Result card

  • SOC4: What kind of support and resources (e.g. ergonomic changes) are needed for the patient as STS is introduced? This imlies a descriptive response.
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What kind of support and resources (e.g. ergonomic changes) are needed for the patient as STS is introduced? This imlies a descriptive response.

Authors: Alessandra Lo Scalzo, Ingrid Wilbacher

Internal reviewers: Pseudo253 Pseudo253, Pseudo285 Pseudo285, Pseudo294 Pseudo294, Pseudo332 Pseudo332

Acknowledgments: Maja Boban

We used the domain specific search (described above in the Domain Methodology section), in a systematic review method, including studies relevant to the social outcomes, no restriction of the study design. The quality assessment is summarized for all included studies for the social domain in the appendix. The results are given in a descriptive way summarising the text contents of the studies

Patients need

  • Education
  • Empowerment
  • Technical introduction
  • Tangible benefits from measuring
  • Acceptance of the program/ system and trust in function
  • Still contact to their physician
  • Some programs need patients to already have the appropriate telephone devices and telephone lines

For health outcome

  • Action has to be initiated (monitoring is no treatment effect)
  • The more severely ill, the more phone calls are necessary and the lower the outcome

Unsolved issues

  • institutional feasibility
  • the appropriate support package which guarantees the expected outcome-results

Systematic reviews

Remote monitoring is a part of a complex package of support which does not have any impact if no action is dictated. The whole package includes education and empowerment of the patient, early detection of deterioration and pharmacological intervention if necessary. Remote monitoring is not simple data-gathering, it is a system, so that a reduction of mortality or a reduction of hospitalisation are not solely attributed to one format of RM intervention or another [Pandor 2013]. The appropriate features of the STS intervention to guarantee positive outcomes has not yet been established, although reduced service utilization and improved clinical outcomes were found in research [Garcia 2007] referring to Cleland 2005 (1) , Benatar 2003 (2), Goldberg 2003 (3), Galbreath 2004 (4). The best medical practices such as training of health professionals, staffing or regularity of monitoring and follow-up, remain to be developed [Achelrod 2014]. The acceptability (institutional feasibility ) of HF-monitoring by health authorities is more or less unknown yet. [Martinez 2006].

RCTs

Patients need appropriate introductions on technical issues for proper use of the telephone support system  [Wakefield 2009, Jerant 2013], special health education concerning their disease status, i.e. about exercise recommendations, low sodium intake, medication regimen, increased swelling or shortness of breath [Seto 2012, Brandon 2009], and need to learn how to measure the required data (i.e. weight, blood pressure) correctly [Jerant 2013].

 

Observational study

Participants with lower initial perceived health received significantly more calls than did participants with higher initial perceived health.  The negative and significant coefficient + 11 shows that for any additional call, the slope of the growth curve becomes slightly flatter, indicating that those participants who were more strongly impaired showed a weaker improvement over time despite receiving significantly more calls than did participants with less severe impairment [Boehme 2012]

Qualitative studies

Patients wish that the monitoring system is adjunct to their relationship with their clinician at the heart function clinic. It should not be a replacement. They would take their measurements even for longterm, if they perceive clear tangible benefits from it or if their heart condition ever worsened. [Seto 2010, Lynga 2013]

The support system should be easy to use, supported by appropriate training and technical support if needed. [Seto 2010, Sander 2012]

Clinicians would like a remote monitoring system if it would not result in a significant increased workload, especially during nights, weekend,vacations. They also mentioned concerns about the legal situation in case if they did not respond to an alert and the patients’ health worsened as a result. The patients’ instructions needed to be appropriate and safe. [Seto 2010]

Patients’ positive engagement in telehealth service is a crucial factor for the success of the service and understanding how patients perceive telehealth can influence its acceptability and diffusion. Several barriers had been identified to affect the level of telehealth uptake by patients with HF and COPD, including preference for one-to-one with their healthcare professionals, technology anxiety, technical problems, the belief that telehealth to be unnecessary,[Obeh 2015] referring to Gorst 2014 (5)8

  • Cleland JG, Louis AA, Rigby AS, Janssens U, Balk AH. Noninvasive home telemonitoring for patients with heart failure at high risk of recurrent admission and death: the Trans-European Network- Home-Care Management System (TEN-HMS) study. J Am Coll Cardiol 2005;45:1654–64
  • Benatar D, Bondmass M, Ghitelman J, Avitall B. Outcomes of chronic heart failure. Arch Intern Med 2003;163:347–52
  • Goldberg LR, Piette JD, Walsh MN, et al. Randomized trial of a daily electronic home monitoring system in patients with advanced heart failure: the Weight Monitoring in Heart Failure (WHARF) trial. Am Heart J 2003;146:705–12
  • Galbreath AD, Krasuski RA, Smith B, et al. Long-term healthcare and cost outcomes of disease management in a large, randomized, community-based population with heart failure. Circulation 2004;110:3518–26
  • Gorst SL, Armitage CJ, Brownsell S, Hawley MS. Home Telehealth Uptake and Continued Use Among Heart Failure and Chronic Obstructive Pulmonary Disease Patients: a Systematic Review. Annals of Behavioral Medicine. 2014; 48(3): 323–336.
Important
Completely
Lo Scalzo A, Wilbacher I Result Card SOC4 In: Lo Scalzo A, Wilbacher I Social aspects 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