conducted to assess if the frequency of contact was significantly different by change in HbA1c levels from 3 to 6, 6 to 9, and 9 to 12 months.ResultsSignificant negative correlations were found between age and HbA1c (r=−0.10, P=0.015) and DBP (r=−0.16, P<0.001), a significant positive correlation was found between age and SBP (r=0.15, P=0.001). A significant correlation was found between sex and DBP (rpb=−0.11, P=0.015); female participants had lower DBP levels than males. Frequency of contact was not related to the change in clinical outcomes. However, the frequency of contact for the time period 3 to 6 months was associated with change in HbA1c for the 6- to 9- month period and frequency of contact during the 6- to 9- month period was associated with change in HbA1c from 9 to 12 months.ConclusionExamination of the SPO measures in the telemonitoring environment assisted in understanding the effectiveness of this type of unique intervention and the need for further in-depth exploration of self-management techniques among individuals with T2D.

Funding of telemedicine in the Portuguese National Health Service

The funding of the Portuguese National Health Service is based on the state budget, i.e., in public taxes. As a public service, the National Health Service has some constraints in giving financial incentives to discriminate the quality and quantity of services. There is an effort towards this direction, through separation between public payers and public providers, i.e., inside the National Health Service, there is a public entity (named ACSS) which has the responsibility to pay for services to public providers (health centers and hospitals). Complementing this effort, a methodology was launched based on internal contracts, e.g., a public hospital is committed to achieving productivity goals and receives funding from the ACSS, according to the degree of achievement. In a similar way, telemedicine has followed this methodology. Telemedicine in Portugal relates primarily to the following types of services: online and store-and-forward teleconsultation in dermatology, where the hospital dermatologist provides support to the family doctor in the primary health care, and remote monitoring in chronic obstructive pulmonary disease patients, where the hospital provides support to these patients at home. Online teleconsultations are made with videoconferencing equipment and the store-and-forward teleconsultations are related to sending photographs from the primary health centre to the dermatologist doctor in the hospital. A teleconsultation between hospitals and health centres, both in its online or store-and-forward version, is financed with a 10% increase over a standard consultation. In this case, funding is per procedure or medical act and has no upper maximum. Currently, there are 5 public hospitals participating in the telemonitoring program of patients with chronic obstructive pulmonary disease. Each hospital has a maximum of 15 patients at home who are continuously telemonitored, with the technical support of private companies. These hospitals receive a fixed amount per user and per year.

Patient Education and Telemedicine in COPD - Update 2015

Chronic Obstructive Pulmonary Disease (COPD) remains the fourth recognized cause of death worldwide. Smoking is known as the most important risk factor for COPD with nicotine abstinence being the most effective COPD prophylaxis. Smoking cessation programs are less effective and may be considered as disease secondary prevention actions with smoking cessation slowing down lung function decline. Severe exacerbations, if not treated, on time (no comma) are responsible for the highest number of lung related deaths among COPD patients. As the definition of COPD exacerbation may be subjective, attributing symptoms to an exacerbation can be difficult, especially among less educated patients. This problem may be even more important in areas where the doctor/patient ratio is small and where patients need to travel long distances to obtain consultation and medical help. For these reasons COPD telemonitoring programs are being tested and implemented in some countries. This review is an updated overview of the current scientific evidence regarding patient education and telemonitoring implementation in COPD, based on the article on this topic published herein in 2013. The evidence provided, herein, is presented to help identify the effectiveness of education and telemonitoring in COPD in societies with different economies. Keywords: COPD education, COPD telemonitoring.

Impact of a primary-based telemonitoring programme in HRQOL, satisfaction and usefulness in a sample of older adults with chronic diseases in Valencia (Spain)

BackgroundChronic patients are frequent users of healthcare services and are prone to hospital admissions. In Valencia (Spain) the Valcronic programme aims to manage chronic patients through different levels of telemonitoring and telecare. This paper examines the impact of the Valcronic programme on self-perceived HRQOL in a one-year period and on perceptions of satisfaction and usefulness in a sample of older adults with chronic diseases. MethodsThe sample (n=74) was randomly selected from Valcronic users and was stratified considering different variables. HRQOL was assessed using the EQ-5D questionnaire at two points in time: before the beginning of the Valcronic programme and after a one-year follow-up. Satisfaction and usefulness were evaluated one year after users’ inclusion. ResultsThe whole sample experienced improvement, although not significant, of its HRQOL; patients over 75 showed impairment. Patients with at least one problem in the EQ-5D dimensions decreased after one year (82.43% vs. 74.32%). Users’ perceptions of satisfaction and usefulness were highly positive. ConclusionsOur sample benefited from the Valcronic programme, experiencing an improvement in their HRQOL, a decreased use of health resources or high satisfaction levels. ImplicationsFurther adjustments are needed to address a comprehensive response to the needs of the global population of reference.

Home Telemedicine in Heart Failure: A Pilot Study of Integrated Telemonitoring and Virtual Provider Appointments.

Congestive heart failure is a significant cause of hospitalization, rehospitalization, and death. Reducing hospital readmission rates is a national priority. Various telemonitoring devices and programs have been developed to help meet this goal. The Health Connect system incorporates monitoring of physiologic data with regular virtual provider appointments. The Health Connect system integrates traditional telemedicine with virtual provider appointments. Virtual appointments empower patients to advocate for their own health by providing numerous opportunities for education and feedback. In addition to early identification of impending decompensation, virtual appointments allow providers to address noncompliance, which is a major factor driving poor outcomes. Further research is required to confirm the benefit of the Health Connect system.

Heart Failure Remote Monitoring: Evidence From the Retrospective Evaluation of a Real-World Remote Monitoring Program

BackgroundGiven the magnitude of increasing heart failure mortality, multidisciplinary approaches, in the form of disease management programs and other integrative models of care, are recommended to optimize treatment outcomes. Remote monitoring, either as structured telephone support or telemonitoring or a combination of both, is fast becoming an integral part of many disease management programs. However, studies reporting on the evaluation of real-world heart failure remote monitoring programs are scarce.ObjectiveThis study aims to evaluate the effect of a heart failure telemonitoring program, Connected Cardiac Care Program (CCCP), on hospitalization and mortality in a retrospective database review of medical records of patients with heart failure receiving care at the Massachusetts General Hospital.MethodsPatients enrolled in the CCCP heart failure monitoring program at the Massachusetts General Hospital were matched 1:1 with usual care patients. Control patients received care from similar clinical settings as CCCP patients and were identified from a large clinical data registry. The primary endpoint was all-cause mortality and hospitalizations assessed during the 4-month program duration. Secondary outcomes included hospitalization and mortality rates (obtained by following up on patients over an additional 8 months after program completion for a total duration of 1 year), risk for multiple hospitalizations and length of stay. The Cox proportional hazard model, stratified on the matched pairs, was used to assess primary outcomes.ResultsA total of 348 patients were included in the time-to-event analyses. The baseline rates of hospitalizations prior to program enrollment did not differ significantly by group. Compared with controls, hospitalization rates decreased within the first 30 days of program enrollment: hazard ratio (HR)=0.52, 95% CI 0.31-0.86, P=.01). The differential effect on hospitalization rates remained consistent until the end of the 4-month program (HR=0.74, 95% CI 0.54-1.02, P=.06). The program was also associated with lower mortality rates at the end of the 4-month program: relative risk (RR)=0.33, 95% 0.11-0.97, P=.04). Additional 8-months follow-up following program completion did not show residual beneficial effects of the CCCP program on mortality (HR=0.64, 95% 0.34-1.21, P=.17) or hospitalizations (HR=1.12, 95% 0.90-1.41, P=.31).ConclusionsCCCP was associated with significantly lower hospitalization rates up to 90 days and significantly lower mortality rates over 120 days of the program. However, these effects did not persist beyond the 120-day program duration.

Feasibility and Acute Care Utilization Outcomes of a Post-Acute Transitional Telemonitoring Program for Underserved Chronic Disease Patients.

Chronic obstructive pulmonary disease (COPD) and heart failure (HF) are chronic diseases that impart significant health and care costs to the patient and health system. Limited access to health services affects disease severity and functional status. Telemonitoring has shown promise in reducing acute care utilization for chronic disease patients, but the benefit for the underserved has not been determined. We evaluated acute care utilization outcomes following an acute event of a 90-day transitional care program integrating telemonitoring technology and home visits for underserved COPD and HF patients. Patients were enrolled into the program between October 2010 and August 2012. Primary outcomes included rates of emergency department (ED) visits and all-cause re-admission at 30, 90, and 180 days postdischarge. Program and functional status at enrollment and discharge and satisfaction with telemonitoring at discharge were measured. Telemonitoring included daily symptomatology recording and was removed at 90 days. A control cohort was identified through electronic health records and propensity-matched via 15 variables to achieve a sample size with balanced baseline characteristics. Program patients showed 50% reduction in 30-day re-admission and 13-19% reduction in 180-day re-admission compared with control patients. There was no significant difference in ED utilization. Patients were satisfied with telemonitoring services, and functional status improved by program end. This feasibility study suggests telemonitoring in the context of a transitional care model following an acute event may reduce all-cause 30-day re-admissions by up to 50% and has the potential to reduce long-term acute care utilization and thus care costs. More rigorous and long-term investigation is warranted.

Capsule commentary on Aikens et al., integrating support persons into diabetes telemonitoring to improve self-management and medication adherence.

This study conducted by Aikens et al.1 explored the potential benefits for medication adherence among diabetics after integrating a support person (relative or friend) into a VA-based telemonitoring program. These patients participated in 3–6 months of weekly telemonitoring via Interactive Voice Response Calls. Patients had the options of designating a care partner. After each interactive voice response (IVR) call that the patient completed, these care partners received an automatically generated email summarizing patient’s general health and self-management status. Clinicians were also notified about their patient’s non-adherence response via an automatically generated fax. The authors computed the physical composite summary, mental composite summary, and measured long-term medication adherence with the validated Morisky Medication Adherence Scale. They concluded that diabetics who were both noncompliant and psychologically distressed were readily engaged with automated telehealth. Another interesting observation was the selection and involvement of the care partner selected by the patient who received emails and text messages after IVR calls. Despite recruiting from 16 geographically different VA clinics, the authors were only able to recruit 98 non-adherent diabetic patients, who opted to involve a care partner. These participants were not selected randomly and their responses about adherence were purely subjective. Therefore, the results are less convincing due to small sample size and limited duration of the study. Previous studies have examined the impact of tele-monitoring on discrete clinical outcomes such as a decrease in HbA1c.2 However, an observational study conducted by Chumbler et al. didn’t find any significant clinical impact of using telehealth monitoring of veterans’ diabetes when comparing patients monitored on a daily basis versus patients monitored weekly.3 Despite these limitations, these preliminary findings should encourage clinicians and specialists to involve a support person at an early stage when evaluating noncompliant diabetics. It is worth mentioning that the VA has been a leader in providing services for veterans with chronic illnesses including diabetes. Future randomized controlled trials should include telemonitoring of diabetic patients with and without a support person and focus on measuring the diagnostic values related to diabetes complications and healthcare utilization.

Hospital Utilization After a Telemonitoring Program: A Pilot Study

The long-term effects of remote monitoring on hospital utilization and health care costs are understudied in home health care. The researchers performed a retrospective study, in a hospital-based home health care agency, to consider the effects of remote monitoring in 326 patients with heart failure 90 days after discharge from services. While statistical significance was not noted, clinical significance suggests that there was a decreased hospital utilization rate and decreased average cost per hospitalization in the remote monitoring group.

Integrating support persons into diabetes telemonitoring to improve self-management and medication adherence.

The purpose of this study was to investigate the potential benefits for medication adherence of integrating a patient-selected support person into an automated diabetes telemonitoring and self-management program, and to determine whether these benefits vary by patients' baseline level of psychological distress. The study was a quasi-experimental patient preference trial. The study included patients with type 2 diabetes who participated in three to six months of weekly automated telemonitoring via interactive voice response (IVR) calls, with the option of designating a supportive relative or friend to receive automated updates on the patient's health and self-management, along with guidance regarding potential patient assistance. We measured long-term medication adherence using the four-point Morisky Medication Adherence Scale (MMAS-4, possible range 0-4), weekly adherence with an IVR item, and psychological distress at baseline with the Mental Composite Summary (MCS) of the SF-12. Of 98 initially nonadherent patients, 42% opted to involve a support person. Participants with a support person demonstrated significantly greater improvement in long-term adherence than those who participated alone (linear regression slopes: -1.17 vs. -0.57, respectively, p =0.001). Among distressed patients in particular, the odds of weekly nonadherence tended to decrease 25% per week for those with a support person (p =0.030), yet remained high for those who participated alone (p =0.820). Despite their multiple challenges in illness self-management, patients with diabetes who are both nonadherent and psychologically distressed may benefit by the incorporation of a support person when they receive assistance via automated telemonitoring.