Original Title: Evaluación e impacto de una intervención de telemonitorización en pacientes domiciliarios con insuficiencia cardiaca o broncopatía crónica controlada desde la atención primaria. Ensayo clínico aleatorizado. Estudio TELBIL

Authors' objectives: The main aim of this study was to determine the impact of a home telemonitoring intervention on the number of hospital admissions and the length of hospital stay, compared to the usual care in home care patients with heart failure (HF) and/or chronic lung disease (CLD) (chronic obstructive pulmonary disease – COPD- in 78.6% of cases, although other diseases such as, asthma, restrictive síndrome, pneumoconiosis or pulmonary hypertension were also considered). The effect of telemonitoring on the use of other healthcare resources (i.e., emergency department attendances, visits to primary care doctors, visits to specialists, home visits and telephone contacts) was also explored together with the evaluation of the impact on the quality of life and mortality, adherence to telemonitoring and the level of satisfaction of patients/caregivers and healthcare professionals with the new technology.

Authors' results and conclusions: Fifty-eight patients were recruited; 28 were assigned to the IG and 30 to the CG. Forty-three patients completed the 12-month follow-up, 21 from the IG (3 of the remaining patients died, 3 abandoned the trial and 1 was institutionalized) and 22 from the CG (the 8 remaining patients died). The average age was 81 (SD 7.5) years; 41% were women and 10% lived alone and in 45% of cases patients were cared for by spouses/partners. In 30% of cases patients had HF, in 26% CLD and in 46% patients had both diseases simultaneously. Fifty-two percent of patients received oxygen therapy in the home, 86% showed some comorbidity and 98% complied adequately with the prescribed therapy. At 12 months of follow-up, 9 patients in the IG had no hospital admissions at all, compared to 3 in the CG, p=0.033; the relative risk (IG vs CG) of having at least one hospital admission due any cause was 0.66 (IC 95%: 0.44 to 0.99), and 0.74 (IC 95%: 0.48 to 1.14) for specific admissions. The average hospital stay was lower in the IG, being of 9 days (SD 4.3) compared to 10.7 and of 9 days (SD 4.5) compared to 11.2, for all-cause and specific admissions, respectively. With regard to the use of health resources, in the IG, the average number of telephone contacts per patient was 22.8 compared to 8.6 in the CG, p=0.001. On the other hand, there was a decrease in the number of nursing home visits in the IG (15.3 contacts per patient in the IG compared to 25.4 in the CG), although without significant statistical difference. Conclusions The results of the TELBIL study show that primary care-based telemonitoring increases the percentage of in-home patients with no hospital admissions after 12 months of follow-up. The study also shows a trend to reduce total and cause-specific hospitalisations and hospital stay. With regard to the use of healthcare resources, this study shows that telemonitoring leads to a significant increase in the number of telephone contacts between healthcare professionals and patients, but this is balanced by a decrease in the use of other healthcare services provided by primary care health centres, particularly, home nursing visits. The present investigation demonstrates the feasibility of this mode of healthcare provision in elderly patients with high levels of comorbidity and limited computer literacy.

Authors' methods: A randomised controlled trial with a one-year follow-up was carried out at 20 Primary Healthcare Centres in the Bilbao region (Bizkaia) in order to assess the impact of a telemonitoring intervention on in-home patients with HF and/or CLD, compared to usual healthcare practice. Patients taking part in the study fulfilled the following inclusion criteria: home care patients, aged 14 or above, diagnosed with HF and/or CLD, with two or more hospital admissions in the previous year. In addition to the usual care, the intervention group (IG) was followedup through by telemonitoring, which consisted of daily transmissions from the patients’ homes of the following self-measured clinical parameters using a smart phone-personal digital assistant (PDA) with the help of the caregivers: blood oxygen saturation, blood pressure, heart and respiratory rates, body weight and temperature. Additionally, patients completed a brief health status questionnaire aimed at assessing the patient’s perception of his/her medical and functional condition. The questionnaire also contained items concerning compliance with medication and diet. All data were stored on a Web-based platform and were accessible by health professionals (GPs and nurses) during business hours from Monday to Friday. When the measurements fell outside the established limits, alerts were triggered via the PDA terminal and the clinical staff acted according to the medical condition of the patient. In the control group (CG), patients received only usual care, consisting of regular medical examinations in line with the established programmes for monitoring home-based patients. The primary outcome measure was the number of hospital admissions that occurred in a period of 12 months post-randomisation. Secondary outcome measures included the length of hospital stay (number of bed-days for emergency admissions with a primary diagnosis of HF, CLD and other causes during 12 months after randomisation), mortality rates, impact on quality of life, telemonitoring compliance, patient and professional satisfaction with the new procedure and the effect on the use of other healthcare resources (emergency department attendances, home visits, appointments at the health centres and with the specialists and telephone calls). The data obtained were analysed at 3, 6 and 12 months post-randomisation. The primary and secondary outcome measures in both groups of patients were compared to determine statistically significant differences. The Student’s t-test and the non-parametric Wilcoxon test were used for the comparison of quantitative variables for normally and non-normally distributed data, respectively. For the comparison of categorical variables, the Chisquare or Fisher’s exact test were used. The level of statistical significance was set at p

Project Status: Completed

Year Published: 2013

URL for published report: https://www.euskadi.eus/contenidos/informacion/2013_osteba_publicacion/es_def/adjuntos/INTERVENCION%20DE%20TELEMONITORIZACION.pdf

English language abstract: An English language summary is available

Publication Type: Other

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: Osteba (Basque Office for Health Technology Assessment) Health Department of the Basque Government