Result card

  • CUR1: For which health conditions and for what purposes is structured telephone support (STS) for adult patients with chronic heart failure used?
English

For which health conditions and for what purposes is structured telephone support (STS) for adult patients with chronic heart failure used?

Authors: Ingrid Wilbacher, Nadine Berndt, Francesca Gillespie

Internal reviewers: Alessandra Lo Scalzo, Christian Vladescu, Christina Mototolea, Kristina Lampe, Maria Camerlingo

For this question the results of the CUR domain search were used. In fact, the CUR domain literature was a selection of studies from the basic search done for the whole project done by the project coordinator, and a range of studies (n=14) were selected that provided answers to the question. The results of these studies are described below.

Structured telephone support is one specific type of remote heart failure monitoring. It is monitoring and/or self-care management using simple telephone technology, usually initiated by a healthcare professional (e.g. nurse, physician, social worker or pharmacist) who collects relevant patient data and stores them in a computer. Data can hence be reviewed by the healthcare professional and if necessary, action can immediately be untaken.

Healthcare costs, rapid advances in communication and diagnostic technology, and the availability of low-cost telemedicine equipment are important factors that have significantly contributed to the increasing use of telemedicine for the provision of care {71}. There is a range of different technological modalities for monitoring and/or self-care management. Data may be transferred automatically or manually, through the telephone line, mobile networks or a secure web server to those with expertise in interpreting the data. A distinction is often made between invasive or non-invasive telemedicine interventions for heart failure. Invasive interventions are implanted devices measuring clinical variables which are most often automatically transmitted, whereas non-invasive remote monitoring for heart failure include telemonitoring or structured telephone support {48}. Telemonitoring is specific branch of telemedicine. It is defined as the use of electronic information processing technologies to monitor and transmit clinical data related to patient health status between geographically separated individuals, the choice of data collected is determined by the health problem {99}, it concerns digital, broadband, satellite, wireless or blue-tooth transmission of clinical data {47}. Telemedicine is an approach using remote monitoring by structured telephone support of prognostic factors in order to promote an early identification of clinical deterioration in HF patients, prevent hospital readmission for acute decompensated HF, and avoid further complications {3}. Signs and symptoms reported by patients are collected and subsequently entered and stored in a computer system by the healthcare professional, usually physicians or nurses. The data are then remotely reviewed by healthcare professionals. Appropriate action can be initiated, and deterioration can be rapidly detected, which leads to decrease in unnecessary hospital visits, a decrease in hospital (re-)admissions, an improved quality of life {75}. The highest risk period for hospital readmission is the first few weeks after discharge {90}. Telemonitoring provides the opportunity for the patient to get involved in his own disease management and has the potential to improve patient safety and quality of care {21}.

With particular reference to heart failure (HF), the clinical indications, the clinical benefit, and underlying purposes of telemedicine, of which structured telephone support is one specific intervention, have been clearly outlined in the literature:

The rising healthcare costs, rapid advances in communication and diagnostic technology, and the availability of low-cost telemedicine equipment are important factors that have significantly contributed to the increasing use of telemedicine for the provision of care {71}. A range of different technological modalities for monitoring and/or self-care management exists in telemedicine.

Technologies vary from devices such as:

-implantable pacing, defillibrator technologies or cardiac resynchronization devices (remote monitoring by integration of signals from several monitored variables);

-structured telephone support (normal telephone, usually conducted by nurses who call patients to provide monitoring of the patients’ signs and symptoms, supported by a computer that collects and stores the data);

-videophone or video-consulting, interactive voice response systems (a computer voice guides the patient to press phone keys in response to questions);

-telemonitoring in which clinical data are electronically transmitted to a health-care team including telephone touch-pad-based telemonitoring modalities and website-based telemonitoring modalities {75},{14}.

In telemonitoring data may be transferred automatically or manually, through the telephone line, the GSM or a secure web server to those with expertise in interpreting the data, whereas in structured telephone support a healthcare professional conducts the call with the patient to gather data that is entered in a computer system. A distinction is often made between invasive or non-invasive telemedicine interventions for heart failure. Invasive interventions are implanted devices measuring clinical variables which are most often automatically transmitted, whereas non-invasive remote monitoring for heart failure include telemonitoring or structured telephone support {48}.

Telemonitoring is a specific branch of telemedicine. It is defined as the use of electronic information processing technologies to monitor and transmit clinical data related to patient health status between geographically separated individuals. Telemonitoring may be continuous or intermittent, usually event-triggered, and the choice of data collected is determined by the health problem of the individual patient {99}. As such, in specialized telemonitoring devices and telephone touch-pads for data entry, patients need to enter their signs, symptoms, and other necessary clinical data such as blood pressure and heart rate {75}. It concerns digital, broadband, satellite, wireless or blue-tooth transmission of clinical data for remote follow-up of a patient over a longer period of time. Home telemonitoring is the remote care delivery or monitoring between a healthcare provider and a patient at a distant location {47}. Structured telephone support, as subject of the current Core HTA, is one specific type of remote heart failure monitoring. It is monitoring and/or self-care management using simple telephone technology, usually initiated by a healthcare professional (e.g. nurse, physician, social worker or pharmacist), in which data is stored on a computer {47}.

Structured telephone support as one particular telemonitoring intervention comes along with several practical general advantages. One important advantage of structured telephone support is an improvement of the observation of patients implying long-term monitoring to detect changes in the patients’ condition and thereby having the potential to improve outcomes {99}. Structured telephone support may be particularly suited to make care more accessible to a larger number of patients including those constrained by geography, transport or infirmity {75},{14}. It thereby can also meet the needs of healthcare systems regarding the shortage of healthcare professionals and increasing costs which are problems many countries are facing {92}. It is a patient management care, also labelled as integrated care approach, that ensures appropriate monitoring and treatment of an increasing number of chronically ill patients at a relatively low cost {91}. Structured telephone support shifts health care out of a clinical setting into the patient’s home environment or another non-hospital setting facilitating supported self-care, giving the patient enhanced autonomy and control of their disease. Structured telephone support can assist patients in self-monitoring their signs and symptoms and be individually tailored and flexible {11}, {47}, and often includes education or self-care training {25}. It is accepted by patients and likely to be patient-friendly and to enable daily contact with patients without the need for face-to-face contact {47}, {48}, {95}. The underlying purpose is to provide health professionals with accurate and timely information required to remotely detect any deviant health parameter and complications associated with the disease, before an emergency or a scheduled face-to-face follow-up visit is required. It is not an emergency system but helps to generate a fast response. Participation of patients in a telemonitoring programme on a daily basis holds the potential favorable effect to improve health behaviors including adherence to medical recommendations {8},{99} {24}.

Structured telephone support as one particular telemonitoring intervention comes along with several advantages that apply especially to cardiac patients, but that may also apply to patient groups with other chronic diseases including diabetes, chronic obstructive pulmonary disease, asthma and hypertension {91},{118},{62}. The systematic review of Paré et al. {91} revealed evidence concerning the reliability and accuracy of home telemonitoring as an approach to patient management among patients with these chronic diseases, in particular in the cases of pulmonary conditions and HF. The positive effects of telemonitoring in the above named chronic diseases (including HF) primarily result from the fact that telemonitoring allows for frequent patient follow-up, and as a result warning signs of the health state can be detected and appropriate action can be initiated on time. On the other side, telemonitoring has revealed to promote an improvement of patients’ self-management and treatment adherence {92}. According to Woottoon 2012 {118}, the main aims of telemonitoring are to support integrated care in chronic disease management by providing information and education in order to improve patients’ self-management, facilitating contact with the healthcare professional and improving electronic records {118}.

In HF, telemedicine is an approach using remote monitoring of prognostic factors by structured telephone support in order to promote an early identification of clinical deterioration in HF patients, prevent hospital readmission for acute decompensated HF, and avoid further complications {3}. Prognostic factors that are monitored include weight, blood pressure, pulse oximetry, respiratory rate, body temperature, oxygen saturation, electrocardiograph (ECG) changes, fluid status, ankle swelling over time, infection, intrathoracic impedance, arrhythmias, heart rates during rest and exertion {3}, but also other factors including self-care, education, lifestyle modification, and medicine administration {47}. As already mentioned, one favorable consequence of structured telephone support is that may promote HF patients’ treatment adherence and self-management {8},{99}.

With frequent structured telephone support, signs and symptoms reported by patients are collected and subsequently entered by the healthcare professional who is talking over the phone with the patient in a computer system. The data can then be remotely reviewed by healthcare professionals, usually physicians or nurses. If the clinical data do not correspond with agreed parameters or in case complications are observed by an increase in the severity of HF signs and symptoms, healthcare professionals are alerted. Appropriate action can be initiated, and deterioration can be rapidly detected and addressed, for example by adjusting medication or arranging a clinical visit. A timely medical care response or improvement in treatment adherence is prompted and this, in turn, may potentially lead to a decrease in unnecessary hospital visits, a decrease in hospital (re-) admissions, an improved quality of life, fewer events and deteriorations for HF, and reduced healthcare costs {75}. Because the highest risk period for hospital readmission is the first few weeks after discharge, it is suggested that daily telephone support is of particular high benefit during that period {90}. Last but not least, structured telephone support as one particular telemonitoring intervention has the potential to improve patient safety and quality of care {21}.

Important
Completely
Wilbacher I et al. Result Card CUR1 In: Wilbacher I et al. Health Problem and Current Use of the Technology In: Jefferson T, Cerbo M, Vicari N [eds.]. Structured telephone support (STS) for adult patients with chronic heart failure [Core HTA], Agenas - Agenzia nazionale per i servizi sanitari regionali ; 2015. [cited 16 June 2021]. Available from: http://corehta.info/ViewCover.aspx?id=305

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