Original Title: Telemonitorización de pacientes pluripatológicos con enfermedad cardiaca o respiratoria. Evaluación de su implantación en Atención Primaria

Authors' objectives: To evaluate the impact of a primary care-based telemonitoring intervention coupled with improvements in health professionals´ performance for the follow-up and management of multi-pathological patients with heart or lung disease, with difficulty to access the health services, under real implementation conditions.

Authors' recommendations: Forty two patients participated in the study, 28 of whom completed the 12-month follow-up. The mean age was 78.86 years (SD 7.52), 57.76% were women, and in 97.6% of cases a family member was responsible for the patient´s care. The inclusion disease was: chronic lung disease (23.81%), heart failure (14.29%) and both conditions simultaneously (57.14%). The remaining 5% of patients was selected for other pathologies in addition to chronic lung disease. There were no statistically significant differences in the baseline data among patients coming from the TELBIL study (previous telemonitoring RCT) and newly-recruited patients. Likewise, both patient groups showed a similar progression. The before-and-after analysis showed that the total hospital admissions decreased significantly from 2.57 (SD 1.62) to 1.07 (SD 1.49) during the 12-month follow-up period. The specific hospital admissions fell from 1.86 (SD 1.21) to 0.61 (SD 1.20), being such a difference statistically significant. The study also shows a trend to reduce hospital stay by 3.45 days compared to the pre-telemonitoring period, although this difference was not statistically significant (p=0.074). The average number of visits decreased from 4.25 (SD 2.59) to 2.11 (SD 2.61) over the 12 months of telemonitoring (p˂0.001). Telemonitoring had no effect on patients’ functional capacity or health-related quality of life (HRQOL). Patients, caregivers and health professionals showed high levels of satisfaction with the telemonitoring system used in the study. Conclusions The TELBIL-A study shows that, for patients with similar characteristics to the ones recruited for the present study, integration of telemonitoring in routine clinical practice is feasible and has the potential to reduce hospital admissions, length of hospital stays and visits to hospital emergency services, in a manner that is a highly satisfactory for both patients and health professionals. Home telemonitoring is emerging as a beneficial alternative care-provision model for elderly patients with chronic multiple comorbidities.

Authors' methods: We carried out a before-and-after study with aone-year follow-up period. Inclusion criteria were: patients with heart failure and/or chronic lung disease (mostly chronic obstructive pulmonary disease, COPD) or patients with other comorbidities which caused relevant dependency for the basic activities of daily living, aged 14 or above, who have difficulty in accessing health services outside the home, and had two or more hospital admissions in the previous year with at least one related to the medical conditions under study. Telemonitoring consisted of daily transmissions of selected selfmeasured clinical parameters (i.e., respiratory-rate, heart-rate, blood-pressure, oxygen-saturation, weight and temperature) depending on the clinical condition of each patient and a brief clinical, medication and dietary questionnaire. All health professionals involved in patient care had access to the Web platform. Alerts were triggered when recorded values fell outside established limits which led to appropriate clinical actions being taken by the health professionals involved in the care of the patient. The thresholds of the clinical parameters were established in a dynamic and individualised way for each patient. The main outcome measure was the number of (total and specific) hospital admissions that occurred during the 12 months before and after the start of the study. Secondary outcome measures included: the length of hospital stay, the number of emergency department visits, the effect on functional status and quality of life, and the acceptance of the intervention by both, patients and health professionals. The data obtained were analysed at 4, 8 and 12 months after the start of the study. Primary and secondary outcome measures were analysed in order to determine whether there were significant differences in patient status compared to the previous year, using a before-and-after analysis. For variables related to total and specific hospital admissions, length of hospital stay and visits to the emergency services, the before-and-after analysis was performed using the parametric t-test for related samples and the non-parametric Wilcoxon signed-rank test, for normally and non-normally distributed data, respectively. For functional status and quality of life (visual analogue scale –VAS- and utility index) results, a one-way repeated measures ANOVA was performed instead of a before-and-after analysis. A significance level of 5% was considered.

Project Status: Completed

Year Published: 2015

URL for published report: https://www.ogasun.ejgv.euskadi.eus/r51-catpub/es/k75aWebPublicacionesWar/k75aObtenerPublicacionDigitalServlet?R01HNoPortal=true&N_LIBR=051619&N_EDIC=0001&C_IDIOM=es&FORMATO=.pdf

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: Spain

Organisation Name: Basque Office for Health Technology Assessment

Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz

Contact Name: Lorea Galnares-Cordero

Contact Email: lgalnares@bioef.eus

Copyright: <p>Osteba (Basque Office for Health Technology Assessment) Health Department of the Basque Government</p>