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  • TEC6: In what context and level of care are Structured telephone support (STS) for adult patients with chronic heart failure and the comparator used?
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In what context and level of care are Structured telephone support (STS) for adult patients with chronic heart failure and the comparator used?

Authors: Ingrid Wilbacher, Valentina Prevolnik Rupel

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

The basic literature search was used. Additionally the resulst of Assessment Element TEC5 (B0001) were used to categorize into the settings.

The following studies provided information about the context: {54},{27},{47},{66},{53},{37},{18},{21},{72},{9},{7},{15}

Conclusion: telemedicine/ telemonitoring interventions can be used in all different settings, they are mainly provided in outpatient organisations, the most important part is the additional setting at the patients‘ home.

 A change into multidisciplinary management of HF patients was observed over the last 15 years. {27} Education is seen as one of the key points leading a 37% reduction (P=0.004) of readmission to the hospital for HF or for cardiovascular disease. {42} Telemonitoring aims to shift the focus on control of the disease towards the patient who is supported by the care team. A good relationship between care providers and patients is important. {27} Tele-healthcare can also be seen as an intensification of more conventional methods of delivering care towards optimal comprehensive care as recommeded by guidelines. {27}

The primary function of telemedicine is to provide specialist consultation to distant communities, rather than to provide support for self-management of chronic disease. However, home telecare is a rapidly evolving domain and increasingly focused on supporting the patient rather than the health professionals. Home telemonitoring is used for different modalities and encompasses the use of audio, video, and other telecommunication technologies to monitor patient status at a distance. {49},{,35},{44}, {18} It can be seen as an automated process for the transmission of data on a patient’s health status from home to the respective health care setting. {54} {72}. Hence, telemonitoring does not involve the electronic transmission of data by a health care professional at the patient’s location. {54} {15}.

The tele monitoring interventions are heterogeneous in terms of monitored parameters and HF (heart failure) selection criteria and lack detail in the components of the care packages and usual care {53}

Also the telemedicine equipment varies in the different projects, as do the roles, numbers and education of healthcare professionals, which also makes it difficult to generalise the results from one project to another. The legal framework diverge from country/region to country/region {47} and has to be carefully studied and compared to those of the countries/regions where the studies took place.

 There seems to be potential for self care at home to reduce mortality and morbidity and to improve symptoms in patients suffering from HF, whereas lack of knowledge about disease-specific self-care behaviours is associated with non-adherence to recommended self-care practices. {37}In Europe HF clinics are common and often situated at the hospital or at primary health care centre. Very few of the HF management programmes offer home care and there is a lack of  collaboration across the primary-secondary care interface and a lack of continuity of care. {37}

„Monitoring is not a treatment but rather a different way of systematically organizing effective care.“ {9}.

This continuity of care is seen to be achieved by nurses acting as case manager for the patients at home and in liason among members of the health care team. {21}.

Settings  {21}{72}{9}{7}{15}

telemedical intervention

Primary care/ oupatient

Secondary care/ hospital outpatient

Tertiary care/ inpatient

Patient home

 
 

fluid status monitoring

 

yes

 

yes

 

register heart rate, body temperature, patient activity,

yes

yes

 

yes

 

nurse-led management program after hospital discharge

yes

yes

 

yes

 

disease management program (including cardiologists, nurses, GPs)

yes

 

 

yes

 

patient education

yes

yes

yes

yes

 

self-care supportive strategies

 

 

 

yes

 

case management interventions

yes

 

 

yes

 

monitoring and (daily) transmission of vital parameters and weight

 

yes

 

yes

 

telephone-follow up

yes

 

 

yes

 

home-visits

yes

 

 

yes

 

remote consultation with a nurse by video-camera

yes

 

 

yes

 

weigh daily and respond to questions concerning heart failure symptoms

yes

 

 

yes

 

daily data-transfer to a secure Internet site

 

yes

 

yes

 

response to questions from a computerized interactive voice response system

 

 

 

yes

 

medication management (adherence)

yes

 

 

yes

 

fluid management (adherence)

yes

 

 

yes

 

problem solving

yes

 

 

yes

 

structured telephone support

yes

 

 

yes

 

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

yes

yes

yes

yes

 

standard post-discharge care without intensified attendance at cardiology clinics

 

 

yes

yes

 

clinic-based CHF disease management programme

 

yes

 

yes

 

home visiting

 

 

 

yes

 

Important
Completely
Wilbacher I, Rupel V Result Card TEC6 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