Result card

  • TEC5: What is Structured telephone support (STS) for adult patients with chronic heart failure and the comparator(s)?
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What is Structured telephone support (STS) for adult patients with chronic heart failure and the comparator(s)?

Authors: Ingrid Wilbacher, Valentina Prevolnik Rupel

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

We used the description out of  studies (47},{27},{22}, {15}), 21 from the general literature search, 3 from handsearch and one additional reference. The studies used are provided in the table below.

Definitions

Telemonitoring using structured telephone support is intended to remove time and distance barriers  for the delivery of healthcare services. (The American Nurses Association)

Technology

Using structured telephone support means that the patient stays at home and is instructed to measure and observe the symptoms related to the heart disease. Several measuring devices can be in use, like a scale, a blood pressure device, a 2 channel ECG, a pedometer, etc.) {47}.

The transfer of the measured data is done by telephone, meaning a contact between health care providers and patient, where the observation of symptoms is asked by the healthcare providers and reported by the patient. Within this telephone call the healthcare provider documents the physiological data reported and can ask additional questions, give advice, treatment instructions, medication support and provide education or information accordingly. {27}

The structured telephone support is scheduled regularly and follows a pre-defined system of what is asked and what kind of advice is given. Beside the structure of the monitoring for patients with chronic heart failure the telephone support allows additional individual questions from patients and health care providers. {27} {22} {15}

The data are documented by the health care providers using a kind of database, an interactive option to view the data by both, patients and personnel can be added, requiring an internet connection and a computer on both sides. {47} The internet connection has to be secured within the frame of health care data protection.

Structured telephone support is a modality to replace direct physical patient-physician contact by contact via telephone for monitoring, education, or self-management or various combination using simple telephone technology after discharge in a structured format {22}.

Comparator

Usual care as the comparator requires a careful awareness for temporal changes of standard of care that might have affected the results. The management of care for HF patients changed within the last 15 years and usual care now includes multidiciplinary care, education of the patient and guideline conform medication. {27}

Most trials do not describe specific details of UC but provide explanations like »standard discharge instructions« or »follow up with outpatient provider as usual«. The follow-up setting (primary care or follow-up in a specialty clinic) or the timing of outpatient follow-up in the usual care group are rarely defined. {22}.

Depending on the area, organization and setting „Usual care“ differs between the studies. Usual care also can include  regular specialist CHF department visits and extensive information on the disease and training to the patient. {11}.

The contents of standard and usual care vary among studies, and could include regular visits to outpatient clinics,  training, education or information on disease-specific self-care behaviour, hospital follow-up by nurse and cardiologist and care within primary care providers, with or without home visits to assess vital signs and medication adherence. {7}

Limitations

The limitations of telephone support models are that the telephone calls are primarily initiated by the professional at the preset times (usually protocol driven) and they are thus unable to detect more rapid changes in the condition. {15}.

Descriptions and definitions

The following table lists the descriptions and explanations found in the studies included.

TEC-5 Table 1

Excursus on mHealth

Structured telephone support includes

  • Human to human service - landline phone line/ telephone call by nurse (other healthcare provider) - mobile phone/ telephone call by nurse (other healthcare provider)

  • Human to machine service - smart phone/ table/ App for bluetooth transfer (i.e. from scale)

„m-health“

  • focuses on the human to machine part

For this excursus we did an additional google search (unscientific information collection) with keyword „mhealth“ and a short Pubmed search (broad search for scientific overview) with keyword „mhealth, mobile health AND chronic heart disease“ (– no results found despite some related to „telemedicine“ which is already covered by the general literature search).

 

Definition of mobile health

Mobile health (short “mhealth”) means the use of mobile devices like mobile phones, smartphones, tablet computers or PDAs (personal digital assitant) {73}  {74}  for health services or information {3}, whereas “health” could be meant as lifestyle, prevention, diagnostic assessment, monitoring, support, collecting data for health research, delivery of healthcare information, direct provision of care, reminder of medication time, behaviour, etc. {75} {76} Mobile health also includes the application software (Apps) and the transmitters (like sensors in bracelets or watches). {76}

Mobile technologies enable physicians and other healthcare providers to reach their patients more timely or even in regional distance. The way of communication includes SMS, e-mail, visualizing static text, visual image information and tagging voices. With the use of GPS a geographical mapping component can be added which is now already used for emergency services. The support function can include a decision algorithm out of the collected data. Data collection requires a device for collecting the data (mobile phone, etc.) and a software to house the information. {73}

Current status

There is a rapidly rising market for apps, mainly available for smartphones, and the market of apps is dominated by individuals (30%) or very small companies with 2-9 employees (34%).{77}

Recent estimations count about 97.000 available mhealth apps on the global market, 70% of them target the wellness and fitness segments, 30% target health professionals, access to patient data, patient consultation and monitoring, diagnostic imaging and pharmaceutical information. {84} {78}

Increasing data collection and -use needs a storage capacity to handle the huge amount of data, secure cloud solutions are already worked on within the European Commission cloud computing strategy. {79} {80}

Within Europe a third of people do have internet access through mobile phones, with significant differences between member states (Sweden 63%, Bulgaria 13%, Portugal 16%). {81}

mHealth depends on high capacity and flexible networks. The Commission recently adopted a legislative package (Connected Continent: Building a Telecoms Single Market) {82}, which recognises the need of high-speed and high-quality networks for eHealth at a greater degree of harmonisation. Under Horizon 2020 EU funding will be provided for mHealth with intended support, digital health literacy, and equal access to healthcare. {83} 

Conclusion

The non-invasive telemedicine/telemonitoring contains the following aspects (seperately or combined):

-remote access control (transfer of physiological data)

-nurse-led management program after hospital discharge

-disease management program (including cardiologists, nurses, GPs)

-patient education

-regular outpatient contact

-self-care supportive strategies

-case management interventions

-monitoring and (daily) transmission of vital parameters and weight

-telephone-follow up

-home-visits

-remote consultation with a nurse by video-camera

-weigh daily and respond to questions concerning heart failure symptoms

-daily data-transfer to a secure Internet site

-response to questions from a computerized interactive voice response system

-medication management (adherence),

-fluid management (adherence)

-problem solving

-exercise recommendation

-diet adeherence

-goal setting

-structured telephone support

-human-to-human contact (HH) or human-to-machine interface (HM)

 

Usual care

-standard post-discharge care without intensified attendance at cardiology clinics

-clinic-based CHF disease management programme

-home visiting

There is no consensus definition of the fundamental terms utilized.

There is also an „upcoming“ topic called mHealth meaning mobile health through mobile phones and similar devices using software applications (apps). There is increasing interest on mhealth, especially with the hope of easy and equal acces for information, tele-diagnostic or –care aspects and data collection and use for health purpose. Some major aspects are to be worked out (like network issues, data security, information quality, legal and regulatory aspects etc.) and are aim within the EU horizon 2020.

Critical
Completely
Wilbacher I, Rupel V Result Card TEC5 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