Home Telehealth Uptake and Continued Use Among Heart Failure and Chronic Obstructive Pulmonary Disease Patients: a Systematic Review

Gorst, Sarah L.; Armitage, Christopher J.; Brownsell, Simon; Hawley, Mark

doi:10.1007/s12160-014-9607-x

Cited by 129 publications

(155 citation statements)

References 93 publications

(374 reference statements)

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“…From a usability perspective, there is a clear preference among patients, both in the literature [24,31,32] and in our study, for using Bluetooth-enabled peripheral devices. However, what appears most important is that patients can access TM services using devices they are most familiar with (ie, personal smartphones and tablets) [33][34][35] and that the perceived advantages of a TM program are greater than any usability inconveniences caused by manually entering biometric data [36][37][38]. To our knowledge, ours is the first study to confirm that BYOD is perceived by both clinician and patient users as a viable option for delivering TM services with a caveat that considerations are required to ensure universal accessibility.…”

Section: Comparison With Prior Workmentioning

confidence: 99%

User-Centered Adaptation of an Existing Heart Failure Telemonitoring Program to Ensure Sustainability and Scalability: Qualitative Study (Preprint)

Ware¹,

Ross²,

Cafazzo³

et al. 2018

Preprint

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Background: Telemonitoring (TM) interventions for the management of heart failure (HF) has seen limited adoption in Canadian health systems but isolated examples of TM programs do exist. An example of such a program was launched in a specialty HF clinic in Toronto, Canada and a recent implementation evaluation concluded that reducing the cost of delivering the program is necessary to ensure its sustainability and scalability. Objectives: The objectives of this study are (1) to understand which components of the TM program could be modified to reduce costs and adapted to other contexts while maintaining program fidelity; and (2) to describe the changes made to the TM program to enable its sustainability within the initial implementation site and scalability to other health organizations. Methods: Semi-structured interviews probed the experiences of patients (n=23) and clinicians (n=8) involved in the TM program to identify opportunities for cost reduction and resource optimization. Ideas for adapting the program were informed by the interview results and prioritized based on: (1) potential impact for sustainability and scalability; (2) feasibility; and (3) perceived risks to negatively impacting the program's ability to yield desired health outcomes. Results: Five themes representing opportunities for cost reduction were discussed, including: (1) Bring Your Own Device (BYOD); (2) technical support; (3) clinician role; (4) duration of enrollment; and (5) intensity of monitoring. The hardware used for the TM system and the modalities of providing technical support were found to be highly adaptable which supported the decision to implement a BYOD model, whereby patients use their own smartphone, weight scale and blood pressure cuff as well as the development of a website aimed at reducing the burden on a technical support telehealth analyst (THA). In addition, the interviews suggested that, while it is important to have a clinician who is part of a patient's circle of care monitoring TM alerts, the skill level and experience was moderately adaptable. Thus, a Registered Nurse was determined to be more cost-effective and was hired to replace the existing nurse practitioners in the frontline management of TM alerts as well as taking over the technical support role from a THA. Conclusion: This paper provides a user-centred example of how necessary cost-reduction actions can be taken to ensure the sustainability and scalability of TM programs. In addition, the findings offer insights into what components of a TM program can be safely adapted to ensure its integration in various clinical settings.

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Section: Comparison With Prior Workmentioning

confidence: 99%

User-Centered Adaptation of an Existing Heart Failure Telemonitoring Program to Ensure Sustainability and Scalability: Qualitative Study (Preprint)

Ware¹,

Ross²,

Cafazzo³

et al. 2018

Preprint

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“…Measurement of the usability and acceptance of the technology itself was lacking in most reviews (65), with only one review evaluating patient-nominated barriers and enablers to telehealth use and effectiveness (56). The most commonly identified barriers were technical problems, perceived redundancy, preference for in-person care, technology anxiety, difficulty remembering to interact with the system, need for technical support, and perceived repetition.…”

Section: Evidence For Effectiveness Uptake and Use Of Technology Inmentioning

confidence: 99%

“…Less than 5% of all studies included appeared in more than one systematic review, indicating the breadth and diversity of studies reviewed. The major modes of program delivery were (a) mHealth, text messaging, mobile, and/or smart-phone technologies (n = 21) (5, 7, 14, 19, 23, 35-37, 39, 41, 44, 52, 62, 80, 90, 94, 98, 104, 110, 114, 119); (b) Web-or Internet-based programs (n = 23) (3,8,15,42,49,60,70,72,78,81,82,84,89,96,105,106,108,111,118,124,129,131,135); (c) telehealth and/or telemonitoring (n = 9) (1,21,28,56,65,85,99,100,125); and (d ) social media (n = 3) (22,87,123). One review included studies of mobile and Internet-based technologies to promote physical activity for individuals with type 2 diabetes (31).…”

mentioning

confidence: 99%

Using New Technologies to Improve the Prevention and Management of Chronic Conditions in Populations

Oldenburg

Taylor

O’Neil

et al. 2015

Annu. Rev. Public Health

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Lifestyle factors are important in the development of chronic diseases, such as heart disease, respiratory disease, and diabetes, and chronic disease risk can be reduced by changes in lifestyle behaviors linked to these conditions. The use of mass media and community-wide strategies targeting these behaviors has been extensively evaluated since the 1970s. This review summarizes some examples of interventions and their use of media conducted within the old communications landscape of the 1970s and 1980s and the key lessons learned from their design, implementation, and evaluation. We then consider the potential and evidence base for using contemporary technology applications and platforms-within the new communications landscape-to improve the prevention and management of lifestyle-related chronic diseases in the future. We discuss the implications and adaptation of lessons derived from the ways in which new technologies are being used in commercial and political contexts and their relevance for public health. Finally, we consider some recent examples of applying new technologies to public health issues and consider some of the challenges in this rapidly developing field. COMMUNITY INTERVENTIONS CONDUCTED WITHIN THE OLD COMMUNICATIONS LANDSCAPESeminal epidemiological studies of the 1950s and 1960s (33, 38) demonstrated the influence of lifestyle-related factors in the development of chronic diseases, such as cancers and heart and respiratory diseases. The potential to ameliorate the risk and burden of lifestyle-related chronic disease using lifestyle-based behavior change strategies was soon realized and continues to this day (47). In developed countries, theory-based community interventions targeting lifestyle-related behavior risk factors commenced in the 1970s and have continued to the present day. Community Studies in the 1970sThe North Karelia Project, Finland. In the early 1970s, Finland had one of the highest cardiovascular disease (CVD) mortality rates in the world. The North Karelia Project started in 1972 as a national pilot and demonstration program aimed at reducing population levels of wellestablished CVD risk factors and thus the incidence of CVD (73,103). This comprehensive, community-wide intervention program utilized multiple lifestyle change strategies, including use of the state-of-the-art mass media of that time-that is, radio, television, billboards, newspapers, magazine articles, pamphlets, and other printed materials-combined with environmental and legislative approaches. The project developed and evaluated a model that systematically addressed the steps leading to changes in social norms and community-wide behavior change. After the initial intervention phase (1972)(1973)(1974)(1975)(1976)(1977), the project findings and lessons were further adapted and more widely implemented to develop a comprehensive national heart health program in Finland.An evaluation involving population surveys and disease registers showed that the population risk factor levels in Finland were greatly redu...

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“…However there is currently limited knowledge about the influences and determinants of home telehealth compliance in frail elderly people and their carers [22]. Their ability to adhere to a strict regime of tele-monitoring has been identified as an important influence on the success of telemonitoring programs [23] and there is a perception that patients will not adhere to a monitoring protocol and will often abandon the program [24,25].…”

Section: Introductionmentioning

confidence: 99%

Patient Adherence to Scheduled Vital Sign Measurements During Home Telemonitoring: Analysis of the Intervention Arm in a Before and After Trial (Preprint)

Celler¹,

Argha²,

Varnfield³

et al. 2017

Preprint

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Background This paper presents findings on patient compliance with scheduled vital signs measurements in the recently completed Commonwealth Scientific and Industrial Research Organization (CSIRO) national trial of home telemonitoring of patients with chronic conditions, carried out at five locations along the east coast of Australia. ObjectivesTo investigate the ability of chronically ill patients to carry out a daily schedule of vital signs measurements as part of a chronic disease management care plan, over prolonged periods exceeding six months, and to explore different levels of compliance for different measurements, as a function of age, gender and supervisory models. MethodsPatients were required to monitor on a daily basis a range of vital signs determined by their chronic condition and co-morbidities. Vital signs included non-invasive blood pressure, pulse oximetry, spirometry, ECG, blood glucose level, body temperature and body weight.Compliance was calculated as the number days during which at least one measurement was taken over all days where measurements were scheduled. ResultsPatients were monitored on average for 302 days although some continued beyond 12 months. The overall compliance rate for all measurements was 64.8%. The compliance rates of patients monitored in hospital settings relative to those monitored in community settings were significantly higher for spirometry (69.3 versus 41.0%, p<0.001), body weight (64.5 versus 40.5%, p=<0.001) and body temperature (66.8 versus 55.2%, p=0.026), and the compliance rates for blood pressure (68.5 versus 59.7%, p=0.042), ECG (65.6 versus 56.5%, p=0.047) and pulse oximetry (67.0 versus 56.4%, p=0.018) were significantly higher in male relative to female subjects. Compliance with blood glucose measurements (58.1 versus 50.2%, p=0.237) was not significantly different overall. No statistical differences were observed between rates of compliance for younger patients group (≤70 years old) and older patient group (>70 yo). ConclusionsPatients with chronic conditions were able to record their vital signs at home at least once every two days over prolonged periods of time. Surprisingly, male patients maintained a higher compliance than female patients over time, and patients supervised by hospital based care coordinators reported higher levels of compliance with their measurement schedule relative to patients supervised in community settings. This was most noticeable for spirometry.

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Home Telehealth Uptake and Continued Use Among Heart Failure and Chronic Obstructive Pulmonary Disease Patients: a Systematic Review

Cited by 129 publications

References 93 publications

User-Centered Adaptation of an Existing Heart Failure Telemonitoring Program to Ensure Sustainability and Scalability: Qualitative Study (Preprint)

User-Centered Adaptation of an Existing Heart Failure Telemonitoring Program to Ensure Sustainability and Scalability: Qualitative Study (Preprint)

Using New Technologies to Improve the Prevention and Management of Chronic Conditions in Populations

Patient Adherence to Scheduled Vital Sign Measurements During Home Telemonitoring: Analysis of the Intervention Arm in a Before and After Trial (Preprint)

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