Remote Patient Monitoring at Home in Patients With COVID-19: Narrative Review (Preprint)

Abstract

BACKGROUND During the COVID-19 pandemic healthcare providers boosted their care capacity by implementing remote patient monitoring (RPM). This way they wanted to reduce the strain on hospital capacity as well as relieve primary care and emergency departments. OBJECTIVE With this literature review we aim at describing which RPM interventions were used for COVID-19 patients, reporting on the characteristics of the patients with COVID-19 included in RPM, and providing an overview of the effects of RPM on outcome variables such as length of stay, hospital (re)admissions, and mortality. METHODS A combination of different searches in several database types (traditional databases, trial registers, daily (google) searches and daily Pubmed alerts) were run from March 2020 till December 2021. A search update for randomized clinical trials was done in April 2022. RESULTS The initial search yielded more than 4 448 articles (not including daily searches). After deduplication and assessment for eligibility, 241 articles were retained describing 164 telemonitoring projects from 160 centres. None of the 164 studies covering 248 431 included patients reported on the presence of a randomized control group. There is a large variety in number of emergency department (ED) visits and no convincing evidence that RPM leads to less or more ED-visits as well as hospital (re)admissions. Mortality was generally low, and there is weak to no evidence that RPM is associated with lower mortality. There is neither evidence that RPM shortens previous hospital length of stay. Most papers claim savings, however the scientific base for these claims is doubtful. The overall patient experiences with RPM were positive, as patients felt more reassured. However, the overall positive picture might be skewed because many patients declined RPM for several reasons (e.g. technological embarrassment, feeling too good, etc.). A literature update detected three small scale randomized controlled trials (RCT’s) which could not demonstrate statistically significant differences in these outcomes. CONCLUSIONS There is up till now no convincing evidence that COVID-19 RPM patients is effective in avoiding ED-visits, hospital (re)admissions, shortening length of hospital stay or reducing mortality, but there is also no signal RPM has reverse unexpected outcomes. Further research should focus on developing, implementing, and evaluating an RPM framework.

Monitoring COVID-19 in Belgian general practice: A tool for syndromic surveillance based on electronic health records

“…When visually comparing the Barometer data with national hospital admissions data, we perceived the Barometer’s ‘suspected COVID-19 curve’ peaking 10 days before hospital admissions (at the start of the study period). COVID-19 care may explain the differences between the two curves and particularly the absence of peaks in hospital admissions in the second part of the study period due to experience, improved knowledge of the disease and vaccination (which started in nursing homes in early 2021), patients became less likely to be hospitalised and follow up at home was instituted [ 18 ]. The Barometer’s ‘confirmed COVID-19 cases’ curve followed the same trend as the hospital admissions curve.…”