Personalised telehealth intervention for chronic disease management: A pilot randomised controlled trial

Abstract

Introduction

The aim of this study was to assess the impact of home-based telehealth monitoring on health outcomes, quality of life and costs over 12 months for patients with diabetes and/or chronic obstructive pulmonary disease (COPD) who were identified as being at high risk of readmission to hospital.

Methods

This pilot study was a randomised controlled trial combined with an economic analysis to examine the outcomes of standard care versus home-based telehealth for people with diabetes and/or COPD who were at risk of hospital readmission within one year. The primary outcomes were (i) hospital admission and length of stay (LOS); and (ii) health-related quality of life (HRQOL); and the secondary outcomes were (i) health-related clinical outcomes; (ii) anxiety and depression scores; and (iii) health literacy. The costs of the intervention and hospitalisations were included.

Results

A total of 86 and 85 participants were randomised to the intervention and control groups respectively. The difference between groups in hospital LOS was –3.89 (95% confidence interval (CI): –9.40, 1.62) days, and for HRQOL, 0.09 (95% CI: 0.05, 0.14) in favour of the telehealth monitoring group. There was a saving of AUD$6553 (95% CI: –12145, –961) in the cost of hospitalisation over 12 months, which offset the increased cost of tele-monitoring. The intervention group showed an improvement in anxiety, depression and health literacy at 12 months, and in the diabetes group, a reduction in microalbuminuria.

Discussion

The telehealth monitoring intervention improved patient's health outcomes and quality of life at no additional cost.

Keywords

Cost analysis cost-effectiveness home telecare telecare telehealth

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References

Leppin

Gionfriddo

Kessler

et al.

Preventing 30-day hospital readmissions: a systematic review and meta-analysis of randomized trials. JAMA Intern Med 2014; 174: 1095–1107.

Clarke

Currie

. Depression, anxiety and their relationship with chronic diseases: a review of the epidemiology, risk and treatment evidence. Med J Aust 2009; 190(7): pS54–pS60.

Bashshur

Shannon

Smith

et al.

The empirical foundations of telemedicine interventions for chronic disease management. Telemed J E Health 2014; 20: 769–800.

Wootton

. Twenty years of telemedicine in chronic disease management–an evidence synthesis. J Telemed Telecare 2012; 18: 211–220.

Celler

Lovell

Basilakis

. Using information technology to improve the management of chronic disease. Med J Aust 2003; 179: 242–246.

Deakin University. Centre for Pattern Recognition and Data Analytics (PRaDA), http://www.deakin.edu.au/research/prada (2015, accessed 15 November 2017).

TELUS Health. Remote patient monitoring, https://www.telushealth.co/#_ga=2.201928465.1807012878.1502158210-31777883.1502158210 (2017, accessed 17 October 2017).

StataCorp. Stata Statistical Software: Release 14.2, http://www.stata.com/stata14/ (2017, accessed 12 November 2017).

The Assessment of Quality of Life. AQoL-8D, http://www.aqol.com.au/choice-of-aqol-instrument/58.html (2014, accessed 10 October 2017).

10.

Darkins

Ryan

Kobb

et al.

Care coordination/home telehealth: the systematic implementation of health informatics, home telehealth, and disease management to support the care of veteran patients with chronic conditions. Telemed J E Health 2008; 14: 1118–1126.

11.

De San Miguel

Smith

Lewin

. Telehealth remote monitoring for community-dwelling older adults with chronic obstructive pulmonary disease. Telemed J E Health 2013; 19: 652–657.

12.

Paré

Sicotte

St.-Jules

et al.

Cost-minimization analysis of a telehomecare program for patients with chronic obstructive pulmonary disease. Telemed J E Health 2006; 12: 114–121.

13.

Cruz

Brooks

Marques

. Home telemonitoring effectiveness in COPD: a systematic review. Int J Clin Pract 2014; 68: 369–378.

14.

Balk

Leenders

Davidse

et al.

275 Personalized tele-guidance of heart failure patients. Effects of the MOTIVA interactive health care platform on hospital admissions, quality of life, knowledge of disease and self-care. A pilot study. Eur J Heart Fail 2007; 6: 56–56.

15.

Cartwright

Hirani

Rixon

et al.

Effect of telehealth on quality of life and psychological outcomes over 12 months (Whole Systems Demonstrator telehealth questionnaire study): nested study of patient reported outcomes in a pragmatic, cluster randomised controlled trial. BMJ 2013; 346: f653.

16.

Williams

Baker

Parker

et al.

Relationship of functional health literacy to patients' knowledge of their chronic disease: A study of patients with hypertension and diabetes. Arch Intern Med 1998; 158: 166–172.

17.

Zamora

HCE

. Health literacy among older adults: a systematic literature review. J Gerontol Nurs 2011; 37: 41–51.

18.

MacIsaac

Ekinci

Jerums

. Progressive diabetic nephropathy. How useful is microalbuminuria?: contra. Kidney Int 2014; 86: 50–57.

19.

Parving

H-H

Persson

Rossing

. Microalbuminuria: a parameter that has changed diabetes care. Diabetes Res Clin Pract 2015; 107: 1–8.

20.

Gross

de Azevedo

Silveiro

et al.

Diabetic nephropathy: diagnosis, prevention, and treatment. Diabetes Care 2005; 28: 164–176.

21.

Osborne

Elsworth

Whitfield

. The Health Education Impact Questionnaire (heiQ): an outcomes and evaluation measure for patient education and self-management interventions for people with chronic conditions. Patient Educ Couns 2007; 66: 192–201.

22.

Spitzer

Kroenke

Williams

et al.

A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 2006; 166: 1092–1097.

23.

Kroenke

Spitzer

Williams

. The PHQ-9. J Gen Intern Med 2001; 16: 606–613.

24.

Agency Medical Directors' Group. The Patient Health Questionnaire (PHQ-9) – overview, http://www.agencymeddirectors.wa.gov/files/AssessmentTools/14-PHQ-9%20overview.pdf (2015, accessed 25 October 2017).

25.

Schrover

Evans

Giugliani

et al.

Minimal clinically important difference for the 6-min walk test: literature review and application to Morquio A syndrome. Orphanet J Rare Dis 2017; 12: 78.

26.

O'Driscoll

Howard

Davison

. BTS guideline for emergency oxygen use in adult patients. Thorax 2008; 63: vi1–vi68.

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