Impact of telemonitoring home care patients with heart failure or chronic lung disease from primary care on healthcare resource use (the TELBIL study randomised controlled trial)

Martín-Lesende, Iñaki; Orruño, Estibalitz; Bilbao, Amaia; Vergara, Itziar; Cairo, Ma Carmen; Bayón, Juan Carlos; Reviriego, Eva; Romo, María I; Larrañaga, Jesús; Asúa, José M.; Abad, Roberto; Recalde, E.

doi:10.1186/1472-6963-13-118

Cited by 75 publications

(113 citation statements)

References 23 publications

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“…A Italian randomised trial5 of tele-assistance in chronic respiratory patients requiring long-term oxygen therapy (LTOT) or home mechanical ventilation showed 36% fewer hospitalisations or general practitioner (GP) calls, and reduction in healthcare costs in the telemonitoring group, with the effect more pronounced in patients with COPD. In Bilbao, Spain, telemonitoring in COPD and heart failure resulted in a greater proportion of patients without an admission over 12 months 6. A Cochrane review and meta-analysis of telemonitoring in COPD in 20127 found a decrease in hospitalisations and visits to the emergency room but no impact on quality of life.…”

Section: Introductionmentioning

confidence: 99%

Randomised crossover trial of telemonitoring in chronic respiratory patients (TeleCRAFT trial)

Chatwin

Hawkins

Panicchia

et al. 2016

Thorax

104

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ObjectiveTo assess the impact of home telemonitoring on health service use and quality of life in patients with severe chronic lung disease.DesignRandomised crossover trial with 6 months of standard best practice clinical care (control group) and 6 months with the addition of telemonitoring.Participants68 patients with chronic lung disease (38 with COPD; 30 with chronic respiratory failure due to other causes), who had a hospital admission for an exacerbation within 6 months of randomisation and either used long-term oxygen therapy or had an arterial oxygen saturation (SpO2) of <90% on air during the previous admission. Individuals received telemonitoring (second-generation system) via broadband link to a hospital-based care team.Outcome measuresPrimary outcome measure was time to first hospital admission for an acute exacerbation. Secondary outcome measures were hospital admissions, general practitioner (GP) consultations and home visits by nurses, quality of life measured by EuroQol-5D and hospital anxiety and depression (HAD) scale, and self-efficacy score (Stanford).ResultsMedian (IQR) number of days to first admission showed no difference between the two groups—77 (114) telemonitoring, 77.5 (61) control (p=0.189). Hospital admission rate at 6 months increased (0.63 telemonitoring vs 0.32 control p=0.026). Home visits increased during telemonitoring; GP consultations were unchanged. Self-efficacy fell, while HAD depression score improved marginally during telemonitoring.ConclusionsTelemonitoring added to standard care did not alter time to next acute hospital admission, increased hospital admissions and home visits overall, and did not improve quality of life in chronic respiratory patients.Trial registration numberNCT02180919 (ClinicalTrials.gov).

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Section: Introductionmentioning

confidence: 99%

Randomised crossover trial of telemonitoring in chronic respiratory patients (TeleCRAFT trial)

Chatwin

Hawkins

Panicchia

et al. 2016

Thorax

104

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“…344,345 A home telehealth programme for patients with severe COPD, implemented as a cluster RCT in the Madrid region. 346 Home enteral nutrition support for children with chronic diseases across Spain.…”

Section: Box 4 Selected Telecare Pilot Projects In Spainmentioning

confidence: 99%

Outpatient services and primary care: scoping review, substudies and international comparisons

Winpenny

Miani

Pitchforth

et al. 2016

Health Serv Deliv Res

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AimThis study updates a previous scoping review published by the National Institute for Health Research (NIHR) in 2006 (Roland M, McDonald R, Sibbald B.Outpatient Services and Primary Care: A Scoping Review of Research Into Strategies For Improving Outpatient Effectiveness and Efficiency. Southampton: NIHR Trials and Studies Coordinating Centre; 2006) and focuses on strategies to improve the effectiveness and efficiency of outpatient services.Findings from the scoping reviewEvidence from the scoping review suggests that, with appropriate safeguards, training and support, substantial parts of care given in outpatient clinics can be transferred to primary care. This includes additional evidence since our 2006 review which supports general practitioner (GP) follow-up as an alternative to outpatient follow-up appointments, primary medical care of chronic conditions and minor surgery in primary care. Relocating specialists to primary care settings is popular with patients, and increased joint working between specialists and GPs, as suggested in the NHS Five Year Forward View, can be of substantial educational value. However, for these approaches there is very limited information on cost-effectiveness; we do not know whether they increase or reduce overall demand and whether the new models cost more or less than traditional approaches. One promising development is the increasing use of e-mail between GPs and specialists, with some studies suggesting that better communication (including the transmission of results and images) could substantially reduce the need for some referrals.Findings from the substudiesBecause of the limited literature on some areas, we conducted a number of substudies in England. The first was of referral management centres, which have been established to triage and, potentially, divert referrals away from hospitals. These centres encounter practical and administrative challenges and have difficulty getting buy-in from local clinicians. Their effectiveness is uncertain, as is the effect of schemes which provide systematic review of referrals within GP practices. However, the latter appear to have more positive educational value, as shown in our second substudy. We also studied consultants who held contracts with community-based organisations rather than with hospital trusts. Although these posts offer opportunities in terms of breaking down artificial and unhelpful primary–secondary care barriers, they may be constrained by their idiosyncratic nature, a lack of clarity around roles, challenges to professional identity and a lack of opportunities for professional development. Finally, we examined the work done by other countries to reform activity at the primary–secondary care interface. Common approaches included the use of financial mechanisms and incentives, the transfer of work to primary care, the relocation of specialists and the use of guidelines and protocols. With the possible exception of financial incentives, the lack of robust evidence on the effect of these approaches and the contexts in which they were introduced limits the lessons that can be drawn for the English NHS.ConclusionsFor many conditions, high-quality care in the community can be provided and is popular with patients. There is little conclusive evidence on the cost-effectiveness of the provision of more care in the community. In developing new models of care for the NHS, it should not be assumed that community-based care will be cheaper than conventional hospital-based care. Possible reasons care in the community may be more expensive include supply-induced demand and addressing unmet need through new forms of care and through loss of efficiency gained from concentrating services in hospitals. Evidence from this study suggests that further shifts of care into the community can be justified only if (a) high value is given to patient convenience in relation to NHS costs or (b) community care can be provided in a way that reduces overall health-care costs. However, reconfigurations of services are often introduced without adequate evaluation and it is important that new NHS initiatives should collect data to show whether or not they have added value, and improved quality and patient and staff experience.FundingThe NIHR Health Services and Delivery Research programme.

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“…El uso de telemonitorización en domicilio para pacientes con enfermedades crónicas cardiacas y pulmonares que ya habían ingresado por descompensación de su patología redujo el número de nuevos reingresos del 86 al 57% y la mortalidad del 26,5 al 12,5% (sin significación estadística) 49 . Dos estudios de telemonitorización en domicilio de pacientes con EPOC mostraron diferentes resultados.…”

Section: Tecnologías De La Información Y De La Comunicación (Tic)unclassified

The patient and the crossing between Primary and Hospital care. Systematic review of trials for the implementation of tools for integration in Spain

Corral‐Gudino

Cengotita-Bengoa

Sánchez

et al. 2017

An Sist Sanit Navar

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revisiones0el paciente y su travesía entre la atención primaria y la hospitalaria. revisión sistemática de ensayos clínicos para la implementación de herramientas para la integración en españa Fundamento. Los servicios de salud evolucionan hacia la integración, con el fin de reducir la fragmentación de la atención, mejorando la eficiencia y los resultados en salud. Este trabajo valora la efectividad de distintas herramientas para la integración en España. Método. Revisión en MEDLINE (última búsqueda: 31 de julio de 2017) de ensayos clínicos realizados en España. El riesgo de sesgo se valoró utilizando la propuesta de la colaboración Cochrane. resultados. Se incluyeron veintiún estudios: hospitalización a domicilio (cuatro estudios, 455 pacientes), consultas externas mediante videoconferencia (tres, 2438), enfermeras de enlace (cuatro, 1051), mejora del autocuidado (cuatro, 1219), monitorización de parámetros biomédicos en domicilio (tres, 162), uso de aplicaciones informáticas (dos, 225) y conciliación de la medicación (uno, 172). La hospitalización a domicilio, las enfermeras de enlace y la mejora del autocuidado redujeron los reingresos en pacientes ancianos, con insuficiencia cardiaca (IC) o enfermedad pulmonar obstructiva crónica (EPOC). La mejora del autocuidado y las enfermeras de enlace disminuyeron la mortalidad en IC. La hospitalización a domicilio disminuyó los días de hospitalización en EPOC. La mejora del autocuidado redujo el número de visitas a consulta en asma. La consulta externa mediante videoconferencia disminuyó el tiempo hasta el diagnóstico y el tratamiento en áreas rurales. La calidad de la evidencia fue baja o muy baja ya que los estudios tenían dos o más riesgos de sesgo. Conclusiones. La aplicación de herramientas para la integración mejoró algunos resultados en salud en pacientes con enfermedades crónicas, aunque la evidencia es escasa. De todas las herramientas cabe destacar la mejoría en los resultados conseguida con el autocuidado. Palabras clave. Continuidad del cuidado. Cuidado en atención primaria. Hospital a domicilio. Auto-cuidado. Pacientes no ingresados. ABsTrACTBackground. Health services are moving towards a complete integration to try and reduce fragmentation, increase efficiencies and improve health outcomes. This study estimates the effectiveness in of different tools for integrated care in Spain. Methods. We performed a systematic review of articles using MEDLINE (last search July31 st , 2017). Randomized clinical trials reporting health outcomes of tools for integrated care used in Spain were included. Studies were appraised for quality using the Cochrane Risk of Bias assessment.

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Impact of telemonitoring home care patients with heart failure or chronic lung disease from primary care on healthcare resource use (the TELBIL study randomised controlled trial)

Cited by 75 publications

References 23 publications

Randomised crossover trial of telemonitoring in chronic respiratory patients (TeleCRAFT trial)

Randomised crossover trial of telemonitoring in chronic respiratory patients (TeleCRAFT trial)

Outpatient services and primary care: scoping review, substudies and international comparisons

The patient and the crossing between Primary and Hospital care. Systematic review of trials for the implementation of tools for integration in Spain

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