Outcomes of a home telehealth intervention for patients with heart failure

Abstract

We evaluated the efficacy of two telehealth applications, delivered by telephone and videophone, for improving outcomes of patients following hospital discharge for an acute exacerbation of heart failure. The outcomes measured were patient self-efficacy, satisfaction with care and knowledge of and compliance with prescribed medications. At hospital discharge, patients were randomly assigned to either control (usual care), telephone or videophone groups. Study nurses contacted the intervention patients each week for 90 days after discharge. A total of 148 patients were enrolled: 49 were randomized to usual care, 52 to the videophone intervention and 47 to the telephone intervention. At 90 days, 126 patients (85%) had completed follow-up; at 180 days, 109 patients (74%) had completed follow-up. There were no significant differences between the groups in medication compliance, self-efficacy or satisfaction with care. The intervention group patients were more likely to have had their medications adjusted during the 90-day intervention period. Knowledge scores improved in the intervention group patients, although these scores were lower at enrolment compared to the control group. It is possible that routine monitoring of symptoms by the study nurses led to medication adjustments and accounted for the intervention patients' significantly delayed time to readmission relative to the control patients.

Improving medication adherence of patients with chronic heart failure: challenges and solutions

“…15 Medication adherence rates assessed from selfreports were reported to be anywhere from 78% to 100% in four studies. [16][17][18][19] Investigators used a variety of questionnaires to measure adherence (eg, Revised Heart Failure Compliance Questionnaire). [16][17][18][19] Adherence was measured by arbitrary cutoff points (80%).…”

“…[16][17][18][19] Investigators used a variety of questionnaires to measure adherence (eg, Revised Heart Failure Compliance Questionnaire). [16][17][18][19] Adherence was measured by arbitrary cutoff points (80%). 20 Patients' self-report of their adherence can introduce bias due to inaccurate recall or reporting an overly optimistic estimation of adherence to the health care providers.…”

“…The results from these studies provide insight on the current status of medication adherence. For purposes of this paper, these studies were grouped into four categories: 1) pharmacist-led education, 16,22,29,33 2) registered nurse-or case mangers-led education, 21,23,32 3) usage of tele-health or web-based modules, 19,30,31 and 4) interdisciplinary team-led education. 24 …”

“…There was higher adherence in the intervention group compared to the control group at the end of intervention period (78.8% vs 67.9%). There were 19 …”

Access to care for vulnerable veterans with hepatitis C: a hybrid conceptual framework and a case study to guide translation

“…To reach veterans residing in outlying areas, the VHA has developed telemedicine capabilities which also serve veterans in Hawaii, American Samoa, Guam, Puerto Rico, and the US Virgin Islands. The VHA national home telehealth program has served 32,000 veterans [38][39][40][41].…”