Our report is to a large extent based on the core HTA information, but we have also used other sources
Austria - HVB
telemonitoring, chronic heart failure, structured telephone support
The EUnetHTA report was adapted for use in Austria. The main results of each domain were translated, data were added.
Wilbacher I. Telemonitoring bei chronischer Herzinsuffizienz. http://www.hauptverband.at/portal27/hvbportal/content?contentid=10007.768267&viewmode=content
Background and methods
During the Joint Action of EUnetHTA a common assessment was delivered for Structured telephone support (STS) for adult patients with chronic heart failure.
The aim of this report is to provide the results in the context of Austria. The results of the EUnetHTA report were translated and added by local data/ specialities if possible.
- Telemedicine is a kind of remote monitoring e.g. by structured telephone support of prognostic factors in order to detect and prevent deterioration in HF patients, and to reduce hospital readmission and GP visits.
- Symptoms are reported by patients by telephone and collected by a healthcare professional who enters and stores the data into a documentation system. The healthcare professionals are usually physicians or community nurses.
- The reviewed literature shows substantial heterogeneity among studies in terms of duration and content of the provided service, the content of the telemedicine interventions and the selected patient groups. Details about the definition of “standard care” are lacking.
- Consensus was observed about the necessity and benefit of patient education.
- Included components monitored are: self-management, education, monitoring of weight, dietary adaptation including reduction of salt intake, monitoring of medication compliance, exercise advice and pharmaceutical adaptation if necessary.
- The effectivity of the intervention shows a trend towards lowering of general mortality (by 12-25%) and decrease of hospital admissions due to HF (by 8-24%). Other endpoints like disease-specific mortality, functional improvement, reduced GP visits show no differences or inconsistent results.
- The cost-effectiveness for STS could not be calculated with the available data. Some studies provide a calculation within their settings but with limitations according to the included costs.
- The organisational resulst are limited to be tranfered to the Austrian health system. Especially the operative solution of involved staff is to be questioned, becaused there are no „community nurses“ in Austria.
- The results of the social aspects show good learning effects for the patients concerning their disease management and the handling of devices. Patients feel secure if observed by telephon contact and they like to have somebody to adress possible problems. Compliance is dependent on the individual and could be different between different social types.
- Some legal aspects seem to be unsolved at the moment, especially concerning the responsibilities, data protection issues and documentation safety.
Telemonitoring should lead to early detection and reaction of deterioration and emergency situations due to a remote cooperation between a compliant patient and a health professional team documenting the trend and giving advice. This should reduce hospital admissions and „control visits“ at the GPs and save transport time for the patients. These endpoints could not be proved by scientific evidence now for STS in patients with chronic heart failure.
The educational part seems to be beneficial, patients feel more secure with more information about their disease and how to manage it. The telephone support after hospital discharge could be seen as training time for the patient to manage his/her disease at home appropriately.
- Selection of patients who benefit most
- Selection of the most beneficial provided service „basket“
- Organisational implementation
- Costs and cost-benefit