Result card

  • CUR2: What kind of variations in use are there across countries/regions/settings?
English

What kind of variations in use are there across countries/regions/settings?

Authors: Ingrid Wilbacher, Nadine Berndt, Francesca Gillespie

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

For this AE the results of the basic search were used,

Additionally the following article was used from handsearch:

MAST REgioNs of Europe WorkINg toGether for HEALTH (Grant Agreement No 250487). D1.12 v1.5 Renewing Health Final Project Report - Public

All provided text-parts about variations in different settings were used, mainly provided descriptively in the studies.

Most studies report care provided by a multidisciplinary team, but a great deal of heterogeneity regarding the professionals involved was described. Collaboration between primary care and secondary care was scarcely reported. In almost all the studies, nurses played a coordinating or leading role, but description of the specialization of clinical background were lacking. Almost all programmes also had physicians involved, which could be cardiologists, and/or primary care physicians or other specialists such as geriatricians or internists. Additionally, other professionals (psychologist, dietician, physical therapist, social worker, pharmacist) were involved in the programmes, mostly as a member of the multidisciplinary team or occasionally as the main provider of an intervention (e.g. a pharmacist). A different variation of systems for telemonitoring was found, ranging from assessment of symptoms and/or vital signs to data transmission and automatic alarms. {51}

Substantial heterogeneity among studies was noted {119 }, the content of the telemedicine interventions vary between patient groups and with regard to duration and content.

Among the included 15 reviews 188 references were cited about telemedicine for patients with heart failure. 69 (37 %) of these references are from Europe, 30 (16 %) are from South America, Asia and New Zealand, and 89 (47 %) are from the US.

There were 62 studies from Europe cited in the reviews. Out of the 62 European studies, 16 mentioned educational strategies within the telemedicinal programme. The involved persons in the educational programmes were cardiologists (3 studies), multidisciplinary teams at least for the care plan (25 studies), physician-/primary care led (1 study each), and nurse-led (4 studies) programmes. The other reviews did not mention their specific programme used (32 studies).

In 17 studies, the transfer mode was via telephone/ cell phone transmission, in 4 studies through implantable devices, 1 study described interactive videoconferencing, transtelephonic monitoring, 1 study described hospital-at-home service, 2 studies just described non-invasive telemonitoring, and in 36 studies the transfer mode was not clear.

There are differences in the level of complexity among the technologies and decision systems within telemedicine.{14} Many studies (i.e. n=69, 99 % of the included studies in {51}) report care provided by a multidisciplinary team, but the involved professionals are heterogeneous. Scarcely reported is the collaboration between primary care and in-hospital care provider. In almost all the studies, nurses played a coordinating or leading role, described as homecare nurses, hospital nurses, HF nurses, cardiac rehabilitation nurses, research nurses, practice nurses, and/or district nurses. The description of the specialization of clinical background was lacking. Physicians were involved in almost all programmes, described as cardiologists, primary care physicians, or other specialists such as geriatricians or internists. Additionally, other professionals (psychologist, dietician, physical therapist, social worker, pharmacist) can be involved in the programmes, as a member of the multidisciplinary team or occasionally as the main provider of an intervention (e.g. a pharmacist). The different variations of systems for telemonitoring range from assessment of symptoms and/or vital signs to data transmission and automatic alarms. {51}Substantial heterogeneity among studies was also noted in regard to intervention components, methodologic quality, target population, clinical setting, telemedicine technology, outcomes assessed, personnel involved, and other key factors {52}, There was also a variation within the monitored parameters, the HF selection criteria and lacked detail in the components of the RM (remote monitoring) care packages and usual care.{90}The content of the telemedicine interventions also vary between patient groups and in duration and content. Some include videoconferencing between patients and healthcare professionals, others include monitoring of disease-specific health data by use of medical devices, and some include elements of health coaching. {119}

The used strategies described as telemonitoring for the European studies in the used reviews are listed in the table at appendix 1.  

Important
Completely
Wilbacher I et al. Result Card CUR2 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

References