Result card

  • TEC4: What information of Structured telephone support (STS) for adult patients with chronic heart failure should be provided for patients outside the target group and the general public?
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What information of Structured telephone support (STS) for adult patients with chronic heart failure should be provided for patients outside the target group and the general public?

Authors: Ingrid Wilbacher, Valentina Prevolnik Rupel

Internal reviewers: Alessandra LoScalco, Antonio Migliore, Christina Mototolea, Silvia Gabriela Scintee

Nine studies out of the general literature search and one additional reference provided answer for this question ({54}, {47},{20},{26},{27},{29},{31},{9},{32},{7})

The informed consent of a patient using telemonitoring can be shown in the level of participation and compliance. The effectiveness of telemonitoring is directly related to attitudinal and behavioural aspects like

-Compliance with symptom entry

-Compliance with data transmission

-Awareness for an earlier detection of decompensation

-Positive attitude to empowerment

-Satisfaction with self-competence

To reach a higher level of compliance the MAST study reports

-A regularly feedback about the monitoring results

-Daily videoconferencing for follow-up was accepted and clinically useful

-tele-consultations, as they resulted in 76% of the patients feeling safer or more secure

-both verbal and nonverbal communication

-There is a need to rethink how communication and feedback is given to the patients

Information to patients outside the target group and the general public should therefore focus on the reasons and the explanaition for inclusion or exclusion of people/ patients for access to structured telephone support. People should be informed that structured telephone support is not suitable for all individuals nor is it appropriate under all medical circumstances{15}

The reported effects and impacts of telemonitoring can be divided into five categories: {54}

  • data quality

  • patient clinical condition

  • patient attitude and behavior

  • clinical effectiveness

  • economic viability

The most commonly assessed telemonitoring effects are at the attitudinal and/or behavioral level (like medication compliance, compliance with symptoms entry and data transmission, awareness, empowerment, satisfaction). {54}

Attitudinal and behavioral changes can be achieved with  

  • feedback to patients with telemedicine services {47}

  • a regular follow-up about every 3-4 month {47},videoconferencing for follow-up {47}

  • tele-consultations (resulting in 76% of the patients feeling safer or more secure after discharge) that offer both verbal and nonverbal communication {47}

  • the way of information and feedback communication taking into account the needed levels in different generations of care levels {47}

Patient empowerment due to self-mangement can

  • decrease in heart failure hospitalization risk and a reduction in mortality {33}, {15}{32}

  • lead to a better drug therapy and compliance {15}

  • lead to an earlier detection of decompensation, so that interventions can be made that reduce the need for subsequent hospitalization {15}

  • Reported benefits for the patients‘ psychological well-being, and safety {20}

  • patients require fewer overall visits to the follow-up clinic {20}

  • RM detects clinical abnormalities that would be either completely missed by less frequent in-office visits, or detected significantly without continuous remote monitoring data assessment.  {20}

Recommendations and statements among the included studies

  • The Heart Failure Society of America and The European Society of Cardiology heart Failure Association recommend enrollments in disease management programs (DMP) for patients with HF who have been recently hospitalized or for high-risk HF patients. {26}Dedicated telemonitoring for heart failure may be a practical adjunct in selective centres and patients on top of usual care, but it should never replace it as a standard of care because sicentific evidence remains conflicting, insufficient and heterogeneous. {27}{27}

  • Telemonitoring is not suitable for all individuals nor is it appropriate under all medical circumstances. Knowing the aim of the intervention for a specific patient is a key success factor. {29}

    The knowledge about HF can be increased by TM, but the evidence is conflicting (2 hospitals measured increased knowledge for patients, one showed no difference to the control group in the proportion of correct answers to questions about medication in three groups (i.e. telephone, videophone, control) at 90- and 180 days) {7}

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Wilbacher I, Rupel V Result Card TEC4 In: Wilbacher I, Rupel V Description and technical characteristics of 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