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Caiani EG, Kemps H, Hoogendoorn P, Asteggiano R, Böhm A, Borregaard B, Boriani G, Brunner La Rocca HP, Casado-Arroyo R, Castelletti S, Christodorescu RM, Cowie MR, Dendale P, Dunn F, Fraser AG, Lane DA, Locati ET, Małaczyńska-Rajpold K, Merșa CO, Neubeck L, Parati G, Plummer C, Rosano G, Scherrenberg M, Smirthwaite A, Szymanski P. Standardized assessment of evidence supporting the adoption of mobile health solutions: A Clinical Consensus Statement of the ESC Regulatory Affairs Committee: Developed in collaboration with the European Heart Rhythm Association (EHRA), the Association of Cardiovascular Nursing & Allied Professions (ACNAP) of the ESC, the Heart Failure Association (HFA) of the ESC, the ESC Young Community, the ESC Working Group on e-Cardiology, the ESC Council for Cardiology Practice, the ESC Council of Cardio-Oncology, the ESC Council on Hypertension, the ESC Patient Forum, the ESC Digital Health Committee, and the European Association of Preventive Cardiology (EAPC). EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2024; 5:509-523. [PMID: 39318699 PMCID: PMC11417493 DOI: 10.1093/ehjdh/ztae042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 05/10/2024] [Accepted: 05/14/2024] [Indexed: 09/26/2024]
Abstract
Mobile health (mHealth) solutions have the potential to improve self-management and clinical care. For successful integration into routine clinical practice, healthcare professionals (HCPs) need accepted criteria helping the mHealth solutions' selection, while patients require transparency to trust their use. Information about their evidence, safety and security may be hard to obtain and consensus is lacking on the level of required evidence. The new Medical Device Regulation is more stringent than its predecessor, yet its scope does not span all intended uses and several difficulties remain. The European Society of Cardiology Regulatory Affairs Committee set up a Task Force to explore existing assessment frameworks and clinical and cost-effectiveness evidence. This knowledge was used to propose criteria with which HCPs could evaluate mHealth solutions spanning diagnostic support, therapeutics, remote follow-up and education, specifically for cardiac rhythm management, heart failure and preventive cardiology. While curated national libraries of health apps may be helpful, their requirements and rigour in initial and follow-up assessments may vary significantly. The recently developed CEN-ISO/TS 82304-2 health app quality assessment framework has the potential to address this issue and to become a widely used and efficient tool to help drive decision-making internationally. The Task Force would like to stress the importance of co-development of solutions with relevant stakeholders, and maintenance of health information in apps to ensure these remain evidence-based and consistent with best practice. Several general and domain-specific criteria are advised to assist HCPs in their assessment of clinical evidence to provide informed advice to patients about mHealth utilization.
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Affiliation(s)
- Enrico G Caiani
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, P.zza L. da Vinci 32, 20133 Milan, Italy
- IRCCS Istituto Auxiologico Italiano, San Luca Hospital, Piazzale Brescia 20, 20149 Milan, Italy
| | - Hareld Kemps
- Department of Cardiology, Maxima Medical Centre, Veldhoven, The Netherlands
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Petra Hoogendoorn
- National eHealth Living Lab, Leiden University Medical Center, Leiden, The Netherlands
| | - Riccardo Asteggiano
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
- Poliambulatori Gruppo LARC—Laboratorio Analisi e Ricerca Clinica, Cardiology, Turin, Italy
| | - Allan Böhm
- Premedix Academy NGO, Bratislava, Slovakia
- 3rd Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Britt Borregaard
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Hans-Peter Brunner La Rocca
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiovascular Research Institute, University of Maastricht, Maastricht, The Netherlands
| | - Ruben Casado-Arroyo
- Department of Cardiology, Hopital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Silvia Castelletti
- IRCCS Istituto Auxiologico Italiano, San Luca Hospital, Piazzale Brescia 20, 20149 Milan, Italy
| | - Ruxandra Maria Christodorescu
- Department V-Internal Medicine, University of Medicine and Pharmacy V.Babes Timisoara, Timisoara, Romania
- Research Center, Institute of Cardiovascular Diseases, Timisoara, Romania
| | - Martin R Cowie
- Late CVRM, Biopharmaceuticals R&D, Astrazeneca, Boston MA, USA
| | - Paul Dendale
- Department of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Department of Cardiology, Hartcentrum Hasselt, Hasselt, Belgium
| | - Fiona Dunn
- Active Medical Devices, BSI, Milton Keynes, UK
- TEAM-NB, The European Association Medical devices of Notified Bodies, Sprimont, Belgium
| | - Alan G Fraser
- School of Medicine, Cardiff University, Heath Park, Cardiff, UK
| | - Deirdre A Lane
- Department of Cardiovascular Medicine and Liverpool Centre for Cardiovascular Sciences, University of Liverpool, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Emanuela T Locati
- Department of Arrhythmology & Electrophysiology, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Katarzyna Małaczyńska-Rajpold
- Department of Cardiology, Lister Hospital, East and North Hertfordshire NHS Trust, London, UK
- Heart Division, Arrhythmia Section, Royal Brompton Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Caius O Merșa
- Rhea, Research Center for Heritage and Anthropology, West University of Timișoara, Timișoara, Romania
| | - Lis Neubeck
- Centre for Cardiovascular Health, Edinburgh Napier University, Edinburgh, UK
| | - Gianfranco Parati
- IRCCS Istituto Auxiologico Italiano, San Luca Hospital, Piazzale Brescia 20, 20149 Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Chris Plummer
- Department of Cardiology, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Giuseppe Rosano
- CAG Cardiovascular, St George’s University Hospital, London, UK
- Cardiology, San Raffaele Cassino Hospital, Cassino, Italy
| | - Martijn Scherrenberg
- Department of Cardiology, Hartcentrum Hasselt, Hasselt, Belgium
- Faculty of Medicine, University of Antwerp, Antwerp, Belgium
| | | | - Piotr Szymanski
- Center for Postgraduate Medical Education, Marymoncka, Warsaw, Poland
- Clinical Cardiology Center, National Institute of Medicine MSWiA, Wołoska, Warsaw, Poland
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Stewart C, Wu H, Alagappan U, Azuara-Blanco A, King AJ, Tatham AJ, Hernández R, Lowe B, Shotton D, Appiah N, Coffey T, Vadiveloo T, MacLennan G, Gillies K. Feasibility of in-home monitoring for people with glaucoma: the I-TRAC mixed-methods study. Health Technol Assess 2024; 28:1-163. [PMID: 39248430 PMCID: PMC11404360 DOI: 10.3310/gtwd6802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2024] Open
Abstract
Background Glaucoma is a chronic disease of the optic nerve and a leading cause of severe visual loss in the UK. Once patients have been diagnosed, they need regular monitoring at hospital eye services. Recent advances in technology mean patients with glaucoma can now monitor their disease at home. This could be more convenient for patients and potentially reduce costs and increase capacity for the NHS. However, it is uncertain whether self-monitoring would be acceptable or possible for patients with glaucoma. Objectives The objectives were to: identify which patients are most appropriate for home monitoring; understand views of key stakeholders (patients, clinicians, researchers) on whether home glaucoma monitoring is feasible and acceptable; develop a conceptual framework for the economic evaluation of home glaucoma monitoring; and explore the need for and provide evidence on the design of a future study to evaluate the clinical and cost-effectiveness of digital technologies for home monitoring of glaucoma. Design In-home Tracking of glaucoma: Reliability, Acceptability, and Cost (I-TRAC) was a multiphase mixed-methods feasibility study with key components informed by theoretical and conceptual frameworks. Setting Expert glaucoma specialists in the UK recruited through professional glaucoma societies; study site staff and patient participants recruited through three UK hospital eye services (England, Scotland, Northern Ireland); and UK research teams recruited though existing networks. Intervention Home tonometer that measures intraocular pressure and a tablet computer with a visual function application. Patients were asked to use the technology weekly for 12 weeks. Results Forty-two patients were recruited. Retention and completion of follow-up procedures was successful, with 95% (n = 40) completing the 3-month follow-up clinic visits. Adherence to the interventions was generally high [adherence to both devices (i.e. ≥ 80% adherence) was 55%]. Overall, patients and healthcare professionals were cautiously optimistic about the acceptability of digital technologies for home monitoring of patients with glaucoma. While most clinicians were supportive of the potential advantages glaucoma home monitoring could offer, concerns about the technologies (e.g. reliability and potential to miss disease progression) and how they would fit into routine care need to be addressed. Additionally, clarity is required on defining the ideal population for this intervention. Plans for how to evaluate value for money in a future study were also identified. However, the study also highlighted several unknowns relating to core components of a future evaluative study that require addressing before progression to a definitive effectiveness trial. Limitations The main limitation relates to our sample and its generalisability, for example, the over-representation of educated persons of white ethnicity who were generally experienced with technology and research motivated. Conclusions The In-home Tracking of glaucoma: Reliability, Acceptability, and Cost study has demonstrated 'cautious optimism' when considering patients' and healthcare professionals' views on the acceptability of digital technologies for home monitoring of patients with glaucoma. However, the study also highlighted several unknowns relating to the research question and design of a future evaluative study that require addressing before progression to a randomised controlled trial. Future work Further research is required to determine the appropriate population (i.e. low vs. high risk of progression) and further refine the intervention components and delivery for planning of future evaluation studies. Study registration This study is registered as Research Registry #6213. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR129248) and is published in full in Health Technology Assessment; Vol. 28, No. 44. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Carrie Stewart
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Hangjian Wu
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Uma Alagappan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Anthony J King
- Ophthalmology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Rodolfo Hernández
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | | | | | - Nana Appiah
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Taylor Coffey
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Thenmalar Vadiveloo
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
- The Centre for Health Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
- The Centre for Health Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - Katie Gillies
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Pagano M, Corallo F, Anselmo A, Giambò FM, Micali G, Duca A, D’Aleo P, Bramanti A, Garofano M, Bramanti P, Cappadona I. Optimisation of Remote Monitoring Programmes in Heart Failure: Evaluation of Patient Drop-Out Behaviour and Healthcare Professionals' Perspectives. Healthcare (Basel) 2024; 12:1271. [PMID: 38998806 PMCID: PMC11241166 DOI: 10.3390/healthcare12131271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/12/2024] [Accepted: 06/25/2024] [Indexed: 07/14/2024] Open
Abstract
Heart failure (HF) is a growing epidemic, affecting millions of people worldwide, and is a major cause of mortality, morbidity, and impaired quality of life. Traditional cardiac rehabilitation is a valuable approach to the physical and quality-of-life recovery of patients with cardiovascular disease. The innovative approach of remote monitoring through telemedicine offers a solution based on modern technologies, enabling continuous collection of health data outside the hospital environment. Remote monitoring devices present challenges that could adversely affect patient adherence, resulting in the risk of dropout. By applying a cognitive-behavioral model, we aim to identify the antecedents of dropout behavior among patients adhering to traditional cardiac rehabilitation programs and remote monitoring in order to improve the latter. Our study was conducted from October 2023 to January 2024. In the first stage, we used data from literature consultation. Subsequently, data were collected from the direct experience of 49 health workers related to both remote monitoring and traditional treatment, recruited from the authors' workplace. Results indicate that patients with cardiovascular disease tend to abandon remote monitoring programs more frequently than traditional cardiac rehabilitation therapies. It is critical to design approaches that take these barriers into account to improve adherence and patient satisfaction. This analysis identified specific antecedents to address, helping to improve current monitoring models. This is crucial to promote care continuity and to achieve self-management by patients in the future.
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Affiliation(s)
- Maria Pagano
- IRCCS Centro Neurolesi Bonino-Pulejo, Via Palermo, S.S. 113, C.da Casazza, 98124 Messina, Italy
| | - Francesco Corallo
- IRCCS Centro Neurolesi Bonino-Pulejo, Via Palermo, S.S. 113, C.da Casazza, 98124 Messina, Italy
| | - Anna Anselmo
- IRCCS Centro Neurolesi Bonino-Pulejo, Via Palermo, S.S. 113, C.da Casazza, 98124 Messina, Italy
| | - Fabio Mauro Giambò
- IRCCS Centro Neurolesi Bonino-Pulejo, Via Palermo, S.S. 113, C.da Casazza, 98124 Messina, Italy
| | - Giuseppe Micali
- IRCCS Centro Neurolesi Bonino-Pulejo, Via Palermo, S.S. 113, C.da Casazza, 98124 Messina, Italy
| | - Antonio Duca
- IRCCS Centro Neurolesi Bonino-Pulejo, Via Palermo, S.S. 113, C.da Casazza, 98124 Messina, Italy
| | - Piercataldo D’Aleo
- IRCCS Centro Neurolesi Bonino-Pulejo, Via Palermo, S.S. 113, C.da Casazza, 98124 Messina, Italy
| | - Alessia Bramanti
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Marina Garofano
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Placido Bramanti
- IRCCS Centro Neurolesi Bonino-Pulejo, Via Palermo, S.S. 113, C.da Casazza, 98124 Messina, Italy
- Faculty of Psychology, Università degli Studi eCampus, Via Isimbardi 10, 22060 Novedrate, Italy
| | - Irene Cappadona
- IRCCS Centro Neurolesi Bonino-Pulejo, Via Palermo, S.S. 113, C.da Casazza, 98124 Messina, Italy
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Idris H, Nugraheni WP, Rachmawati T, Kusnali A, Yulianti A, Purwatiningsih Y, Nuraini S, Susianti N, Faisal DR, Arifin H, Maharani A. How Is Telehealth Currently Being Utilized to Help in Hypertension Management within Primary Healthcare Settings? A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:90. [PMID: 38248553 PMCID: PMC10815916 DOI: 10.3390/ijerph21010090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/29/2023] [Accepted: 01/10/2024] [Indexed: 01/23/2024]
Abstract
Telehealth has improved patient access to healthcare services and has been shown to have a positive impact in various healthcare settings. In any case, little is understood regarding the utilization of telehealth in hypertension management in primary healthcare (PHC) settings. This study aimed to identify and classify information about the types of interventions and types of telehealth technology in hypertension management in primary healthcare. A scoping review based on PRISMA-ScR was used in this study. We searched for articles in four databases: Pubmed, Scopus, Science Direct, and Embase in English. The selected articles were published in 2013-2023. The data were extracted, categorized, and analyzed using thematic analysis. There were 1142 articles identified and 42 articles included in this study. Regarding the proportions of studies showing varying trends in the last ten years, most studies came from the United States (US) (23.8%), were conducted in urban locations (33.3%), and had a quantitative study approach (69%). Telehealth interventions in hypertension management are dominated by telemonitoring followed by teleconsultation. Asynchronous telehealth is becoming the most widely used technology in managing hypertension in primary care settings. Telehealth in primary care hypertension management involves the use of telecommunications technology to monitor and manage blood pressure and provide medical advice and counselling remotely.
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Affiliation(s)
- Haerawati Idris
- Department of Health Administration & Policy, Faculty of Public Health, Sriwijaya University, Indralaya 30662, Indonesia
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Central Jakarta 10340, Indonesia; (W.P.N.); (T.R.); (A.K.); (A.Y.); (Y.P.); (S.N.); (N.S.); (D.R.F.)
| | - Wahyu Pudji Nugraheni
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Central Jakarta 10340, Indonesia; (W.P.N.); (T.R.); (A.K.); (A.Y.); (Y.P.); (S.N.); (N.S.); (D.R.F.)
| | - Tety Rachmawati
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Central Jakarta 10340, Indonesia; (W.P.N.); (T.R.); (A.K.); (A.Y.); (Y.P.); (S.N.); (N.S.); (D.R.F.)
| | - Asep Kusnali
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Central Jakarta 10340, Indonesia; (W.P.N.); (T.R.); (A.K.); (A.Y.); (Y.P.); (S.N.); (N.S.); (D.R.F.)
| | - Anni Yulianti
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Central Jakarta 10340, Indonesia; (W.P.N.); (T.R.); (A.K.); (A.Y.); (Y.P.); (S.N.); (N.S.); (D.R.F.)
| | - Yuni Purwatiningsih
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Central Jakarta 10340, Indonesia; (W.P.N.); (T.R.); (A.K.); (A.Y.); (Y.P.); (S.N.); (N.S.); (D.R.F.)
| | - Syarifah Nuraini
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Central Jakarta 10340, Indonesia; (W.P.N.); (T.R.); (A.K.); (A.Y.); (Y.P.); (S.N.); (N.S.); (D.R.F.)
| | - Novia Susianti
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Central Jakarta 10340, Indonesia; (W.P.N.); (T.R.); (A.K.); (A.Y.); (Y.P.); (S.N.); (N.S.); (D.R.F.)
| | - Debri Rizki Faisal
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Central Jakarta 10340, Indonesia; (W.P.N.); (T.R.); (A.K.); (A.Y.); (Y.P.); (S.N.); (N.S.); (D.R.F.)
| | - Hidayat Arifin
- Department of Basic Nursing Care, Faculty of Nursing, Universitas Airlangga, Surabaya 60286, Indonesia;
| | - Asri Maharani
- Division of Nursing, Midwifery & Social Work, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK;
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Teo VHY, Teo SH, Burkill SM, Wang Y, Chew EAL, Ng DWL, Tang WE, Koh GCH. Effects of technology-enabled blood pressure monitoring in primary care: A quasi-experimental trial. J Telemed Telecare 2024; 30:121-130. [PMID: 34328375 PMCID: PMC10748448 DOI: 10.1177/1357633x211031780] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/20/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Technology to enhance hypertension management is increasingly used in primary care; however, it has not been evaluated in an Asian primary care setting. We aimed to understand the clinical impact and cost-effectiveness of a technology-enabled home blood pressure monitor when deployed in primary care, and patients' perspectives about the technology. METHODS A quasi-experimental cohort study was conducted in a polyclinic in Singapore. In total, 120 patients with hypertension were assigned to the telemonitoring intervention group. Patients received a home blood pressure device connected to the clinical care team's dashboard through a mobile gateway. Tele-consultations and nurse-led tele-support were carried out using established clinical protocols. In total, 120 patients assigned to the control group continued to receive usual care in the polyclinic. Clinical outcomes, cost-effectiveness, and patient satisfaction were measured 6 months after recruitment. RESULTS In total, 217 patients completed 6 months of follow-up. Telemonitoring intervention patients had significantly increased odds of having controlled blood pressure by a factor of 2.69 (p = 0.01), with the greatest improvement in those whose blood pressure was uncontrolled at baseline (p < 0.05). The incremental cost-effectiveness ratios for all patients was S$23,935.14/quality-adjusted life year (<1 gross domestic product per capita), which was very cost-effective based on World Health Organization cost-effectiveness thresholds. There was greater satisfaction in telemonitoring intervention group relating to the convenience of recording and sharing blood pressure measurements with the health care team, consultation advice received, understanding by the health care team of their condition, and were more motivated to monitor their blood pressure. DISCUSSION Telemonitoring with tele-consultation improved blood pressure control and was more cost-effective than usual care. Patients receiving telemonitoring intervention were also more motivated and satisfied with their care.
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Affiliation(s)
| | | | - Sarah M Burkill
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Yi Wang
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | - David WL Ng
- National Healthcare Group Polyclinics, Singapore
| | - Wern Ee Tang
- National Healthcare Group Polyclinics, Singapore
| | - Gerald CH Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Ministry of Health Office for Healthcare Transformation, Singapore
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Sousa P, Cardoso D, Vrbová T, Apóstolo J, Santos M, Manso G, Mourão D, Ferreira G, Monteiro M, Manata J, Vaz A, Klugarová J, Klugar M. Postdischarge telephone follow-up among chronic disease patients discharged from a vascular surgery service: a best practice implementation project. JBI Evid Implement 2023; 21:S19-S27. [PMID: 38037445 DOI: 10.1097/xeb.0000000000000380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
OBJECTIVES To improve postdischarge telephone follow-up in the context of chronic disease management (peripheral artery disease), in a vascular surgery service. INTRODUCTION Patients with chronic diseases, such as peripheral artery disease, present a higher risk of complications and greater constraints regarding their adherence to treatment, leading to an increasing mortality rate and decreased functional capacity. Comprehensive discharge planning plus postdischarge telephone follow-up may reduce 30-day re-hospitalization rates. METHODS The project used the JBI audit and feedback methodological approach to implement the best available evidence into practice. Two audit criteria were used: existence of comprehensive discharge planning and timely telephone follow-up. A baseline audit was conducted, followed by analysis of barriers, which led to the implementation of several strategies, namely, a targeted training program, the development of educational resources and standardized procedures for the discharge process, and postdischarge telephone follow-up. RESULTS Results from the baseline and first follow-up audits showed improvement for both criteria. Compliance for criterion 1 (comprehensive discharge planning, including postdischarge telephone follow-up) increased from 0% to 40.7%, and for criterion 2 (patient is followed up by telephone within 2 weeks of discharge) increased from 0% to 44.4%. These two criteria sustained improvements in the second follow-up audit: compliance increased to 45% (criterion 1) and 60% (criterion 2). CONCLUSIONS This implementation project contributed to the optimization of the chronic disease management, including improved compliance with discharge planning and early postdischarge telephone follow-up.
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Affiliation(s)
- Pedro Sousa
- Portugal Centre for Evidence-Based Practice: A JBI Centre of Excellence, Health Sciences Research Unit, Nursing: Nursing School of Coimbra, Portugal
| | - Daniela Cardoso
- Portugal Centre for Evidence-Based Practice: A JBI Centre of Excellence, Health Sciences Research Unit, Nursing: Nursing School of Coimbra, Portugal
| | - Tereza Vrbová
- Cochrane Czech Republic, Czech Republic: A JBI Centre of Excellence, Czech GRADE Network, Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - João Apóstolo
- Portugal Centre for Evidence-Based Practice: A JBI Centre of Excellence, Health Sciences Research Unit, Nursing: Nursing School of Coimbra, Portugal
| | | | | | | | | | | | | | | | - Jitka Klugarová
- Cochrane Czech Republic, Czech Republic: A JBI Centre of Excellence, Czech GRADE Network, Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Miloslav Klugar
- Cochrane Czech Republic, Czech Republic: A JBI Centre of Excellence, Czech GRADE Network, Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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McDonagh ST, Dalal H, Moore S, Clark CE, Dean SG, Jolly K, Cowie A, Afzal J, Taylor RS. Home-based versus centre-based cardiac rehabilitation. Cochrane Database Syst Rev 2023; 10:CD007130. [PMID: 37888805 PMCID: PMC10604509 DOI: 10.1002/14651858.cd007130.pub5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
BACKGROUND Cardiovascular disease is the most common cause of death globally. Traditionally, centre-based cardiac rehabilitation programmes are offered to individuals after cardiac events to aid recovery and prevent further cardiac illness. Home-based and technology-supported cardiac rehabilitation programmes have been introduced in an attempt to widen access and participation, especially during the SARS-CoV-2 pandemic. This is an update of a review previously published in 2009, 2015, and 2017. OBJECTIVES To compare the effect of home-based (which may include digital/telehealth interventions) and supervised centre-based cardiac rehabilitation on mortality and morbidity, exercise-capacity, health-related quality of life, and modifiable cardiac risk factors in patients with heart disease SEARCH METHODS: We updated searches from the previous Cochrane Review by searching the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid) and CINAHL (EBSCO) on 16 September 2022. We also searched two clinical trials registers as well as previous systematic reviews and reference lists of included studies. No language restrictions were applied. SELECTION CRITERIA We included randomised controlled trials that compared centre-based cardiac rehabilitation (e.g. hospital, sports/community centre) with home-based programmes (± digital/telehealth platforms) in adults with myocardial infarction, angina, heart failure, or who had undergone revascularisation. DATA COLLECTION AND ANALYSIS Two review authors independently screened all identified references for inclusion based on predefined inclusion criteria. Disagreements were resolved through discussion or by involving a third review author. Two authors independently extracted outcome data and study characteristics and assessed risk of bias. Certainty of evidence was assessed using GRADE. MAIN RESULTS We included three new trials in this update, bringing a total of 24 trials that have randomised a total of 3046 participants undergoing cardiac rehabilitation. A further nine studies were identified and are awaiting classification. Manual searching of trial registers until 16 September 2022 revealed a further 14 clinical trial registrations - these are ongoing. Participants had a history of acute myocardial infarction, revascularisation, or heart failure. Although there was little evidence of high risk of bias, a number of studies provided insufficient detail to enable assessment of potential risk of bias; in particular, details of generation and concealment of random allocation sequencing and blinding of outcome assessment were poorly reported. No evidence of a difference was seen between home- and centre-based cardiac rehabilitation in our primary outcomes up to 12 months of follow-up: total mortality (risk ratio [RR] = 1.19, 95% confidence interval [CI] 0.65 to 2.16; participants = 1647; studies = 12/comparisons = 14; low-certainty evidence) or exercise capacity (standardised mean difference (SMD) = -0.10, 95% CI -0.24 to 0.04; participants = 2343; studies = 24/comparisons = 28; low-certainty evidence). The majority of evidence (N=71 / 77 comparisons of either total or domain scores) showed no significant difference in health-related quality of life up to 24 months follow-up between home- and centre-based cardiac rehabilitation. Trials were generally of short duration, with only three studies reporting outcomes beyond 12 months (exercise capacity: SMD 0.11, 95% CI -0.01 to 0.23; participants = 1074; studies = 3; moderate-certainty evidence). There was a similar level of trial completion (RR 1.03, 95% CI 0.99 to 1.08; participants = 2638; studies = 22/comparisons = 26; low-certainty evidence) between home-based and centre-based participants. The cost per patient of centre- and home-based programmes was similar. AUTHORS' CONCLUSIONS This update supports previous conclusions that home- (± digital/telehealth platforms) and centre-based forms of cardiac rehabilitation formally supported by healthcare staff seem to be similarly effective in improving clinical and health-related quality of life outcomes in patients after myocardial infarction, or revascularisation, or with heart failure. This finding supports the continued expansion of healthcare professional supervised home-based cardiac rehabilitation programmes (± digital/telehealth platforms), especially important in the context of the ongoing global SARS-CoV-2 pandemic that has much limited patients in face-to-face access of hospital and community health services. Where settings are able to provide both supervised centre- and home-based programmes, consideration of the preference of the individual patient would seem appropriate. Although not included in the scope of this review, there is an increasing evidence base supporting the use of hybrid models that combine elements of both centre-based and home-based cardiac rehabilitation delivery. Further data are needed to determine: (1) whether the short-term effects of home/digital-telehealth and centre-based cardiac rehabilitation models of delivery can be confirmed in the longer term; (2) the relative clinical effectiveness and safety of home-based programmes for other heart patients, e.g. post-valve surgery and atrial fibrillation.
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Affiliation(s)
- Sinead Tj McDonagh
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, Exeter, UK
| | - Hasnain Dalal
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, Exeter, UK
| | - Sarah Moore
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, Exeter, UK
| | - Christopher E Clark
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, Exeter, UK
| | - Sarah G Dean
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, Exeter, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Aynsley Cowie
- Cardiac Rehabilitation, University Hospital Crosshouse, NHS Ayrshire and Arran, Kilmarnock, UK
| | | | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
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8
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Teo SH, Chew EAL, Ng DWL, Tang WE, Koh GCH, Teo VHY. Implementation and use of technology-enabled blood pressure monitoring and teleconsultation in Singapore's primary care: a qualitative evaluation using the socio-technical systems approach. BMC PRIMARY CARE 2023; 24:71. [PMID: 36927496 PMCID: PMC10018584 DOI: 10.1186/s12875-023-02014-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 02/21/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Telemedicine is becoming integral in primary care hypertension management, and is associated with improved blood pressure control, self-management and cost-effectiveness. This study explored the experiences of patients and healthcare professionals and their perceived barriers and facilitators in implementing and using a technology-enabled blood pressure monitoring intervention with teleconsultation in the Singapore primary care setting. METHODS This was a qualitative study embedded within the Primary Technology-Enhanced Care Hypertension pilot trial. Patients were selected purposively and invited to participate by telephone; healthcare professionals involved in the trial were invited to participate by email. Individual semi-structured interviews were conducted in English or Mandarin with thirteen patients and eight healthcare professionals. Each interview was audio-recorded and transcribed verbatim. Data were analyzed inductively to identify emergent themes which were then grouped into the dimensions of the socio-technical systems model to study the interactions between the technical, individual and organizational factors involved in the process. RESULTS Several emergent themes were identified. The factors involved in the implementation and use of the intervention are complex and interdependent. Patients and healthcare professionals liked the convenience resulting from the intervention and saw an improvement in the patient-provider relationship. Patients appreciated that the intervention helped form a habit of regular blood pressure monitoring, improved their self-management, and provided reassurance that they were being monitored by the care team. Healthcare professionals found that the intervention helped to manage workload by freeing up time for other urgent matters. Nevertheless, participants highlighted challenges with usability of the equipment and management portal, data access, and some expressed technology anxiety. Participants suggested patient segmentation for the intervention to be more targeted, wished for a more user-friendly equipment and proposed allocating more resources to the intervention. CONCLUSIONS The implementation and use of telemedicine for hypertension management can engender various benefits and challenges to patients, healthcare professionals and the healthcare system. Stakeholder feedback gathered on the sociotechnical aspects of the technology should be taken into consideration to guide the design, implementation and evaluation of future telemedicine interventions in primary care. TRIAL REGISTRATION This study was registered on ClinicalTrials.gov on October 9, 2018. ID: NCT03698890.
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Affiliation(s)
- Sok Huang Teo
- grid.466910.c0000 0004 0451 6215National Healthcare Group Polyclinics, Singapore, Singapore
| | - Evelyn Ai Ling Chew
- grid.466910.c0000 0004 0451 6215National Healthcare Group Polyclinics, Singapore, Singapore
| | - David Wei Liang Ng
- grid.466910.c0000 0004 0451 6215National Healthcare Group Polyclinics, Singapore, Singapore
| | - Wern Ee Tang
- grid.466910.c0000 0004 0451 6215National Healthcare Group Polyclinics, Singapore, Singapore
| | - Gerald Choon Huat Koh
- grid.415698.70000 0004 0622 8735Ministry of Health Office for Healthcare Transformation, Singapore, Singapore
- grid.4280.e0000 0001 2180 6431Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Valerie Hui Ying Teo
- grid.466910.c0000 0004 0451 6215National Healthcare Group Polyclinics, Singapore, Singapore
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9
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Öner A, Dittrich H, Arslan F, Hintz S, Ortak J, Brandewiede B, Mann M, Krockenberger K, Thiéry A, Ziegler A, Schmidt C. Comparison of telemonitoring combined with intensive patient support with standard care in patients with chronic cardiovascular disease - a randomized clinical trial. Eur J Med Res 2023; 28:22. [PMID: 36631889 PMCID: PMC9832250 DOI: 10.1186/s40001-023-00991-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 01/03/2023] [Indexed: 01/13/2023] Open
Abstract
IMPORTANCE Healthcare concepts for chronic diseases based on tele-monitoring have become increasingly important during COVID-19 pandemic. OBJECTIVE To study the effectiveness of a novel integrated care concept (NICC) that combines tele-monitoring with the support of a call centre in addition to guideline therapy for patients with atrial fibrillation, heart failure, or treatment-resistant hypertension. DESIGN A prospective, parallel-group, open-label, randomized, controlled trial. SETTING Between December 2017 and August 2019 at the Rostock University Medical Center (Germany). PARTICIPANTS Including 960 patients with either atrial fibrillation, heart failure, or treatment-resistant hypertension. INTERVENTIONS Patients were randomized to either NICC (n = 478) or standard-of-care (SoC) (n = 482) in a 1:1 ratio. Patients in the NICC group received a combination of tele-monitoring and intensive follow-up and care through a call centre. MAIN OUTCOMES AND MEASURES Three primary endpoints were formulated: (1) composite of all-cause mortality, stroke, and myocardial infarction; (2) number of inpatient days; (3) the first plus cardiac decompensation, all measured at 12-months follow-up. Superiority was evaluated using a hierarchical multiple testing strategy for the 3 primary endpoints, where the first step is to test the second primary endpoint (hospitalization) at two-sided 5%-significance level. In case of a non-significant difference between the groups for the rate of hospitalization, the superiority of NICC over SoC is not shown. RESULTS The first primary endpoint occurred in 1.5% of NICC and 5.2% of SoC patients (OR: 3.3 [95%CI 1.4-8.3], p = 0.009). The number of inpatient treatment days did not differ significantly between both groups (p = 0.122). The third primary endpoint occurred in 3.6% of NICC and 8.1% of SoC patients (OR: 2.2 [95%CI 1.2-4.2], p = 0.016). Four patients died of all-cause death in the NICC and 23 in the SoC groups (OR: 4.4 [95%CI 1.6-12.6], p = 0.006). Based on the prespecified hierarchical statistical analysis protocol for multiple testing, the trial did not meet its primary outcome measure. CONCLUSIONS AND RELEVANCE Among patients with atrial fibrillation, heart failure, or treatment-resistant hypertension, the NICC approach was not superior over SoC, despite a significant reduction in all-cause mortality, stroke, myocardial infarction and cardiac decompensation. Trial registration ClinicalTrials.gov Identifier: NCT03317951.
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Affiliation(s)
- Alper Öner
- grid.413108.f0000 0000 9737 0454Department of Cardiology, Zentrum Für Innere Medizin (ZIM), Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057 Rostock, Germany
| | - Hermann Dittrich
- grid.413108.f0000 0000 9737 0454Department of Cardiology, Zentrum Für Innere Medizin (ZIM), Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057 Rostock, Germany
| | - Fatih Arslan
- grid.10419.3d0000000089452978Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sissy Hintz
- grid.413108.f0000 0000 9737 0454Department of Cardiology, Zentrum Für Innere Medizin (ZIM), Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057 Rostock, Germany
| | - Jasmin Ortak
- grid.413108.f0000 0000 9737 0454Department of Cardiology, Zentrum Für Innere Medizin (ZIM), Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057 Rostock, Germany
| | | | - Miriam Mann
- grid.413108.f0000 0000 9737 0454Department of Cardiology, Zentrum Für Innere Medizin (ZIM), Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057 Rostock, Germany
| | | | | | - Andreas Ziegler
- Cardio-CARE, Medizincampus Davos, Davos, Switzerland ,grid.16463.360000 0001 0723 4123School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa ,grid.13648.380000 0001 2180 3484Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Christian Schmidt
- grid.413108.f0000 0000 9737 0454Department of Cardiology, Zentrum Für Innere Medizin (ZIM), Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057 Rostock, Germany
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Redon J, Seeman T, Pall D, Suurorg L, Kamperis K, Erdine S, Wühl E, Mancia G. Narrative update of clinical trials with antihypertensive drugs in children and adolescents. Front Cardiovasc Med 2022; 9:1042190. [PMID: 36479567 PMCID: PMC9721463 DOI: 10.3389/fcvm.2022.1042190] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/04/2022] [Indexed: 08/27/2023] Open
Abstract
INTRODUCTION To date, our knowledge on antihypertensive pharmacological treatment in children and adolescents is still limited because there are few randomized clinical trials (CTs), hampering appropriate management. The objective was to perform a narrative review of the most relevant aspects of clinical trials carried out in primary and secondary hypertension. METHODS Studies published in PubMed with the following descriptors: clinical trial, antihypertensive drug, children, adolescents were selected. A previous Cochrane review of 21 randomized CTs pointed out the difficulty that statistical analysis could not assess heterogeneity because there were not enough data. A more recent meta-analysis, that applied more stringent inclusion criteria and selected 13 CTs, also concluded that heterogeneity, small sample size, and short follow-up time, as well as the absence of studies comparing drugs of different classes, limit the utility. RESULTS In the presented narrative review, including 30 studies, there is a paucity of CTs focusing only on children with primary or secondary, mainly renoparenchymal, hypertension. In trials on angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs) and diuretics, a significant reduction of both SBP and DBP in mixed cohorts of children with primary and secondary hypertension was achieved. However, few studies assessed the effect of antihypertensive drugs on hypertensive organ damage. CONCLUSIONS Given the increasing prevalence and undertreatment of hypertension in this age group, innovative solutions including new design, such as 'n-of-1', and optimizing the use of digital health technologies could provide more precise and faster information about the efficacy of each antihypertensive drug class and the potential benefits according to patient characteristics.
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Affiliation(s)
- Josep Redon
- INCLIVA Research Institute, CIBERObn Institute of Health Charles III, University of Valencia, Madrid, Spain
| | - Tomas Seeman
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University Prague, Prague, Czechia
| | - Dénes Pall
- Department of Medical Clinical Pharmacology, University of Debrecen, Debrecen, Hungary
| | | | - Konstantinos Kamperis
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Serap Erdine
- Hypertension and Atherosclerosis Center, Marmara University School of Medicine, Istanbul, Turkey
| | - Elke Wühl
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg University Hospital, Heidelberg, Germany
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11
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Lapage L, Foulon S, Poels P, Hoekman B, Vermeulen J, Dorrestijn A, Ector J, Haemers P, Voros G, Garweg C, Willems R. Is it feasible to outsource the remote monitoring of implantable cardiac defibrillators in a large tertiary hospital? Acta Cardiol 2022:1-12. [PMID: 36222546 DOI: 10.1080/00015385.2022.2119664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
AIM To provide a detailed description of the workflow at our telecardiology centre and to analyse the workload of real-world remote monitoring with the aim to assess the feasibility to outsource this service. METHODS A retrospective analysis was conducted on the telecardiology service provided at the University Hospitals of Leuven by extracting patient demographic data, general time usage and detailed information about the type of remote contacts. 10,869 contacts in 948 patients have been included. A 2-week prospective study was conducted on the same service by documenting and monitoring every action performed by specialised nurses when analysing and solving remote monitoring transmissions. 337 contacts in 262 patients were collected during this period. RESULTS Both analyses indicated similar numbers of events and interventions. Unplanned transmissions were more challenging and required more interventions than planned transmissions. Relatively little time (retrospective median: 1.83 min; prospective median: 1.56 min, per event) was spent on incoming non-actionable 'normal' transmissions (retrospective: 46%; prospective: 40% of all events). Retrospectively 54% and prospectively 60% of transmissions showed abnormalities and were responsible for most of the time expended. Disease-related issues were the most frequent cause for these 'abnormal' alerts. Contacting patients and physicians were key interventions undertaken. Interaction initiated by patients mainly involved the installation process (42%) and bedside monitoring problems (32%). CONCLUSION External data centres could deal with 40% of the transmissions, but the decline in workload would be negligible for the in-hospital remote monitoring team, because very little time is spent dealing with the many 'non-event' transmissions whereas most of the time is spent solving clinical problems. Providing sufficient resources and optimising communication protocols is necessary to aid in managing the workload of the remote monitoring team. Implications for practiceContacting patients and physicians are key interventions for specialist nurses in remote monitoring centres.Detailed timing confirmed that most time was spent on relevant disease-related clinical problems.Despite dealing with ∼40% of transmissions, outsourcing to external data centres would decrease the workload only by 15-25%.Patient initiated contacts with questions concerning remote monitoring form a high burden and should be countered by scaling the service and creating communication protocols.
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Affiliation(s)
- Liesbeth Lapage
- Master in Nursing, University Leuven, Leuven, Belgium.,Department for Nursing, UC Leuven-Limburg, Leuven, Belgium
| | - Stefaan Foulon
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Patricia Poels
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Boukje Hoekman
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Jonas Vermeulen
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Axel Dorrestijn
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Joris Ector
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, University Leuven, Leuven, Belgium
| | - Peter Haemers
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, University Leuven, Leuven, Belgium
| | - Gabor Voros
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, University Leuven, Leuven, Belgium
| | - Christophe Garweg
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Rik Willems
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, University Leuven, Leuven, Belgium
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12
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Yang JY, Wu YW, Chuang W, Lin TC, Chang SW, Cheng SH, Kuo RN. An Integrated Community-Based Blood Pressure Telemonitoring Program - A Population-Based Observational Study. ACTA CARDIOLOGICA SINICA 2022; 38:612-622. [PMID: 36176366 PMCID: PMC9479044 DOI: 10.6515/acs.202209_38(5).20220330a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 03/30/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Home blood pressure telemonitoring (BPT) has been shown to improve blood pressure control. A community-based BPT program (the Health+ program) was launched in 2015 in an urban area around a medical center. OBJECTIVES To examine the impact of the BPT program on the use of medical resources. METHODS We conducted a retrospective propensity-score (PS)-matched observational cohort study using the National Health Insurance Research Database (NHIRD) 2013-2016 in Taiwan. A total of 9,546 adults with a high risk of cardiovascular disease participated in the integrated BPT program, and 19,082 PS-matched controls were identified from the NHIRD. The primary and secondary outcome measures were changes in 1-year emergency department visit rate, hospitalization rate, duration of hospital stay, and healthcare costs. RESULTS The number of emergency department visits in the Health+ group significantly reduced (0.8 to 0.6 per year vs. 0.8 to 0.9 per year, p < 0.0001) along with a significant decrease in hospitalization rate (43.7% to 21.3% vs. 42.7% to 35.3%, p < 0.001). The duration of hospital stay was also lower in the Health+ group (4.3 to 3.3 days vs. 5.3 to 6.5 days, p < 0.0001). The annual healthcare costs decreased more in the Health+ group (USD 1642 to 1169 vs. 1466 to 1393 per year, p < 0.001), compared with the controls. Subgroup analysis of the Health+ group revealed that the improvements in outcomes were significantly greater among those who were younger and had fewer comorbidities, especially without diabetes or hypertension. CONCLUSIONS A community-based integrated BPT program may improve patients' health outcomes and reduce healthcare costs.
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Affiliation(s)
- Ju-Yeh Yang
- Institute of Health Policy and Management, National Taiwan University, Taipei;
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Lee-Ming Institute of Technology;
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Department of Internal Medicine
| | - Yen-Wen Wu
- Cardiology Division of Cardiovascular Medical Center;
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Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City;
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National Yang-Ming University School of Medicine, Taipei
| | - Wenpo Chuang
- Cardiology Division of Cardiovascular Medical Center
| | | | - Shu-Wen Chang
- Center of Community Health Development;
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Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City;
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Department of Ophthalmology, National Taiwan University, Taipei, Taiwan
| | - Shou-Hsia Cheng
- Institute of Health Policy and Management, National Taiwan University, Taipei
| | - Raymond N. Kuo
- Institute of Health Policy and Management, National Taiwan University, Taipei
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13
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Goharinejad S, Hajesmaeel-Gohari S, Jannati N, Goharinejad S, Bahaadinbeigy K. Review of Systematic Reviews in the Field of Telemedicine. Med J Islam Repub Iran 2021; 35:184. [PMID: 36042824 PMCID: PMC9391764 DOI: 10.47176/mjiri.35.184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Indexed: 11/09/2022] Open
Abstract
Background: Although the systematic reviews regarding telemedicine have increased in recent decades, no comprehensive studies have been conducted to review these systematic reviews. The present study aimed to review the published systematic reviews regarding telemedicine applications for the report and appraisal of several aspects. Methods: The literature search was performed in the PubMed database for the systematic reviews published during January 2010-June 2020 in the field of telemedicine using "telemedicine" Mesh terms. The extracted data from the selected articles were the year of publication, telemedicine specialty, clinical outcomes, cost evaluation, and satisfaction assessment. Data analysis was performed using descriptive statistics. Results: Among 746 retrieved articles, 191 cases were selected and reviewed. Most of the studies were focused on telemedicine (n=35; 18.3%), followed by telerehabilitation (n=22; 11.5%), tele-diabetes (n=18; 9.4%), telecardiology (n=16; 8.3%), home telecare (n=13; 6.8%), telepsychiatry (n=12; 6.3%), teledermatology (n=11; 5.7%), and teleneurology (n=9; 4.7%). The selected studies were primarily focused on clinical outcomes (72.7%), followed by cost-effectiveness (32.4%) and user satisfaction (29.3%). In addition, they mostly indicated that telemedicine services yielded acceptable clinical outcomes (72.5%), cost-effectiveness (67.7%), and healthcare provider/patient satisfaction (83.9%). Conclusion: Although telerehabilitation, tele-diabetes, telecardiology, home telecare, and telepsychiatry were studied further, there are still some specific specialties such as teleradiology, telepathology, and telepediatric that should be considered more. Moreover, investigation of various outcomes could result in a more comprehensive view of this field. Therefore, further investigations in this regard would improve telemedicine applications and encourage potential telemedicine providers to initiate these applications.
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Affiliation(s)
- Saeideh Goharinejad
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Sadrieh Hajesmaeel-Gohari
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Nazanin Jannati
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Samira Goharinejad
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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CLARKE LORCAN, ANDERSON MICHAEL, ANDERSON ROB, KLAUSEN MORTENBONDE, FORMAN REBECCA, KERNS JENNA, RABE ADRIAN, KRISTENSEN SØRENRUD, THEODORAKIS PAVLOS, VALDERAS JOSE, KLUGE HANS, MOSSIALOS ELIAS. Economic Aspects of Delivering Primary Care Services: An Evidence Synthesis to Inform Policy and Research Priorities. Milbank Q 2021; 99:974-1023. [PMID: 34472653 PMCID: PMC8718591 DOI: 10.1111/1468-0009.12536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Policy Points The 2018 Declaration of Astana reemphasized the importance of primary health care and its role in achieving universal health coverage. While there is a large amount of literature on the economic aspects of delivering primary care services, there is a need for more comprehensive overviews of this evidence. In this article, we offer such an overview. Evidence suggests that there are several strategies involving coverage, financing, service delivery, and governance arrangements which can, if implemented, have positive economic impacts on the delivery of primary care services. These include arrangements such as worker task-shifting and telemedicine. The implementation of any such arrangements, based on positive economic evidence, should carefully account for potential impacts on overall health care access and quality. There are many opportunities for further research, with notable gaps in evidence on the impacts of increasing primary care funding or the overall supply of primary care services. CONTEXT The 2018 Declaration of Astana reemphasized the importance of primary health care and its role in achieving universal health coverage. To strengthen primary health care, policymakers need guidance on how to allocate resources in a manner that maximizes its economic benefits. METHODS We collated and synthesized published systematic reviews of evidence on the economic aspects of different models of delivering primary care services. Building on previous efforts, we adapted existing taxonomies of primary care components to classify our results according to four categories: coverage, financing, service delivery, and governance. FINDINGS We identified and classified 109 reviews that met our inclusion criteria according to our taxonomy of primary care components: coverage, financing, service delivery, and governance arrangements. A significant body of evidence suggests that several specific primary care arrangements, such as health workers' task shifting and telemedicine, can have positive economic impacts (such as lower overall health care costs). Notably absent were reviews on the impact of increasing primary care funding or the overall supply of primary care services. CONCLUSIONS There is a great opportunity for further research to systematically examine the broader economic impacts of investing in primary care services. Despite progress over the last decade, significant evidence gaps on the economic implications of different models of primary care services remain, which could help inform the basis of future research efforts.
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Affiliation(s)
- LORCAN CLARKE
- London School of Economics and Political Science
- Trinity College Dublin
| | | | | | | | | | - JENNA KERNS
- London School of Economics and Political Science
| | | | | | | | | | - HANS KLUGE
- World Health Organization Regional Office for Europe (WHO/Europe)
| | - ELIAS MOSSIALOS
- London School of Economics and Political Science
- Imperial College London
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15
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Adlung L, Cohen Y, Mor U, Elinav E. Machine learning in clinical decision making. MED 2021; 2:642-665. [DOI: 10.1016/j.medj.2021.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/22/2021] [Accepted: 04/06/2021] [Indexed: 12/24/2022]
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Yanicelli LM, Goy CB, Martínez EC, Herrera MC. Heart failure non-invasive home telemonitoring systems: A systematic review. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 201:105950. [PMID: 33540328 DOI: 10.1016/j.cmpb.2021.105950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 01/18/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND OBJECTIVE Heart Failure (HF) is mostly a lifestyle-related disease that is suited to telemonitoring since patients' signs and symptoms can be assessed remotely by healthcare providers. Today, non-invasive telemonitoring programs are increasingly used in HF care to detect patients' deterioration. This study aims to review and assess the distinctive characteristics of the different telemonitoring systems (TMS) tested in HF patients through clinical trials (CTs). Discussing the impact of the evaluation results of these systems is also another objective of this work. METHODS The search for CTs studies related to non-invasive home TMS in HF patients has been made in Cochrane Library. Research works of interest were limited to those articles published between 2005 and March 2019. RESULTS A total of 24 CTs that fully met the inclusion criteria were included in the final review. The main functionalities of these TMS were analyzed and compared among them. Also, the monitored parameters and significant findings of each trial were described. CONCLUSIONS This review shows a wide difference among available functionalities deployed by the reviewed systems. Most of them did not take into account the recommendations of HF management specialists, detailed in the evidence-based Clinical Practice Guidelines (CPGs) of the most relevant cardiology associations. Due to this, there is a wide variety of TMS, which makes a comparison among them difficult. However, the few systems that comply with the CPGs recommendations found promising results, suggesting that the design of TMS for the HF management should take into account the recommendations of specialists (CPGs).
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Affiliation(s)
- Lucía M Yanicelli
- INGAR - Instituto de Desarrollo y diseño, CONICET & Universidad Tecnológica Nacional, Avellaneda 3657, Santa Fe, S3002GJC, Argentina; Laboratorio de Investigaciones Cardiovasculares Multidisciplinarias - LICaM-, Universidad Nacional de Tucumán, Av. Independencia 1800, Tucumán T4002BLR, Argentina.
| | - Carla B Goy
- Departamento de Electrónica, Eléctrica y Computación, Universidad Nacional de Tucumán, Av. Independencia 1800, Tucumán T4002BLR, Argentina
| | - Ernesto C Martínez
- INGAR - Instituto de Desarrollo y diseño, CONICET & Universidad Tecnológica Nacional, Avellaneda 3657, Santa Fe, S3002GJC, Argentina
| | - Myriam C Herrera
- Laboratorio de Investigaciones Cardiovasculares Multidisciplinarias - LICaM-, Universidad Nacional de Tucumán, Av. Independencia 1800, Tucumán T4002BLR, Argentina; Departamento de Bioingeniería, Universidad Nacional de Tucumán, Av. Independencia 1800, Tucumán T4002BLR, Argentina
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Taylor ML, Thomas EE, Snoswell CL, Smith AC, Caffery LJ. Does remote patient monitoring reduce acute care use? A systematic review. BMJ Open 2021; 11:e040232. [PMID: 33653740 PMCID: PMC7929874 DOI: 10.1136/bmjopen-2020-040232] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 02/01/2021] [Accepted: 02/10/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Chronic diseases are associated with increased unplanned acute hospital use. Remote patient monitoring (RPM) can detect disease exacerbations and facilitate proactive management, possibly reducing expensive acute hospital usage. Current evidence examining RPM and acute care use mainly involves heart failure and omits automated invasive monitoring. This study aimed to determine if RPM reduces acute hospital use. METHODS A systematic literature review of PubMed, Embase and CINAHL electronic databases was undertaken in July 2019 and updated in October 2020 for studies published from January 2015 to October 2020 reporting RPM and effect on hospitalisations, length of stay or emergency department presentations. All populations and disease conditions were included. Two independent reviewers screened articles. Quality analysis was performed using the Joanna Briggs Institute checklist. Findings were stratified by outcome variable. Subgroup analysis was undertaken on disease condition and RPM technology. RESULTS From 2050 identified records, 91 studies were included. Studies were medium-to-high quality. RPM for all disease conditions was reported to reduce admissions, length of stay and emergency department presentations in 49% (n=44/90), 49% (n=23/47) and 41% (n=13/32) of studies reporting each measure, respectively. Remaining studies largely reported no change. Four studies reported RPM increased acute care use. RPM of chronic obstructive pulmonary disease (COPD) was more effective at reducing emergency presentation than RPM of other disease conditions. Similarly, invasive monitoring of cardiovascular disease was more effective at reducing hospital admissions versus other disease conditions and non-invasive monitoring. CONCLUSION RPM can reduce acute care use for patients with cardiovascular disease and COPD. However, effectiveness varies within and between populations. RPM's effect on other conditions is inconclusive due to limited studies. Further analysis is required to understand underlying mechanisms causing variation in RPM interventions. These findings should be considered alongside other benefits of RPM, including increased quality of life for patients. PROSPERO REGISTRATION NUMBER CRD42020142523.
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Affiliation(s)
- Monica L Taylor
- Centre for Online Health, Centre for Health Services Research, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Emma E Thomas
- Centre for Online Health, Centre for Health Services Research, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Centaine L Snoswell
- Centre for Online Health, Centre for Health Services Research, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Anthony C Smith
- Centre for Online Health, Centre for Health Services Research, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Liam J Caffery
- Centre for Online Health, Centre for Health Services Research, The University of Queensland, Woolloongabba, Queensland, Australia
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Ye R, Shi R, Liu K, Zhang X, Wang S, Liao H, Li X, Gou Q, Rong X, Zhang Z, Yang C, Yang X, Chen X. Internet-based patient- primary care physician-cardiologist integrated management model of hypertension in China: study protocol for a multicentre randomised controlled trial. BMJ Open 2020; 10:e039447. [PMID: 33067295 PMCID: PMC7569994 DOI: 10.1136/bmjopen-2020-039447] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION The control rate of hypertension is low in China, especially in rural, western and minority areas. This is related to poor medical skills among physicians in primary care institutions and low levels of trust among patients. However, primary healthcare institutions are the main battleground for the prevention and treatment of hypertension. It is worth exploring how to most effectively integrate patients, primary care physicians and cardiologists in tertiary hospitals, to build a long-term mechanism for the prevention and treatment of hypertension. In this study, we aim to evaluate the clinical effectiveness and conduct a health economic evaluation of an internet-based patient-primary care physician-cardiologist integrated management model of hypertension in areas of China with different socioeconomic levels. METHODS AND ANALYSIS This is a 12-month, multicentre, randomised controlled trial involving patients with hypertension in urban communities and rural areas of Sichuan Province, China. Each primary healthcare institution will cooperate with their tertiary hospital through the Red Shine Chronic Disease Management System (RSCDMS). Patients will be randomly assigned 1:1 to two groups: (1) a traditional care group; (2) an intervention group in which primary care physicians and cardiologists can share patient data and manage patients together through the RSCDMS. Patients can upload their blood pressure (BP) values and communicate with physicians using the system. The primary outcome is the change in systolic BP over a 12-month period. Secondary outcomes are changes in diastolic BP, BP control rate, values of 24-hour ambulatory BP monitoring, difference in cost-effectiveness between the groups, patient satisfaction, medication adherence and home BP monitoring compliance. All data will be recorded and stored in the RSCDMS and analysed using IBM SPSS V.26.0. ETHICS AND DISSEMINATION This study has been approved by the Biomedical Research Ethics Committee of the West China Hospital of Sichuan University in Sichuan, China (No. 2020-148). Written informed consent will be obtained from all participants. The results of this study will be disseminated to the public through academic conferences and peer-reviewed journals. TRIAL REGISTRATION NUMBER ChiCTR2000030677.
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Affiliation(s)
- Runyu Ye
- Cardiology, West China Hospital of Sichuan University, Chengdu, Sichaun, China
| | - Rufeng Shi
- Cardiology, West China Hospital of Sichuan University, Chengdu, Sichaun, China
| | - Kai Liu
- Cardiology, West China Hospital of Sichuan University, Chengdu, Sichaun, China
| | - Xin Zhang
- Cardiology, West China Hospital of Sichuan University, Chengdu, Sichaun, China
| | - Si Wang
- Cardiology, West China Hospital of Sichuan University, Chengdu, Sichaun, China
| | - Hang Liao
- Cardiology, West China Hospital of Sichuan University, Chengdu, Sichaun, China
| | - Xinran Li
- Cardiology, West China Hospital of Sichuan University, Chengdu, Sichaun, China
| | - Qiling Gou
- Cardiology, West China Hospital of Sichuan University, Chengdu, Sichaun, China
| | - Xi Rong
- Cardiology, West China Hospital of Sichuan University, Chengdu, Sichaun, China
| | - Zhipeng Zhang
- Cardiology, West China Hospital of Sichuan University, Chengdu, Sichaun, China
| | - Changqiang Yang
- Cardiology, West China Hospital of Sichuan University, Chengdu, Sichaun, China
| | - Xiangyu Yang
- Cardiology, West China Hospital of Sichuan University, Chengdu, Sichaun, China
| | - Xiaoping Chen
- Cardiology, West China Hospital of Sichuan University, Chengdu, Sichaun, China
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Abstract
Background: Norway is interested in implementing remote patient monitoring (RPM) within primary health services. This systematic review will first identify the types of RPM that are of interest to Norwegian health authorities, then synthesize the effects of RPM on clinical health and health service utilization outcomes among adults with chronic diseases. Methods: We will perform systematic literature searches in multiple databases, using RPM-related searches, such as telemedicine, telemonitoring, and eHealth. Based on what research exists, the review will be selected from a cascading menu of review types. Methodological quality will be assessed through appropriate checklists, while the quality of the evidence will be assessed through Grading of Recommendations Assessment, Development, and Evaluation. Discussion: This flexible protocol specifies the production of different possible types of reviews of RPM. It is anticipated that the results of the review will inform the development of effective RPM programs to the most appropriate chronic disease groups.
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Ionov MV, Zhukova OV, Yudina YS, Avdonina NG, Emelyanov IV, Kurapeev DI, Zvartau NE, Konradi AO. Value-based approach to blood pressure telemonitoring and remote counseling in hypertensive patients. Blood Press 2020; 30:20-30. [PMID: 32954832 DOI: 10.1080/08037051.2020.1813015] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE Blood pressure telemonitoring and remote counselling (BPTM) improves blood pressure (BP) control in patients with hypertension (HTN). Studies assessing the efficacy of BPTM from a value-based perspective are lacking. We investigated whether BPTM fits all principles of the value-based approach (clinical and economic effectiveness, improvement in patient-reported outcome/experience measures (PROM/PREM)). MATERIALS AND METHODS Two hundred and forty ambulatory patients with uncontrolled HTN were randomised in a 2: 1 manner to BPTM (n = 160, mean age 47 y.o.) and usual care (UC, n = 80; 49 y.o.) with baseline and 3-month follow-up clinic visits. BPTM employed a mobile application (for patients) and a desktop version (for clinician), which allowed communication and exchange of medical data. The main outcomes were changes in office and ambulatory systolic (S) BPs, rate of BP control. The incremental cost-effectiveness ratio (ICER) and incremental cost-utility ratio (ICUR) were evaluated in economic analysis. The MOS SF-36 score was taken as a PROM, and the PEQ score was used as a PREM. RESULTS Larger decreases in office and ambulatory SBPs (-16.8 and -8.9 mm Hg, respectively; p < .05) was achieved in BPTM group while the treatment intensity was equal (2.4 drugs). The ICER 11.1 EUR/-1 mm Hg 24-hour SBP/1 year was 75% effective as per willingness-to-pay threshold. BPTM improved PROM (+2.1 in mean MOS SF-36; p = .04), reduced long-term mortality (+0.11 life years gained), leading to +0.49 quality-adjusted life years (QALYs) gained as compared with UC. The ICUR was 4 169.4 EUR/QALY gained. Patient-reported experience was higher in the BPTM (+10 PEQ, p = .01). The UC group showed minor changes in MOS SF-36 and PEQ (+1.3; +6, respectively; p n.s.). CONCLUSIONS Being cost-effective, BPTM incorporates both clinical benefits and patient-perceived value. Larger randomised studies are needed to confirm our findings.
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Affiliation(s)
- Mikhail V Ionov
- Almazov National Medical Research Center, Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation.,Institute of Translational Medicine, ITMO University, Saint-Petersburg, Russian Federation
| | - Olga V Zhukova
- Ministry of Health of the Russian Federation, Privolzhsky Research Medical University, Nizhny Novgorod, Russian Federation
| | - Yulia S Yudina
- Almazov National Medical Research Center, Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation
| | - Natalya G Avdonina
- Almazov National Medical Research Center, Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation
| | - Igor V Emelyanov
- Almazov National Medical Research Center, Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation
| | - Dmitri I Kurapeev
- Almazov National Medical Research Center, Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation.,Institute of Translational Medicine, ITMO University, Saint-Petersburg, Russian Federation
| | - Nadezhda E Zvartau
- Almazov National Medical Research Center, Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation.,Institute of Translational Medicine, ITMO University, Saint-Petersburg, Russian Federation
| | - Alexandra O Konradi
- Almazov National Medical Research Center, Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation.,Institute of Translational Medicine, ITMO University, Saint-Petersburg, Russian Federation
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Yanicelli LM, Vegetti M, Goy CB, Martínez EC, Herrera MC. SiTe iC: A telemonitoring system for heart failure patients. Int J Med Inform 2020; 141:104204. [PMID: 32593010 DOI: 10.1016/j.ijmedinf.2020.104204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/27/2020] [Accepted: 05/26/2020] [Indexed: 01/08/2023]
Abstract
In the last years, multidisciplinary post-discharge treatment programs, such as telemonitoring, have been promoted as a strategy for Heart Failure (HF) management. However, the distinctive requirements that a telemonitoring system should have, have not been clearly identified. To this aim, the most relevant requirements for telemonitoring of HF patients are derived from evidence-based Clinical Practice Guidelines (CPGs) for HF management. The main objective of this work is to present a prototype of a telemonitoring system for HF patients, named SiTe iC, that has been developed based on the identified requirements, highlighting its design and evaluation. A first prototype of the system was designed and programmed. It consists of an mHealth app for HF patients, a website for physicians who monitor patients, and a server which runs an Application Programming Interface to allow communication between the app and the website. The system was thoroughly assessed through a clinical trial that demonstrates that telemonitoring using SiTe iC actually improves patients self-care when compared to usual care and it has the potential to avoid patient re-hospitalizations. This study demonstrated that the identified functional requirements for telemonitoring systems are relevant. In addition, thanks to SiTe iC, HF patients would take a more active role in their disease management by improving self-care.
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Affiliation(s)
- Lucía María Yanicelli
- INGAR - Instituto de Desarrollo y diseño, CONICET & Universidad Tecnológica Nacional, Avellaneda 3657, Santa Fe, S3002GJC, Argentina; Laboratorio de Investigaciones Cardiovasculares Multidisciplinarias (LICaM), DBI, FACET, Universidad Nacional de Tucumán, Av. Independencia 1800, Tucumán, T4002BLR, Argentina.
| | - Marcela Vegetti
- INGAR - Instituto de Desarrollo y diseño, CONICET & Universidad Tecnológica Nacional, Avellaneda 3657, Santa Fe, S3002GJC, Argentina
| | - Carla Belén Goy
- Laboratorio de Medios e Interfases (LAMEIN), DBI, FACET, Universidad Nacional de Tucumán, Av. Independencia 1800, Tucumán, T4002BLR, Argentina; Instituto Superior de Investigaciones Biológicas (INSIBIO), CONICET, Chacabuco 461, Tucumán, T4000ILI, Argentina; Departamento de Electricidad, Electrónica y Computación, Facultad de Ciencias Exactas y Tecnología, Universidad Nacional de Tucumán, Av. Independencia 1800, Tucumán, T4002BLR, Argentina
| | - Ernesto Carlos Martínez
- INGAR - Instituto de Desarrollo y diseño, CONICET & Universidad Tecnológica Nacional, Avellaneda 3657, Santa Fe, S3002GJC, Argentina
| | - Myriam Cristina Herrera
- Laboratorio de Investigaciones Cardiovasculares Multidisciplinarias (LICaM), DBI, FACET, Universidad Nacional de Tucumán, Av. Independencia 1800, Tucumán, T4002BLR, Argentina; Departamento de Bioingeniería, Facultad de Ciencias Exactas y Tecnología, Universidad Nacional de Tucumán, Av. Independencia 1800, Tucumán, T4002BLR, Argentina
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22
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Zand A, Nguyen A, Stokes Z, van Deen W, Lightner A, Platt A, Jacobs R, Reardon S, Kane E, Sack J, Hommes D. Patient Experiences and Outcomes of a Telehealth Clinical Care Pathway for Postoperative Inflammatory Bowel Disease Patients. Telemed J E Health 2020; 26:889-897. [DOI: 10.1089/tmj.2019.0102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Aria Zand
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
- Leiden University Medical Center, Department of Digestive Diseases, Leiden, The Netherlands
| | - Audrey Nguyen
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Zack Stokes
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Welmoed van Deen
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Amy Lightner
- UCLA Department of Surgery, David Geffen School of Medicine, University of California at Los Angeles, California, USA
- Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Anya Platt
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Rutger Jacobs
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Sarah Reardon
- UCLA Department of Surgery, David Geffen School of Medicine, University of California at Los Angeles, California, USA
| | - Ellen Kane
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Jonathan Sack
- UCLA Department of Surgery, David Geffen School of Medicine, University of California at Los Angeles, California, USA
| | - Daniel Hommes
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
- Leiden University Medical Center, Department of Digestive Diseases, Leiden, The Netherlands
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Economic evaluation of passive monitoring technology for seniors. Aging Clin Exp Res 2020; 32:1375-1382. [PMID: 31522390 PMCID: PMC7316690 DOI: 10.1007/s40520-019-01323-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 08/14/2019] [Indexed: 12/19/2022]
Abstract
Background Advances such as passive monitoring technology (PMT), which provides holistic supervision of chronically ill and elderly patients, enable and support improved monitoring and observation, thus empowering the growing population of older adults to live more independently while lowering health care expenses. Aims This study develops a conceptual model to estimate the potential savings associated with PMT. Methods We first develop a conceptual model to identify the main cost variables associated with independent living, focusing on three pathways: (1) PMT, (2) independent living supported by the current standard of care, and (3) facility-based care. We examined the impact on three outcomes [i.e., health care costs, institutional costs, and health-related quality of life (HRQoL)] along each of the three care pathways (i.e., PMT, independent living supported by the standard of care, and facility-based care) and developed a cost-benefit model to calculate the net costs and benefits associated with each care pathway. Results The cost–benefit model showed savings between approximately $425 per-member per-month (PMPM) for those using PMT compared to those on the standard of care pathway. Sensitivity analysis demonstrated that a 5% increase in nursing home utilization generates cost savings of more than 30% PMPM. Discussion The total projected cost savings for individuals on the PMT arm are projected to be more than $425 PMPM, with annual savings of $5069 per-person per-year, and over $5.1 million for a target population of 1000 individuals. Conclusions The cost calculations in our cost–benefit simulation model clearly demonstrate the value of PMT and show the potential value to payers and integrated delivery systems in offering PMT to individuals who are likely to benefit the most from the services. Electronic supplementary material The online version of this article (10.1007/s40520-019-01323-2) contains supplementary material, which is available to authorized users.
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Chen L, Cheng L, Gao W, Chen D, Wang C, Ran X. Telemedicine in Chronic Wound Management: Systematic Review And Meta-Analysis. JMIR Mhealth Uhealth 2020; 8:e15574. [PMID: 32584259 PMCID: PMC7381084 DOI: 10.2196/15574] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/28/2019] [Accepted: 05/14/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Chronic wounds have been a great burden to patients and the health care system. The popularity of the internet and smart devices, such as mobile phones and tablets, has made it possible to adopt telemedicine (TM) to improve the management of chronic wounds. However, studies conducted by different researchers have reported contradictory results on the effect of TM on chronic wound management. OBJECTIVE The aim of this work was to evaluate the efficacy and safety of TM in chronic wound management. METHODS We systematically searched multiple electronic databases (MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials [CENTRAL]) to identify eligible studies published from inception to June 12, 2019. Inclusion criteria were randomized controlled trials (RCTs) and interventional cohort studies that investigated the use of TM in chronic wound management. RCT and observational data were analyzed separately. A meta-analysis and qualitative analysis were conducted to estimate endpoints. RESULTS A total of 6 RCTs and 6 cohort studies including 3913 patients were included. Of these, 4 studies used tablets or mobile phones programmed with apps, such as Skype and specialized interactive systems, whereas the remaining 8 studies used email, telephone, and videoconferencing to facilitate the implementation of TM using a specialized system. Efficacy outcomes in RCTs showed no significant differences in wound healing (hazard ratio [HR] 1.16, 95% CI 0.96-1.39; P=.13), and wound healing around 1 year (risk ratio [RR] 1.05, 95% CI 0.89-1.23; P=.15). Noninferiority criteria of TM were met. A decreased risk of amputation in patients receiving TM was revealed (RR 0.45, 95% CI 0.29-0.71; P=.001). The result of cohort studies showed that TM was more effective than standard care (HR 1.74, 95% CI 1.43-2.12; P<.001), whereas the outcome efficacy RR of wound healing around 1 year (RR 1.21, 95% CI 0.96-1.53; P=.56) and 3 months (RR 1.24, 95% CI 0.47-3.3; P=.67) was not significantly different between TM and standard care. Noninferiority criteria of TM were met for wound healing around 1 year in cohort studies. CONCLUSIONS Currently available evidence suggests that TM seems to have similar efficacy and safety, and met noninferiority criteria with conventional standard care of chronic wounds. Large-scale, well-designed RCTs are warranted.
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Affiliation(s)
- Lihong Chen
- Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Lihui Cheng
- Department of Clinical Laboratory, Nuclear Industry 416 Hospital, the 2nd Affiliated Hospital of Chengdu Medical College, Chengdu, China.,School of Clinical Medicine, Southwest Medical University, Luzhou, China
| | - Wei Gao
- Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Dawei Chen
- Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Chun Wang
- Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Xingwu Ran
- Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
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Schweitzer M, Huber L, Gorfer T, Hörbst A. Experiences With Developing and Using Vital Sign Telemonitoring to Support Mobile Nursing in Rural Regions: Feasibility and Usability Study. JMIR Nurs 2020; 3:e17113. [PMID: 34345782 PMCID: PMC8279444 DOI: 10.2196/17113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/02/2020] [Accepted: 03/05/2020] [Indexed: 11/24/2022] Open
Abstract
Background Modern information and communication technology has the potential to support mobile care in rural regions such as the Alpine region, which is characterized by long distances or even physically unreachable areas. Objective This study investigated the potential of supporting mobile nursing organizations in rural regions with the use of mobile telemonitoring systems in a case study setting. Methods As a subproject of the European Union–funded project INTESI, the VITAl parameter MOnitoring (VITAMO) project gathered stakeholders’ requirements for telemonitoring support of mobile care in rural regions and then developed and implemented a prototype system that was used for a 3-month test period with a local nursing organization in Austria. Log analysis, surveys, and interviews were used to evaluate the system according to the Technology Acceptance Model. The focus was technology assessment and user satisfaction of both patients and nurses. Results Participants were provided Bluetooth devices to measure blood pressure, body weight, and blood glucose and to track activity. They also received a tablet with a mobile internet connection to see the results. The nurses were able to access the results remotely. Regularly executed speed tests and log analysis demonstrated the availability of high-speed mobile internet in the rural test region. Log analysis, surveys, and interviews revealed the suitability of the technology environment and showed that the system was easy to use and potentially useful. The perceived usefulness for supporting mobile care was rated meaningfully low, and the frequency of nurses using the tool declined continuously over the field test period. Further group discussions investigated this issue. Conclusions While the technology environment with mobile internet, Bluetooth devices, and smart vital sign monitoring devices was adequate and suitable to support mobile nursing in rural regions, the potential benefit for the nursing organization could not be confirmed. Further analysis revealed that operational care processes did not follow a well-defined care strategy. Technology has the potential to leverage the available environment for developing meaningful solutions. These experiences could contribute to further investigations that need to identify and analyze existing mobile care processes at an organizational level.
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Affiliation(s)
- Marco Schweitzer
- Institute for Biomedical Computer Sciences and Mechatronics UMIT - Private University for Health Sciences, Medical Informatics and Technology Hall in Tyrol Austria
| | - Lukas Huber
- Institute for Biomedical Computer Sciences and Mechatronics UMIT - Private University for Health Sciences, Medical Informatics and Technology Hall in Tyrol Austria
| | - Thilo Gorfer
- Institute for Biomedical Computer Sciences and Mechatronics UMIT - Private University for Health Sciences, Medical Informatics and Technology Hall in Tyrol Austria
| | - Alexander Hörbst
- Medical Technologies Department MCI Management Center Innsbruck Innsbruck Austria
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Ionov MV, Zhukova OV, Zvartau NE, Kurapeev DI, Yudina YS, Konradi AO. Assessment of the clinical efficacy of telemonitoring and distant counseling in patients with uncontrolled hypertension. TERAPEVT ARKH 2020; 92:49-55. [DOI: 10.26442/00403660.2020.01.000481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 11/22/2022]
Abstract
The aim of the study was to investigate the mathematical correlation of the clinical efficacy of blood pressure telemonitoring and distant counseling (BPTM) in patients in uncontrolled hypertension (HTN). Telehealth tools are widely used in HTN management. However clinical efficacy of such interventions assessed mainly in groups investigated without its populational and attributable impact. Materials and methods. The total of 240 patients were included, then randomized in 2:1 manner to BPTM group (n=160, median age 47 y.o.) and control group (n=80, median age 49 y.o). The user - friendly and secure telehealth software was provided with mobile application (patients) and desktop (doctors) platforms which allowed storage and analysis of self-BP monitoring data and remote consultations. A three - month surveillance was designed with mandatory baseline and final face - to - face visits with the assessment of office systolic BP (oSBP). Mathematical evaluation was based on target SBP rates achieved in comparator groups and included the absolute efficacies (AE), the attributable efficacy (AtE), the relative efficacy (RE) and the population attributable efficacy (PAtE). Results. BPTM group characterized by larger decrease in SBP level compared with controls (-16.8±2.9 mm Hg versus -7.9±3.9 mm Hg; p
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Ionov МV, Zvartau NЕ, Emelyanov IV, Konradi AО. Telemonitoring and remote counseling in hypertensive patients. Looking for new ways to do old jobs. ACTA ACUST UNITED AC 2019. [DOI: 10.18705/1607-419x-2019-25-4-337-356] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
XXI century emphasized humanity to embrace the digital era after a reality of Third and Fourth Industrial Revolutions, nowadays dictating new terms of social networking. It is expected that information and communication technologies integrated with value-based medicine will significantly impact healthcare delivery to tremendous number of patients with socially important noncommunicable diseases. Cardiovascular illnesses comprise the greatest part of such pathologies. Hypertension (HTN) being the most prevalent cardiovascular disease is also the key modifiable cardiovascular risk factor yet seems to be an attractive target for both value-based concept and telehealth interventions. Present review addresses up-to-date science on telehealth, sets out the main well-known, but yet unsolved challenges in management of HTN along with the new approaches involving telemedicine programs, digital health outlooks. The main barriers of telehealth implementation are also considered along with the possible solutions.
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Affiliation(s)
- М. V. Ionov
- Almazov National Medical Research Centre;
ITMO University
| | - N. Е. Zvartau
- Almazov National Medical Research Centre;
ITMO University
| | | | - A. О. Konradi
- Almazov National Medical Research Centre;
ITMO University
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Lopes MACQ, Oliveira GMMD, Ribeiro ALP, Pinto FJ, Rey HCV, Zimerman LI, Rochitte CE, Bacal F, Polanczyk CA, Halperin C, Araújo EC, Mesquita ET, Arruda JA, Rohde LEP, Grinberg M, Moretti M, Caramori PRA, Botelho RV, Brandão AA, Hajjar LA, Santos AF, Colafranceschi AS, Etges APBDS, Marino BCA, Zanotto BS, Nascimento BR, Medeiros CR, Santos DVDV, Cook DMA, Antoniolli E, Souza Filho EMD, Fernandes F, Gandour F, Fernandez F, Souza GEC, Weigert GDS, Castro I, Cade JR, Figueiredo Neto JAD, Fernandes JDL, Hadlich MS, Oliveira MAP, Alkmim MB, Paixão MCD, Prudente ML, Aguiar Netto MAS, Marcolino MS, Oliveira MAD, Simonelli O, Lemos Neto PA, Rosa PRD, Figueira RM, Cury RC, Almeida RC, Lima SRF, Barberato SH, Constancio TI, Rezende WFD. Guideline of the Brazilian Society of Cardiology on Telemedicine in Cardiology - 2019. Arq Bras Cardiol 2019; 113:1006-1056. [PMID: 31800728 PMCID: PMC7020958 DOI: 10.5935/abc.20190205] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Carlos Eduardo Rochitte
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP - Brazil
| | - Fernando Bacal
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP - Brazil
| | - Carisi Anne Polanczyk
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brazil
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brazil
- Instituto de Avaliação de Tecnologias em Saúde (IATS), Porto Alegre, RS - Brazil
| | | | | | | | | | | | - Max Grinberg
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP - Brazil
| | - Miguel Moretti
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP - Brazil
| | | | - Roberto Vieira Botelho
- Instituto do Coração do Triângulo (ICT), Uberlândia, MG - Brazil
- International Telemedical Systems do Brasil (ITMS), Uberlândia, MG - Brazil
| | | | - Ludhmila Abrahão Hajjar
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP - Brazil
| | | | | | | | - Bárbara Campos Abreu Marino
- Hospital Madre Teresa, Belo Horizonte, MG - Brazil
- Pontifícia Universidade Católica de Minas Gerais (PUCMG), Belo Horizonte, MG - Brazil
| | - Bruna Stella Zanotto
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brazil
- Instituto de Avaliação de Tecnologias em Saúde (IATS), Porto Alegre, RS - Brazil
| | - Bruno Ramos Nascimento
- Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brazil
| | | | | | - Daniela Matos Arrowsmith Cook
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brazil
- Hospital Copa Star, Rio de Janeiro, RJ - Brazil
- Hospital dos Servidores do Estado do Rio de Janeiro, Rio de Janeiro, RJ - Brazil
| | | | - Erito Marques de Souza Filho
- Universidade Federal Fluminense (UFF), Rio de Janeiro, RJ - Brazil
- Universidade Federal Rural do Rio de Janeiro, Seropédica, RJ - Brazil
| | | | - Fabio Gandour
- Universidade de Brasília (UnB), Brasília, DF - Brazil
| | | | | | | | - Iran Castro
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS - Brazil
- Fundação Universitária de Cardiologia, Porto Alegre, RS - Brazil
| | | | | | | | - Marcelo Souza Hadlich
- Fleury Medicina e Saúde, Rio de Janeiro, RJ - Brazil
- Rede D'Or, Rio de Janeiro, RJ - Brazil
- Unimed-Rio, Rio de Janeiro, RJ - Brazil
| | | | - Maria Beatriz Alkmim
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brazil
- Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brazil
| | | | | | | | | | | | - Osvaldo Simonelli
- Conselho Regional de Medicina do Estado de São Paulo, São Paulo, SP - Brazil
- Instituto Paulista de Direito Médico e da Saúde (IPDMS), Ribeirão Preto, SP - Brazil
| | | | - Priscila Raupp da Rosa
- Hospital Israelita Albert Einstein, São Paulo, SP - Brazil
- Hospital Sírio Libanês, São Paulo, SP - Brazil
| | | | | | | | | | - Silvio Henrique Barberato
- CardioEco-Centro de Diagnóstico Cardiovascular, Curitiba, PR - Brazil
- Quanta Diagnóstico e Terapia, Curitiba, PR - Brazil
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Goy CB, Yanicelli LM, Vargas N, Marquez LLL, Tazar J, Madrid RE, Herrera MC. Vascular Parameters for Ambulatory Monitoring of Congestive Heart Failure Patients: Proof of Concept. Cardiovasc Eng Technol 2019; 10:618-627. [PMID: 31598894 DOI: 10.1007/s13239-019-00432-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 10/01/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Prompt detection of congestion is an essential target in order to prevent heart failure (HF) related hospitalization, being ambulatory monitoring a promising strategy to do so. A successful non-invasive ambulatory monitoring system requires automatic devices for physiological data recording; these data must give information about HF deterioration early enough to predict HF-related adverse events. This work aims to evaluate seven vascular parameters for the ambulatory monitoring of congestive heart failure patients. METHODS Seven vascular parameters are proposed as indicators of HF deterioration. These parameters are obtained using venous occlusion plethysmography; a technique that uses hardware able of being miniaturized and easily integrated into wearables for ambulatory monitoring. The ability of the proposed vascular parameters to detect congestion is evaluated in eight healthy volunteers and ten congestive heart failure patients with different congestion levels-mild, moderate and severe. RESULTS Most parameters distinguish between healthy volunteers and heart failure patients, and some of them present significant differences between volunteers and low levels of congestion-mild or moderate. CONCLUSION Home monitoring of some of the proposed parameters could detect HF deterioration on its onset and alert to health personnel.
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Affiliation(s)
- C B Goy
- Laboratorio de Medios e Interfases (LAMEIN)-Departamento de Bioingeniería, Facultad de Ciencias Exactas y Tecnología, Universidad Nacional de Tucumán, Av. Independencia 1900, Tucumán, Argentina. .,Instituto Superior de Investigaciones Biológicas, Consejo Nacional de Investigaciones Científicas y Técnicas, Chacabuco 461, Tucumán, Argentina. .,Laboratorio de Investigaciones Cardiovasculares Multidisciplinarias-Departamento de Bioingeniería, Facultad de Ciencias Exactas y Tecnología, Universidad Nacional de Tucumán, Av. Independencia 1900, Tucumán, Argentina. .,Departamento de Ing. Eléctrica, Electrónica y Computación, Facultad de Ciencias Exactas y Tecnología, Universidad Nacional de Tucumán, Av. Independencia 1900, Tucumán, Argentina.
| | - L M Yanicelli
- Instituto Superior de Investigaciones Biológicas, Consejo Nacional de Investigaciones Científicas y Técnicas, Chacabuco 461, Tucumán, Argentina.,Laboratorio de Investigaciones Cardiovasculares Multidisciplinarias-Departamento de Bioingeniería, Facultad de Ciencias Exactas y Tecnología, Universidad Nacional de Tucumán, Av. Independencia 1900, Tucumán, Argentina
| | - N Vargas
- Instituto Superior de Investigaciones Biológicas, Consejo Nacional de Investigaciones Científicas y Técnicas, Chacabuco 461, Tucumán, Argentina.,Laboratorio de Investigaciones Cardiovasculares Multidisciplinarias-Departamento de Bioingeniería, Facultad de Ciencias Exactas y Tecnología, Universidad Nacional de Tucumán, Av. Independencia 1900, Tucumán, Argentina
| | | | - J Tazar
- Instituto de Cardiología, Av. Mitre 760, Tucumán, Argentina
| | - R E Madrid
- Laboratorio de Medios e Interfases (LAMEIN)-Departamento de Bioingeniería, Facultad de Ciencias Exactas y Tecnología, Universidad Nacional de Tucumán, Av. Independencia 1900, Tucumán, Argentina.,Instituto Superior de Investigaciones Biológicas, Consejo Nacional de Investigaciones Científicas y Técnicas, Chacabuco 461, Tucumán, Argentina
| | - M C Herrera
- Instituto Superior de Investigaciones Biológicas, Consejo Nacional de Investigaciones Científicas y Técnicas, Chacabuco 461, Tucumán, Argentina.,Laboratorio de Investigaciones Cardiovasculares Multidisciplinarias-Departamento de Bioingeniería, Facultad de Ciencias Exactas y Tecnología, Universidad Nacional de Tucumán, Av. Independencia 1900, Tucumán, Argentina
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30
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Ding EY, Ensom E, Hafer N, Buchholz B, Picard MA, Dunlap D, Rogers E, Lawton C, Koren A, Lilly C, Fitzgibbons TP, McManus DD. Point-of-care technologies in heart, lung, blood and sleep disorders from the Center for Advancing Point-of-Care Technologies. CURRENT OPINION IN BIOMEDICAL ENGINEERING 2019; 11:58-67. [PMID: 32582870 PMCID: PMC7314358 DOI: 10.1016/j.cobme.2019.08.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Recent advancements in point-of-care technologies have transformed care for patients with heart, lung, blood, and sleep disorders by providing rapid, cost-effective, and accessible solutions to challenges in the detection and management of many health conditions. However, major barriers exist throughout the technology development process that inhibit the actualization of many promising and potentially successful ideas. The Center for Advancing Point of Care Technologies has established a system for supporting further innovation in this field and bridging the gap between initial idea conception and implementation. We highlight current and emerging point-of-care technologies throughout the development spectrum and emphasize the need for a needs-driven model of health technology development that involve appropriate stakeholders in the process.
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Affiliation(s)
- Eric Y Ding
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
- Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Emily Ensom
- Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Nathaniel Hafer
- UMass Center for Clinical and Translational Science, University of Massachusetts Medical School, Worcester, MA, USA
- Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Bryan Buchholz
- Department of Biomedical Engineering, University of Massachusetts Lowell, Lowell, MA, USA
- Department of Work Environment, University of Massachusetts Lowell, Lowell, MA, USA
| | - Mary Ann Picard
- Massachusetts Medical Device Development Center, University of Massachusetts, Worcester/Lowell, MA, USA
| | - Denise Dunlap
- The Manning School of Business, University of Massachusetts Lowell, Lowell, MA, USA
| | - Eugene Rogers
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA, USA
| | - Carl Lawton
- Department of Chemical Engineering, University of Massachusetts Lowell, Lowell, M A, USA
| | - Ainat Koren
- Susan and Alan Solomont School of Nursing, University of Massachusetts Lowell, Lowell, MA, USA
| | - Craig Lilly
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Timothy P Fitzgibbons
- Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
- UMass Center for Clinical and Translational Science, University of Massachusetts Medical School, Worcester, MA, USA
| | - David D McManus
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
- Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
- UMass Center for Clinical and Translational Science, University of Massachusetts Medical School, Worcester, MA, USA
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31
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Affiliation(s)
- Victor J. Dzau
- From the Office of the President, National Academy of Medicine (formerly the Institute of Medicine), Washington, DC
| | - Celynne A. Balatbat
- From the Office of the President, National Academy of Medicine (formerly the Institute of Medicine), Washington, DC
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Murphy EK, Amoh J, Arshad SH, Halter RJ, Odame K. Noise-robust bioimpedance approach for cardiac output measurement. Physiol Meas 2019; 40:074004. [PMID: 30840932 DOI: 10.1088/1361-6579/ab0d45] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Congestive heart failure is a problem affecting millions of Americans. A continuous, non-invasive, telemonitoring device that can accurately monitor cardiac metrics could greatly help this population, reducing unnecessary hospitalizations and cost. APPROACH Machine learning (ML) algorithms trained on electrical-impedance tomography (EIT) data are presented for portable cardiac monitoring. The approach was validated on a simulated thorax and a measured tank experiment. A highly detailed 4D chest model (finite element method mesh and conductivity profiles) was developed utilizing the 4D XCAT phantom to provide realistic data. The ML algorithms were trained using databases that assumed the presence of poorly contacting electrodes without any assumptions of knowing which electrodes would be bad in the experiment. The trained ML algorithms were compared to EIT evaluated with and without removing bad electrodes. MAIN RESULTS A regression support vector machine and a deep neural network (DNN) were found to be the most accurate and robust to poorly contacting electrodes while not needing to know which electrodes were in poor contact in the simulated and measured experiments, respectively. SIGNIFICANCE Although the ML algorithms are not always better than EIT (with bad electrodes removed), the comparable results without needing a priori knowledge of which electrodes are bad is seen as a very promising feature. An evaluation of computational costs showed that the DNN required comparable computational power to the other methods while requiring less memory, which could make the DNNs an attractive algorithm for a low-power, portable system. This work represents an important validation of the method using measured data, and model development, which is needed to apply this method on real clinical data. Additionally, the developed 4D simulated thorax model could be an important tool within the EIT community.
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Affiliation(s)
- Ethan K Murphy
- Thayer School of Engineering, Dartmouth College, Hanover, NH 03755, United States of America
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Farias FACD, Dagostini CM, Bicca YDA, Falavigna VF, Falavigna A. Remote Patient Monitoring: A Systematic Review. Telemed J E Health 2019; 26:576-583. [PMID: 31314689 DOI: 10.1089/tmj.2019.0066] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Remote patient monitoring or telemonitoring aims at improving patient care through digitally transmitted health-related data. That allows early detection of disease decompensation and intervention, patient education and improves patient-physician relationship. Despite its relevance, there are no comprehensive reviews evaluating the variables discussed by clinical studies on telemonitoring. Methods: A systematic literature search of PubMed was performed to identify studies about telemonitoring published between 2000 and 2018. These had to be case reports with >5 cases, comparative or clinical studies/trials. The following variables were evaluated: year of publication, author's country, discussed topic, objective of study, follow-up time, number of telemonitoring patients, primary outcome, use of teleconsultation and tele-education, presence of a control group, effectiveness of telemonitoring, telemonitoring strategies, and level of evidence. Results: After screening 947 records, 272 articles were included. The review showed a growing number of publications over the years, with 43.0% being published between 2015 and 2018, providing generally positive results (76.8%). The United States was responsible for 38.2% of articles. Cardiovascular disease was the topic of 47.8% of studies, whereas surgical pathologies and postoperative care represented only 2.6%. Wireless devices or smartphone apps were the most popular strategy (75.7%), with 17.6% of studies employing tele-education and 24.6% employing teleconsultation measures. Most publications were OCEBM Level of Evidence 2 (73.5%). Conclusion: Telemonitoring appears to maximize patient care and effectiveness of treatment. The number of publications illustrates the growing interest in the matter. Telemonitoring has yet to be evaluated in the setting of postoperative care and surgical pathologies.
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Affiliation(s)
| | - Carolina Matté Dagostini
- Cell Therapy Laboratory (LATEC), and University of Caxias do Sul (UCS), Caxias do Sul, Rio Grande do Sul, Brazil
| | - Yan de Assunção Bicca
- Cell Therapy Laboratory (LATEC), and University of Caxias do Sul (UCS), Caxias do Sul, Rio Grande do Sul, Brazil
| | - Vincenzo Fin Falavigna
- Cell Therapy Laboratory (LATEC), and University of Caxias do Sul (UCS), Caxias do Sul, Rio Grande do Sul, Brazil
| | - Asdrubal Falavigna
- Health Sciences Postgraduate Program, University of Caxias do Sul (UCS), Caxias do Sul, Rio Grande do Sul, Brazil
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Do patients actually do what we ask: patient fidelity and persistence to the Targets and Self-Management for the Control of Blood Pressure in Stroke and at Risk Groups blood pressure self-management intervention. J Hypertens 2019; 36:1753-1761. [PMID: 29889157 DOI: 10.1097/hjh.0000000000001738] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Self-management of hypertension can reduce and control blood pressure (BP) compared with clinic monitoring. However, self-management relies on patients following an algorithm, which may be variably adhered to. This study reports fidelity of high-risk patients to the self-management algorithm set by the TASMIN-SR trial. METHODS Patients with hypertension, above target clinic BP and one or more of stroke, diabetes, coronary heart disease or chronic kidney disease, were invited to self-monitor following an individualized self-titration algorithm. Home BP readings and medication change details were submitted monthly for 12 months. Readings downloaded from patients' electronic monitors were compared with written submissions, and protocol fidelity was assessed. RESULTS Two hundred and seventy-six patients were randomized to self-management and 225 (82%) completed the required training sessions. Of these, 166 (74%) completed self-management. A total of 11385 (89.6%) submitted readings were accurate compared with corresponding downloaded monitor readings. Mean error rate was 5.2% per patient, which increased with age but not comorbidities. Patients made 475 of 683 (69.5%) algorithm-recommended medication changes, equating to nearly three medication changes per patient. Mean SBP for patients who completed training and made all recommended changes dropped from 141 mmHg (95% CI 138.26-144.46) to 121 mmHg (95% CI 118.30-124.17 mmHg) compared with 129 mmHg (95% CI 125.27-136.73 mmHg) for patients who made none. CONCLUSION Most patients randomized to self-management completed training; however, 36% of these had dropped out by 12 months. Self-monitoring was largely undertaken properly and accurately recorded. Fidelity with self-management was associated with lower achieved SBP. Successful implementation of self-management into daily practice requires careful training and should be accompanied by monitoring of fidelity.
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Omboni S. Connected Health in Hypertension Management. Front Cardiovasc Med 2019; 6:76. [PMID: 31263703 PMCID: PMC6584810 DOI: 10.3389/fcvm.2019.00076] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 05/24/2019] [Indexed: 11/13/2022] Open
Abstract
e-health is defined as the use of communication and information technologies (ICT) to manage patients and their health in a more efficient way, with the aim of improving the overall quality of care. Healthcare services relying on telehealth (or telemedicine) and mobile health (m-health) are the most popular e-health tools used by healthcare professionals and consumers. These applications allow the exchange of medical data between patients and their doctors or among healthcare professionals, mainly through the Internet, and are used to provide healthcare services remotely (so-called "connected health"). The most popular telemedicine application in the field of hypertension is blood pressure telemonitoring (BPT), which enables transmission of BP and various clinical information from patients' homes or from the community to the doctor's surgery or the hospital. Numerous randomized controlled trials have documented a significant BP reduction combined with an intensification and optimization of the use of antihypertensive medications in patients making use of BPT plus remote counseling by a case manager, with the supervision of a doctor or a community pharmacist (telepharmacy). The major benefits of BPT are usually observed in high-risk patients. BPT can also be based on m-health wireless solutions, provided with educational support, medication trackers and reminders, and teleconsultation. In this context, BPT may favor patient's self-management, as an adjunct to the doctor's intervention, and foster patient's participation in medical decision making, with consequent improvement in BP control and increase in medication adherence. In conclusion, e-health solutions, and in particular telemedicine, are increasingly attaining a key position in the management of the hypertensive patient, with an enormous potential in terms of improvement of the quality of the delivered care, increase in the chance of a successful BP control and effective prevention of cardiovascular diseases.
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Affiliation(s)
- Stefano Omboni
- Clinical Research Unit, Italian Institute of Telemedicine, Varese, Italy
- Scientific Research Department of Cardiology, Science and Technology Park for Biomedicine, Sechenov First Moscow State Medical University, Moscow, Russia
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Anosike C, Adibe MO, Isah A, Ukoha-Kalu OB. Willingness to pay for pharmacist-provided home telemonitoring among patients with chronic diseases in Enugu metropolis. Health Informatics J 2019; 26:829-840. [PMID: 31195915 DOI: 10.1177/1460458219852534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Home telemonitoring is a promising approach in the management of patients with chronic diseases. However, no study has assessed its acceptability and possible service charge in Nigeria. Therefore, this study aimed to evaluate willingness to pay for pharmacist-provided telemonitoring among patients with chronic diseases and to explore its determinants. Hence, using the contingent valuation method, a cross-sectional study was conducted among eligible patients visiting 15 selected community pharmacies in Enugu metropolis, over a period of 3 months. Of the 335 patients who participated in the study, about 40 percent (i.e. 39.4%) were willing to pay an average monthly fee of ₦915.91 ± 485.49 (US$2.99 ± 1.59) for home telemonitoring services. Significant predictors of willingness to pay for home telemonitoring were perceived insufficient income (odds ratio = 0.20, 95% confidence interval = 0.07-0.60, p = 0.040) and health insurance status (odds ratio = 0.39, 95% confidence interval = 0.18-0.86, p = 0.019). Our findings suggest a promising potential for adopting home telemonitoring services among patients with chronic diseases in Enugu metropolis.
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Palmeira CS, Mussi FC, Santos CASDT, Lima ML, Ladeia AMT, Silva LCDJ. Effect of remote nursing monitoring on overweight in women: clinical trial. Rev Lat Am Enfermagem 2019; 27:e3129. [PMID: 30916230 PMCID: PMC6432992 DOI: 10.1590/1518-8345.2651.3129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 11/13/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE to evaluate the effect of remote nursing monitoring on the improvement of anthropometric measurements of overweight women. METHOD controlled, randomized clinical trial, carried out in a reference outpatient clinic for treatment of obesity. The baseline sample was composed of 101 women randomly assigned to two groups, 51 in the intervention group (IG) and 50 in the control group (CG). The IG received remote monitoring through telephone calls and conventional monitoring, and the CG received conventional monitoring. Women were assessed at the baseline and after three months of intervention. A paired t-test and analysis of covariance were used to evaluate intragroup differences in anthropometric measurements, and the statistical significance of 5% was adopted. Eighty one women completed the study. RESULTS in the intergroup comparison after the intervention, a reduction of 1.66 kg in the mean weight (p = 0.017) and of 0.66 kg/m2 in the mean BMI (p = 0.015) was found in the intervention group. There was a borderline statistically significant (p = 0.055) reduction of 2.5 cm in WC with in the intervention group. CONCLUSION the remote monitoring was beneficial in reducing anthropometric measurements. RBR-3hzdgv.
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Affiliation(s)
- Catia Suely Palmeira
- Universidade Federal da Bahia, Serviço Médico Universitário Rubens Brasil, Salvador, BA, Brazil
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Asan O, Cooper Ii F, Nagavally S, Walker RJ, Williams JS, Ozieh MN, Egede LE. Preferences for Health Information Technologies Among US Adults: Analysis of the Health Information National Trends Survey. J Med Internet Res 2018; 20:e277. [PMID: 30341048 PMCID: PMC6245956 DOI: 10.2196/jmir.9436] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 04/19/2018] [Accepted: 05/10/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Emerging health technologies are increasingly being used in health care for communication, data collection, patient monitoring, education, and facilitating adherence to chronic disease management. However, there is a lack of studies on differences in the preference for using information exchange technologies between patients with chronic and nonchronic diseases and factors affecting these differences. OBJECTIVE The purpose of this paper is to understand the preferences and use of information technology for information exchange among a nationally representative sample of adults with and without 3 chronic disease conditions (ie, cardiovascular disease [CVD], diabetes, and hypertension) and to assess whether these preferences differ according to varying demographic variables. METHODS We utilized data from the 2012 and 2014 iteration of the Health Information National Trends Survey (N=7307). We used multiple logistic regressions, adjusting for relevant demographic covariates, to identify the independent factors associated with lower odds of using health information technology (HIT), thus, identifying targets for awareness. Analyses were weighted for the US population and adjusted for the sociodemographic variables of age, gender, race, and US census region. RESULTS Of 7307 participants, 3529 reported CVD, diabetes, or hypertension. In the unadjusted models, individuals with diabetes, CVD, or hypertension were more likely to report using email to exchange medical information with their provider and less likely to not use any of the technology in health information exchange, as well as more likely to say it was not important for them to access personal medical information electronically. In the unadjusted model, additional significant odds ratio (OR) values were observed. However, after adjustment, most relationships regarding the use and interest in exchanging information with the provider were no longer significant. In the adjusted model, individuals with CVD, diabetes, or hypertension were more likely to access Web-based personal health information through a website or app. Furthermore, we assessed adjusted ORs for demographic variables. Those aged >65 years and Hispanic people were more likely to report no use of email to exchange medical information with their provider. Minorities (Hispanic, non-Hispanic black, and Asian people) were less likely to indicate they had no interest in exchanging general health tips with a provider electronically. CONCLUSIONS The analysis did not show any significant association among those with comorbidities and their proclivity toward health information, possibly implying that HIT-related interventions, particularly design of information technologies, should focus more on demographic factors, including race, age, and region, than on comorbidities or chronic disease status to increase the likelihood of use. Future research is needed to understand and explore more patient-friendly use and design of information technologies, which can be utilized by diverse age, race, and education or health literacy groups efficiently to further bridge the patient-provider communication gap.
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Affiliation(s)
- Onur Asan
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, NJ, United States
| | - Farion Cooper Ii
- Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, WI, United States
| | - Sneha Nagavally
- Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, WI, United States
| | - Rebekah J Walker
- Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, WI, United States
| | - Joni S Williams
- Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, WI, United States
| | - Mukoso N Ozieh
- Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, WI, United States
| | - Leonard E Egede
- Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, WI, United States
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Zhang C, Zhang Y, Zhan S, Li D, Jin H, Denys D, Sun B. Telemedical Deep Brain Stimulation: Merits and Limitations. Stereotact Funct Neurosurg 2018; 96:272-273. [DOI: 10.1159/000491603] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 06/27/2018] [Indexed: 11/19/2022]
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Parati G, Dolan E, McManus RJ, Omboni S. Home blood pressure telemonitoring in the 21st century. J Clin Hypertens (Greenwich) 2018; 20:1128-1132. [DOI: 10.1111/jch.13305] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 04/18/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Gianfranco Parati
- Department of Medicine and Surgery; University of Milano-Bicocca; Milano Italy
- Cardiology Unit and Department of Cardiovascular; Neural and Metabolic Sciences; Istituto Auxologco Italiano; S. Luca Hospital; Milano Italy
| | - Eamon Dolan
- Stroke and Hypertension Unit; Connolly Hospital; Dublin Ireland
| | - Richard J. McManus
- Nuffield Department of Primary Care Health Sciences; Green Templeton College; University of Oxford; Oxford UK
| | - Stefano Omboni
- Clinical Research Unit; Italian Institute of Telemedicine; Solbiate Arno Italy
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Ware P, Seto E, Ross HJ. Accounting for Complexity in Home Telemonitoring: A Need for Context-Centred Evidence. Can J Cardiol 2018; 34:897-904. [DOI: 10.1016/j.cjca.2018.01.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/19/2018] [Accepted: 01/21/2018] [Indexed: 01/17/2023] Open
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Grustam AS, Severens JL, De Massari D, Buyukkaramikli N, Koymans R, Vrijhoef HJM. Cost-Effectiveness Analysis in Telehealth: A Comparison between Home Telemonitoring, Nurse Telephone Support, and Usual Care in Chronic Heart Failure Management. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:772-782. [PMID: 30005749 DOI: 10.1016/j.jval.2017.11.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 10/31/2017] [Accepted: 11/30/2017] [Indexed: 05/13/2023]
Abstract
OBJECTIVES To assess the cost effectiveness of home telemonitoring (HTM) and nurse telephone support (NTS) compared with usual care (UC) in the management of patients with chronic heart failure, from a third-party payer's perspective. METHODS We developed a Markov model with a 20-year time horizon to analyze the cost effectiveness using the original study (Trans-European Network-Home-Care Management System) and various data sources. A probabilistic sensitivity analysis was performed to assess the decision uncertainty in our model. RESULTS In the original scenario (which concerned the cost inputs at the time of the original study), HTM and NTS interventions yielded a difference in quality-adjusted life-years (QALYs) gained compared with UC: 2.93 and 3.07, respectively, versus 1.91. An incremental net monetary benefit analysis showed €7,697 and €13,589 in HTM and NTS versus UC at a willingness-to-pay (WTP) threshold of €20,000, and €69,100 and €83,100 at a WTP threshold of €80,000, respectively. The incremental cost-effectiveness ratios were €12,479 for HTM versus UC and €8,270 for NTS versus UC. The current scenario (including telenurse cost inputs in NTS) yielded results that were slightly different from those for the original scenario, when comparing all New York Heart Association (NYHA) classes of severity. NTS dominated HTM, compared with UC, in all NYHA classes except NYHA IV. CONCLUSIONS This modeling study demonstrated that HTM and NTS are viable solutions to support patients with chronic heart failure. NTS is cost-effective in comparison with UC at a WTP of €9000/QALY or higher. Like NTS, HTM improves the survival of patients in all NYHA classes and is cost-effective in comparison with UC at a WTP of €14,000/QALY or higher.
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Affiliation(s)
- Andrija S Grustam
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Professional Health Solutions and Services Department, Philips Research Europe, Eindhoven, The Netherlands.
| | - Johan L Severens
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Daniele De Massari
- Chronic Disease Management Department, Philips Research Europe, Eindhoven, The Netherlands
| | - Nasuh Buyukkaramikli
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Ron Koymans
- Professional Health Solutions and Services Department, Philips Research Europe, Eindhoven, The Netherlands
| | - Hubertus J M Vrijhoef
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Department of Patient and Care, Maastricht UMC, Maastricht, The Netherlands; Department of Family Medicine and Chronic Care, Vrije Universiteit Brussels, Brussels, Belgium
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Bussooa A, Neale S, Mercer JR. Future of Smart Cardiovascular Implants. SENSORS 2018; 18:s18072008. [PMID: 29932154 PMCID: PMC6068883 DOI: 10.3390/s18072008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 06/06/2018] [Accepted: 06/20/2018] [Indexed: 01/07/2023]
Abstract
Cardiovascular disease remains the leading cause of death in Western society. Recent technological advances have opened the opportunity of developing new and innovative smart stent devices that have advanced electrical properties that can improve diagnosis and even treatment of previously intractable conditions, such as central line access failure, atherosclerosis and reporting on vascular grafts for renal dialysis. Here we review the latest advances in the field of cardiovascular medical implants, providing a broad overview of the application of their use in the context of cardiovascular disease rather than an in-depth analysis of the current state of the art. We cover their powering, communication and the challenges faced in their fabrication. We focus specifically on those devices required to maintain vascular access such as ones used to treat arterial disease, a major source of heart attacks and strokes. We look forward to advances in these technologies in the future and their implementation to improve the human condition.
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Affiliation(s)
- Anubhav Bussooa
- School of Engineering James Watt South Building, University of Glasgow, Glasgow G12 8QQ, UK.
- BHF Glasgow Cardiovascular Research Centre Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8TA, UK.
| | - Steven Neale
- School of Engineering James Watt South Building, University of Glasgow, Glasgow G12 8QQ, UK.
| | - John R Mercer
- BHF Glasgow Cardiovascular Research Centre Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8TA, UK.
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Martín-Lesende I, Orruño E, Mateos M, Recalde E, Asua J, Reviriego E, Bayón JC. Telemonitoring in-home complex chronic patients from primary care in routine clinical practice: Impact on healthcare resources use. Eur J Gen Pract 2018; 23:135-142. [PMID: 28446045 PMCID: PMC5965896 DOI: 10.1080/13814788.2017.1306516] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Recent evidence indicates that home telemonitoring of chronic patients reduces the use of healthcare resources. However, further studies exploring this issue are needed in primary care. Objectives: To assess the impact of a primary care-based home telemonitoring intervention for highly unstable chronic patients on the use of healthcare resources. Methods: A one-year follow-up before and after exploratory study, without control group, was conducted. Housebound patients with heart failure or chronic lung disease, with recurrent hospital admissions, were included. The intervention consisted of patient’s self-measurements and responses to a health status questionnaire, sent daily from smartphones to a web-platform (aided by an alert system) reviewed by healthcare professionals. The primary outcome measure was the number of hospital admissions occurring 12 months before and after the intervention. Secondary outcomes were length of hospital stay and number of emergency department attendances. Primary care nurses were mainly in charge of the telemonitoring process and were assisted by the general practitioners when required. Results: For the 28 patients who completed the follow-up (out of 42 included, 13 patients died and 1 discontinued the intervention), a significant reduction in hospitalizations, from 2.6 admissions/patient in the previous year (standard deviation, SD: 1.6) to 1.1 (SD: 1.5) during the one-year telemonitoring follow-up (P <0.001), and emergency department attendances, from 4.2 (SD: 2.6) to 2.1 (SD: 2.6) (P <0.001) was observed. The length of hospital stay was reduced non-significantly from 11.4 to 7.9 days. Conclusion: In this small exploratory study, the primary care-based telemonitoring intervention seemed to have a positive impact decreasing the number of hospital admissions and emergency department attendances.
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Affiliation(s)
- Iñaki Martín-Lesende
- a San Ignacio General Practice, Basque Health Service-Osakidetza , Bilbao-Basurto Integrated Healthcare Organization (IHO) , Bizkaia , Spain
| | - Estibalitz Orruño
- b Basque Office for Health Technology Assessment (OSTEBA) , Ministry for Health, Basque Government , Vitoria-Gasteiz , Araba , Spain
| | - Maider Mateos
- b Basque Office for Health Technology Assessment (OSTEBA) , Ministry for Health, Basque Government , Vitoria-Gasteiz , Araba , Spain
| | - Elizabete Recalde
- c Santutxu-Solokoetxe General Practice, Basque Health Service-Osakidetza , Bilbao Basurto IHO , Bizkaia , Spain
| | - José Asua
- b Basque Office for Health Technology Assessment (OSTEBA) , Ministry for Health, Basque Government , Vitoria-Gasteiz , Araba , Spain
| | - Eva Reviriego
- b Basque Office for Health Technology Assessment (OSTEBA) , Ministry for Health, Basque Government , Vitoria-Gasteiz , Araba , Spain
| | - Juan Carlos Bayón
- b Basque Office for Health Technology Assessment (OSTEBA) , Ministry for Health, Basque Government , Vitoria-Gasteiz , Araba , Spain
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Hashemi A, Nourbakhsh S, Tehrani P, Karimi A. Remote telemonitoring of cardiovascular patients: Benefits, barriers, new suggestions. Artery Res 2018. [DOI: 10.1016/j.artres.2018.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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Methodology and technology for peripheral and central blood pressure and blood pressure variability measurement: current status and future directions - Position statement of the European Society of Hypertension Working Group on blood pressure monitoring and cardiovascular variability. J Hypertens 2017; 34:1665-77. [PMID: 27214089 DOI: 10.1097/hjh.0000000000000969] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Office blood pressure measurement has been the basis for hypertension evaluation for almost a century. However, the evaluation of blood pressure out of the office using ambulatory or self-home monitoring is now strongly recommended for the accurate diagnosis in many, if not all, cases with suspected hypertension. Moreover, there is evidence that the variability of blood pressure might offer prognostic information that is independent of the average blood pressure level. Recently, advancement in technology has provided noninvasive evaluation of central (aortic) blood pressure, which might have attributes that are additive to the conventional brachial blood pressure measurement. This position statement, developed by international experts, deals with key research and practical issues in regard to peripheral blood pressure measurement (office, home, and ambulatory), blood pressure variability, and central blood pressure measurement. The objective is to present current achievements, identify gaps in knowledge and issues concerning clinical application, and present relevant research questions and directions to investigators and manufacturers for future research and development (primary goal).
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Lanssens D, Vandenberk T, Thijs IM, Grieten L, Gyselaers W. Effectiveness of Telemonitoring in Obstetrics: Scoping Review. J Med Internet Res 2017; 19:e327. [PMID: 28954715 PMCID: PMC5637065 DOI: 10.2196/jmir.7266] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 05/01/2017] [Accepted: 07/29/2017] [Indexed: 01/08/2023] Open
Abstract
Background Despite reported positive results of telemonitoring effectiveness in various health care domains, this new technology is rarely used in prenatal care. A few isolated investigations were performed in the past years but with conflicting results. Objective The aim of this review was to (1) assess whether telemonitoring adds any substantial benefit to this patient population and (2) identify research gaps in this area to suggest goals for future research. Methods This review includes studies exploring the effectiveness of telemonitoring interventions for pregnant women reported in the English language. Due to the paucity of research in this area, all reports including uncontrolled nonrandomized and randomized controlled studies were selected. Results Fourteen studies, which performed their data collection from 1988 to 2010, met the inclusion criteria and were published from 1995 to present; four of the 14 published papers were multicenter randomized controlled trials (RCTs), five papers were single-center RCTs, three papers were retrospective studies, one paper was an observational study, and one paper was a qualitative study. Of the 14 papers, nine were available for a risk of bias assessment: three papers were classified as low risk, one as medium risk, and five as high risk. Furthermore, of those 14 papers, 13 focused on telemonitoring for maternal outcomes, and nine of the 14 papers focused on telemonitoring for fetal or neonatal outcomes. The studies reviewed report that telemonitoring can contribute to significant reductions in health care costs, (unscheduled) face-to-face visits, low neonatal birth weight, and admissions to the neonatal intensive care unit (NICU), as well as prolonged gestational age and improved feelings of maternal satisfaction when compared with a control group. When only studies with low risk of bias were taken into account, the added value of telemonitoring became less pronounced: the only added value of telemonitoring is for pregnant women who transmitted their uterine activity by telecommunication. They had significant prolonged pregnancy survivals, and the newborns were less likely to be of low birth weight or to be admitted to the NICU. Following these results, telemonitoring can only be recommended by pregnant women at risk for preterm delivery. It is however important to consider that these studies were published in the mid-90s, which limits their direct applicability given the current technologies and practice. Conclusions This review shows that telemonitoring can be tentatively recommended for pregnant women at risk for preterm delivery. More recent RCTs with a blinded protocol are needed to strengthen the level of evidence around this topic and to have an insight in the added value of the technologies that are available nowadays. In addition, studies investigating patient satisfaction and economic effects in relation to telemonitoring are suggested for future research.
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Affiliation(s)
- Dorien Lanssens
- Mobile Health Unit, Facultiy of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Department of Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Thijs Vandenberk
- Mobile Health Unit, Facultiy of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Inge M Thijs
- Mobile Health Unit, Facultiy of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Department of Physiology, Hasselt University, Hasselt, Belgium
| | - Lars Grieten
- Mobile Health Unit, Facultiy of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Wilfried Gyselaers
- Mobile Health Unit, Facultiy of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Department of Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Department of Physiology, Hasselt University, Hasselt, Belgium
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Greenhalgh T, A’Court C, Shaw S. Understanding heart failure; explaining telehealth - a hermeneutic systematic review. BMC Cardiovasc Disord 2017; 17:156. [PMID: 28615004 PMCID: PMC5471857 DOI: 10.1186/s12872-017-0594-2] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 06/07/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Enthusiasts for telehealth extol its potential for supporting heart failure management. But randomised trials have been slow to recruit and produced conflicting findings; real-world roll-out has been slow. We sought to inform policy by making sense of a complex literature on heart failure and its remote management. METHODS Through database searching and citation tracking, we identified 7 systematic reviews of systematic reviews, 32 systematic reviews (including 17 meta-analyses and 8 qualitative reviews); six mega-trials and over 60 additional relevant empirical studies and commentaries. We synthesised these using Boell's hermeneutic methodology for systematic review, which emphasises the quest for understanding. RESULTS Heart failure is a complex and serious condition with frequent co-morbidity and diverse manifestations including severe tiredness. Patients are often frightened, bewildered, socially isolated and variably able to self-manage. Remote monitoring technologies are many and varied; they create new forms of knowledge and new possibilities for care but require fundamental changes to clinical roles and service models and place substantial burdens on patients, carers and staff. The policy innovation of remote biomarker monitoring enabling timely adjustment of medication, mediated by "activated" patients, is based on a modernist vision of efficient, rational, technology-mediated and guideline-driven ("cold") care. It contrasts with relationship-based ("warm") care valued by some clinicians and by patients who are older, sicker and less technically savvy. Limited uptake of telehealth can be analysed in terms of key tensions: between tidy, "textbook" heart failure and the reality of multiple comorbidities; between basic and intensive telehealth; between activated, well-supported patients and vulnerable, unsupported ones; between "cold" and "warm" telehealth; and between fixed and agile care programmes. CONCLUSION The limited adoption of telehealth for heart failure has complex clinical, professional and institutional causes, which are unlikely to be elucidated by adding more randomised trials of technology-on versus technology-off to an already-crowded literature. An alternative approach is proposed, based on naturalistic study designs, application of social and organisational theory, and co-design of new service models based on socio-technical principles. Conventional systematic reviews (whose goal is synthesising data) can be usefully supplemented by hermeneutic reviews (whose goal is deepening understanding).
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Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Woodstock Rd, Oxford, OX2 6GG UK
| | - Christine A’Court
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Woodstock Rd, Oxford, OX2 6GG UK
| | - Sara Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Woodstock Rd, Oxford, OX2 6GG UK
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Ramar P, Ahmed AT, Wang Z, Chawla SS, Suarez MLG, Hickson LJ, Farrell A, Williams AW, Shah ND, Murad MH, Thorsteinsdottir B. Effects of Different Models of Dialysis Care on Patient-Important Outcomes: A Systematic Review and Meta-Analysis. Popul Health Manag 2017; 20:495-505. [PMID: 28332943 DOI: 10.1089/pop.2016.0157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Ongoing payment reform in dialysis necessitates better patient outcomes and lower costs. Suggested improvements to processes of care for maintenance dialysis patients are abundant; however, their impact on patient-important outcomes is unclear. This systematic review included comparative randomized controlled trials or observational studies with no restriction on language, published from 2000 to 2014, involving at least 5 adult dialysis patients who received a minimum of 6 months of follow-up. The effect size was pooled and stratified by intervention strategy (multidisciplinary care [MDC], home dialysis, alternate dialysis settings, and electronic health record implementation). Heterogeneity (I2) was used to assess the variability in study effects related to study differences rather than chance. Of the 1988 articles screened, 25 international studies with 74,833 maintenance dialysis patients were included. Interventions with MDC or home dialysis were associated with a lower mortality (hazard ratio [HR] = 0.72, 95% confidence interval [CI] 0.61, 0.84, I2 = 41.6%; HR = 0.57, 95% CI 0.41, 0.81, I2 = 89.0%; respectively) and hospitalizations (incidence rate ratio [IRR] = 0.68, 95% CI 0.51, 0.91, I2 = NA; IRR = 0.88, 95% CI 0.64, 1.20, I2 = 79.6%; respectively). Alternate dialysis settings also were associated with a reduction in hospitalizations (IRR = 0.41, 95% CI 0.25, 0.69, I2 = 0.0%). This systematic review underscores the importance of multidisciplinary care, and also the value of telemedicine as a means to increase access to providers and enhance outcomes for those dialyzing at home or in alternate settings, including those with limited access to nephrology expertise because of travel distance.
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Affiliation(s)
- Priya Ramar
- 1 Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery , Mayo Clinic, Rochester, Minnesota
| | - Ahmed T Ahmed
- 2 Division of Preventive, Occupational and Aerospace Medicine, Department of Medicine, Mayo Clinic , Rochester, Minnesota.,3 Division of Psychiatry, Department of Psychiatry and Psychology, Mayo Clinic , Rochester, Minnesota
| | - Zhen Wang
- 1 Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery , Mayo Clinic, Rochester, Minnesota.,4 Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic , Rochester, Minnesota
| | - Sagar S Chawla
- 5 Mayo Medical School, Mayo Clinic College of Medicine , Rochester, Minnesota.,6 Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland
| | | | - LaTonya J Hickson
- 1 Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery , Mayo Clinic, Rochester, Minnesota.,7 Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic , Rochester, Minnesota
| | - Ann Farrell
- 8 Mayo Clinic Libraries , Rochester, Minnesota
| | - Amy W Williams
- 7 Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic , Rochester, Minnesota
| | - Nilay D Shah
- 1 Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery , Mayo Clinic, Rochester, Minnesota.,4 Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic , Rochester, Minnesota
| | - M Hassan Murad
- 1 Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery , Mayo Clinic, Rochester, Minnesota.,2 Division of Preventive, Occupational and Aerospace Medicine, Department of Medicine, Mayo Clinic , Rochester, Minnesota
| | - Bjorg Thorsteinsdottir
- 1 Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery , Mayo Clinic, Rochester, Minnesota.,9 Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic , Rochester, Minnesota
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Russo L, Campagna I, Ferretti B, Agricola E, Pandolfi E, Carloni E, D'Ambrosio A, Gesualdo F, Tozzi AE. What drives attitude towards telemedicine among families of pediatric patients? A survey. BMC Pediatr 2017; 17:21. [PMID: 28095894 PMCID: PMC5240275 DOI: 10.1186/s12887-016-0756-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 12/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Telemedicine has been recognized as a way to improve accessibility, quality, and efficiency of care. In view of the introduction of new telemedicine services, we conducted a survey through a self-administered questionnaire among families of children attending the Bambino Gesù Children's Hospital IRCCS, a tertiary care children's hospital located in Rome, Italy. METHODS We investigated sociodemographic data, clinical information, technological profile, attitude towards telemedicine, perceived advantages of telemedicine, fears regarding telemedicine, willingness to use a smartphone app providing telemedicine services and willingness to use a televisit service. Through logistic regression, we explored the effect of sociodemographic and clinical variables and technological profile on willingness of using a telemedicine app and a televisit service. RESULTS We enrolled a total of 751 families. Most patients had a high technological profile, 81% had at least one account on a social network. Whatsapp was the most popular messaging service (76%). Seventy-two percent of patients would use an app for telemedicine services and 65% would perform a televisit. Owning a tablet was associated with both outcome variables - respectively: OR 2.216, 95% CI 1.358-3.616 (app) and OR 2.117, 95% CI 1.415-3.168 (televisit). Kind of hospitalization, diagnosis of a chronic disease, disease severity and distance from the health care center were not associated with the outcome variables. CONCLUSION Families of pediatric patients with different clinical problems are keen to embark in telemedicine programs, independently from severity of disease or chronicity, and of distance from the hospital.
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Affiliation(s)
- Luisa Russo
- Telemedicine Unit, Bambino Gesù Children's Hospital IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Ilaria Campagna
- Telemedicine Unit, Bambino Gesù Children's Hospital IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Beatrice Ferretti
- Telemedicine Unit, Bambino Gesù Children's Hospital IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Eleonora Agricola
- Telemedicine Unit, Bambino Gesù Children's Hospital IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Elisabetta Pandolfi
- Telemedicine Unit, Bambino Gesù Children's Hospital IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Emanuela Carloni
- Telemedicine Unit, Bambino Gesù Children's Hospital IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Angelo D'Ambrosio
- Telemedicine Unit, Bambino Gesù Children's Hospital IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Francesco Gesualdo
- Telemedicine Unit, Bambino Gesù Children's Hospital IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.
| | - Alberto E Tozzi
- Telemedicine Unit, Bambino Gesù Children's Hospital IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
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