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

Abstract

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.

Experiences of patients with chronic obstructive pulmonary disease receiving integrated telehealth nursing services during COVID-19 lockdown

“…In addition, participants’ opinions regarding the use of the comment section were divided; some would write extensively, while others hesitated as it would lead to an immediate follow-up call from the telenurse. The extensiveness of the questionnaires and its response frequency of patients warrant discussion, however, evidence exists that patients using telemonitoring services prefer a 2 to 3 day per week response rate [ 33 , 34 ]; allowing for increased autonomy and adherence to lifelong chronic disease management. Although patient preferences must be considered when standardizing the clinical telemonitoring protocols, several participants expressed no reluctance and instead encouraged sharing their personal data with the clinical team across levels of care.…”

Experiences of Patients With Chronic Obstructive Pulmonary Disease receiving Integrated Telehealth Nursing Services During COVID-19 Lockdown

“…In addition, participants' opinions regarding the use of the comment section were divided; some would write extensively, while others hesitated as it would lead to an immediate follow-up call from the telenurse. The extensiveness of the questionnaires and its response frequency of patients warrant discussion, however, evidence exists that patients using telemonitoring services prefer a 2 to 3 day per week response rate; 35,36 allowing for increased autonomy and adherence to lifelong chronic disease management. Although patient preferences must be considered when standardizing the clinical telemonitoring protocols, several participants expressed no reluctance and instead encouraged sharing their personal data with the clinical team across levels of care.…”

Experiences of Complex Patients With Telemonitoring in a Nurse-Led Model of Care: Multimethod Feasibility Study

“…Previous research has found varying adherence rates, typically between 40% and 90%, to TM in HF [47,60,61]. Another study found that the average adherence rate to BP monitoring and blood sugar monitoring was 59.7% and 50.2%, respectively [61]. In addition, other previous studies have found an initial drop in patient adherence during onboarding, followed by a steadier adherence rate over time [47,48,60].…”

“…The results indicated an average adherence rate of 77.2% (142/184) in HF monitoring, 55% (29/52) in HTN monitoring, and 72% (19/26) in DM monitoring. Previous research has found varying adherence rates, typically between 40% and 90%, to TM in HF [47,60,61]. Another study found that the average adherence rate to BP monitoring and blood sugar monitoring was 59.7% and 50.2%, respectively [61].…”