Result card

  • CUR3 / ORG10: Who decides which people are eligible for structured telephone support (STS) for adult patients with chronic heart failure and on what basis?
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Who decides which people are eligible for structured telephone support (STS) for adult patients with chronic heart failure and on what basis?

Authors: Ingrid Wilbacher, Nadine Berndt, Francesca Gillespie, Valentina Prevolnik Rupel, Taja Čokl, Eleftheria Karampli

Internal reviewers: Alessandra Lo Scalzo, Christian Vladescu, Christina Mototolea, Kristina Lampe, Maria Camerlingo, Ulla Saalasti - Koskinen, Elle Kisk, Ricardo Ramos

Acknowledgments: ,

Three studies out of the basic literature search provided some information relating the selection of patients for telemonitoring.

Three of the reviews reported eligibility and exclusion criteria for patients included in the studies, but there was no answer on who decides or who should decide to use telemedicine for what patient.

One could take the eligibility criteria used in the studies as a surrogate for the decision basis: clinical severity aspects, aspects of positive attitudes towards self-management, and criteria for acceptance and compliance. The used criteria within the studies are listed below.

Several exclusion criteria were used in the studies. Most commonly patients were excluded from the studies in case they:

-had a moderate or serious cognitive, visual, or physical disability {92};

-did not own a phone or who had a life expectancy measured in months rather than years {92};

-were discharged to a long term care facility {42};

-had some form of cognitive impairment or psychiatric disorder {42};

-had a terminal disease or severe co-morbidity {42}.

When determining eligibility criteria, it cannot be denied that some patients appear to benefit more than others. Several studies have suggested that the beneficial effects on state of health are observed mostly among patients:  

-whose state of health is considered serious (e.g., the studies by Kwon et al {66} and Trappenberg et al {108}); in {92};

-who want to play an active role in the management of their illness (eg, the studies by Madsen et al {72}, Rickerby and Woodward {97}, DelliFraine and Dansky {18}, and Hopp et al {43}) in {92};

-who are interested in using this type of technological device (eg, the studies by Vähätalo et al {109}, and Madsen et al {72}) in {92};

-with a mean age varied between 56–86 years {42} or 59-82 years {25};

-with a proportion of men from 27–99  % among the studies {42} {25};

-with recorded baseline ejection fractions, with trial means varying from 22–43  % {42};

-with New York Heart Association functional class > II {50} {42} {25};

-with a proportion of patients with coronary artery disease or prior myocardial infarction (MI) ranged from 27 percent to 61 percent in most trials {25}.

In terms of the technology, important acceptance criteria are

-the user-friendliness of the device installed in the home and its nonintrusiveness in the lives of patients, particularly for the youngest patients {92};

-level of technological skill {92};

-level of education {92};

-professional constraints {92} ;

-lifestyle {92};

-having a visual or motor deficit {92}.

 

Eligibility to new technology depends on an assessment of the general practitioner of a patient’s condition and the patient's willingness and ability to participate. Access to new technologies depends on support of healthcare providers. In real-world settings, patient selection will be critical for the acceptance and compliance with the programme. Patient selection criteria might include the degree to which the patient is willing to incorporate these technologies into their care or patients at high-risk {40}. Having  an access to a touchtone telephone is an essential inclusion criterion {1} . By Dunagan et al {10} cognitive or psychologic impairment as well as inability to hear and understand English spoken over the telephone were included as non-eligibility criteria.

Three of the reviews reported eligibility and exclusion criteria for patients included in the studies, but there was no answer on who decides or who should decide to use telemedicine for what patient.

One could take the eligibility criteria used in the studies as a surrogate for the decision basis: clinical severity aspects, aspects of positive attitudes towards self-management, and criteria for acceptance and compliance. The used criteria within the studies are listed below.

Several exclusion criteria were used in the studies. Most commonly patients were excluded from the studies in case they:

-had a moderate or serious cognitive, visual, or physical disability {92};

-did not own a phone or who had a life expectancy measured in months rather than years {92};

-were discharged to a long term care facility {42};

-had some form of cognitive impairment or psychiatric disorder {42};

-had a terminal disease or severe co-morbidity {42}.

When determining eligibility criteria, it cannot be denied that some patients appear to benefit more than others. Several studies have suggested that the beneficial effects on state of health are observed mostly among patients:  

-whose state of health is considered serious (e.g., the studies by Kwon et al {66} and Trappenberg et al {108}); in {92};

-who want to play an active role in the management of their illness (eg, the studies by Madsen et al {72}, Rickerby and Woodward {97}, DelliFraine and Dansky {18}, and Hopp et al {43}) in {92};

-who are interested in using this type of technological device (eg, the studies by Vähätalo et al {109}, and Madsen et al {72}) in {92};

-with a mean age varied between 56–86 years {42} or 59-82 years {25};

-with a proportion of men from 27–99  % among the studies {42} {25};

-with recorded baseline ejection fractions, with trial means varying from 22–43  % {42};

-with New York Heart Association functional class > II {50} {42} {25};

-with a proportion of patients with coronary artery disease or prior myocardial infarction (MI) ranged from 27 percent to 61 percent in most trials {25}.

In terms of the technology, important acceptance criteria are

-the user-friendliness of the device installed in the home and its nonintrusiveness in the lives of patients, particularly for the youngest patients {92};

-level of technological skill {92};

-level of education {92};

-professional constraints {92} ;

-lifestyle {92};

-having a visual or motor deficit {92}.

Patient self management of chronic conditions, both the disease and the symptoms, is an aged practice that is accelerating and disseminating throughout the world, fueled in part by home-based and portable technologies. Ethically problematic assumptions have the potential to harm some patients and unnecessarily exclude others from self management. A new and higher standard than the current provider-based practice; that readiness to learn, literacy and intact cognitive function are frequently not essential to competent patient self management; that patients, however, are still excluded from it based on apparent defects in these characteristics; and that quality control standards for self management are essential but are not sufficiently rigorous. Barriers to improved outcomes from self management include the virtual absence of objective measures of patient competence to self manage, and of explicit, publicly available and well-argued descriptions of risk and benefit {1450}.

In clinical trials included the selection of patients was made by the researchers on the basis of specific inclusion criteria. For example, in all STS RCTs reviewed by Inglis et al {490}, having access to a touchtone telephone was an essential inclusion criterion. In a RCT of telephone or videophone communication vs. UC {1}, a Mini Mental Status Examination Score above a certain threshold and a phone line at home were among the inclusion criteria. In the clinical trial reported by Dunagan et al {10} cognitive or psychologic impairment as well as inability to hear and understand English spoken over the telephone were included as non-eligibility criteria.

In real-world settings, patient selection will be critical for the acceptance and compliance with the programme. Patient selection criteria might include the degree to which the patients are willing to incorporate these technologies into their care or, patients at high-risk could be a main target group for these programmes {40}.

Important
Partially
Wilbacher I et al. Result Card CUR3 / ORG10 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