Telehealth Remote Monitoring Systematic Review

Greenwood, Deborah A.; Young, Heather M.; Quinn, Charlene C.

doi:10.1177/1932296813519311

Cited by 86 publications

(59 citation statements)

References 44 publications

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“…Tele-health remote monitoring interventions that incorporate multiple elements of structured self-monitoring of BG have been shown to be the most effective in achieving A1C level reduction. 25 …”

Section: Discussionmentioning

confidence: 99%

Evidence-based Mobile Medical Applications in Diabetes

Drincic

Prahalad

Greenwood

et al. 2016

Endocrinology and Metabolism Clinics of North America

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Section: Discussionmentioning

confidence: 99%

Evidence-based Mobile Medical Applications in Diabetes

Drincic

Prahalad

Greenwood

et al. 2016

Endocrinology and Metabolism Clinics of North America

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“…Several diabetes reviews included elements of remote clinical review, with some reporting positive outcomes [27,30,40]. In asthma and COPD, the findings were typically neutral [27,67].…”

Section: Resultsmentioning

confidence: 99%

“…The only review to address explicitly the question of which components were associated with improved disease outcomes was Greenwood et al, weighted 2 stars [30]. They defined 7 separate components of telehealth (patient education, health care provider education, self-monitoring profile, blood glucose goals, use of blood glucose data to modify behavior, feedback to patients, and 2-way interaction).…”

Section: Resultsmentioning

confidence: 99%

Telehealth Interventions to Support Self-Management of Long-Term Conditions: A Systematic Metareview of Diabetes, Heart Failure, Asthma, Chronic Obstructive Pulmonary Disease, and Cancer

Hanlon¹,

Daines²,

Campbell³

et al. 2017

J Med Internet Res

465

354

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BackgroundSelf-management support is one mechanism by which telehealth interventions have been proposed to facilitate management of long-term conditions.ObjectiveThe objectives of this metareview were to (1) assess the impact of telehealth interventions to support self-management on disease control and health care utilization, and (2) identify components of telehealth support and their impact on disease control and the process of self-management. Our goal was to synthesise evidence for telehealth-supported self-management of diabetes (types 1 and 2), heart failure, asthma, chronic obstructive pulmonary disease (COPD) and cancer to identify components of effective self-management support.MethodsWe performed a metareview (a systematic review of systematic reviews) of randomized controlled trials (RCTs) of telehealth interventions to support self-management in 6 exemplar long-term conditions. We searched 7 databases for reviews published from January 2000 to May 2016 and screened identified studies against eligibility criteria. We weighted reviews by quality (revised A Measurement Tool to Assess Systematic Reviews), size, and relevance. We then combined our results in a narrative synthesis and using harvest plots.ResultsWe included 53 systematic reviews, comprising 232 unique RCTs. Reviews concerned diabetes (type 1: n=6; type 2, n=11; mixed, n=19), heart failure (n=9), asthma (n=8), COPD (n=8), and cancer (n=3). Findings varied between and within disease areas. The highest-weighted reviews showed that blood glucose telemonitoring with feedback and some educational and lifestyle interventions improved glycemic control in type 2, but not type 1, diabetes, and that telemonitoring and telephone interventions reduced mortality and hospital admissions in heart failure, but these findings were not consistent in all reviews. Results for the other conditions were mixed, although no reviews showed evidence of harm. Analysis of the mediating role of self-management, and of components of successful interventions, was limited and inconclusive. More intensive and multifaceted interventions were associated with greater improvements in diabetes, heart failure, and asthma.ConclusionsWhile telehealth-mediated self-management was not consistently superior to usual care, none of the reviews reported any negative effects, suggesting that telehealth is a safe option for delivery of self-management support, particularly in conditions such as heart failure and type 2 diabetes, where the evidence base is more developed. Larger-scale trials of telehealth-supported self-management, based on explicit self-management theory, are needed before the extent to which telehealth technologies may be harnessed to support self-management can be established.

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“…Baseline HbA 1c levels in the reviewed studies ranged from near normal (6.5%) to extremely elevated (9.8%), which is similar to the results of our study. In one review from Greenwood et al (28), it was noted, unsurprisingly, that when study participants’ mean baseline HbA 1c level was at or close to goal, a small intervention effect was seen. The relationship of the baseline HbA 1c level to the intervention effect demonstrates the importance of choosing the optimal population for interventions.…”

Section: Discussionmentioning

confidence: 99%

Dulce Digital: An mHealth SMS-Based Intervention Improves Glycemic Control in Hispanics With Type 2 Diabetes

et al. 2017

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OBJECTIVEType 2 diabetes is growing in epidemic proportions and disproportionately affects lower-income, diverse communities. Text messaging may provide one of the most rapid methods to overcome the “digital divide” to improve care.RESEARCH DESIGN AND METHODSA randomized, nonblinded, parallel-groups clinical trial design allocated N = 126 low-income, Hispanic participants with poorly controlled type 2 diabetes to receive the Dulce Digital intervention or usual care (UC). Dulce Digital participants received up to three motivational, educational, and/or call-to-action text messages per day over 6 months. The primary outcome was HbA1c; lipids, blood pressure, and BMI were secondary outcomes. Satisfaction and acceptability were evaluated via focus groups and self-report survey items.RESULTSThe majority of patients were middle-aged (mean age 48.43 years, SD 9.80), female (75%), born in Mexico (91%), and uninsured (75%) and reported less than a ninth-grade education level (73%) and mean baseline HbA1c 9.5% (80 mmol/mol), SD 1.3, and fasting plasma glucose 187.17 mg/dL, SD 64.75. A statistically significant time-by-group interaction effect indicated that the Dulce Digital group achieved a significantly greater reduction in HbA1c over time compared with UC (P = 0.03). No statistically significant effects were observed for secondary clinical indicators. The number of blood glucose values texted in by participants was a statistically significant predictor of month 6 HbA1c (P < 0.05). Satisfaction and acceptability ratings for the Dulce Digital intervention were high.CONCLUSIONSUse of a simple, low-cost text messaging program was found to be highly acceptable in this sample of high-risk, Hispanic individuals with type 2 diabetes and resulted in greater improvement in glycemic control compared with UC.

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Telehealth Remote Monitoring Systematic Review

Cited by 86 publications

References 44 publications

Evidence-based Mobile Medical Applications in Diabetes

Evidence-based Mobile Medical Applications in Diabetes

Telehealth Interventions to Support Self-Management of Long-Term Conditions: A Systematic Metareview of Diabetes, Heart Failure, Asthma, Chronic Obstructive Pulmonary Disease, and Cancer

Dulce Digital: An mHealth SMS-Based Intervention Improves Glycemic Control in Hispanics With Type 2 Diabetes

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