A comparison of in-person home care, home care with telephone contact and home care with telemonitoring for disease management

Abstract

SummaryWe compared the effects of evidence-based disease management guidelines delivered to patients with heart failure and diabetes using three different modalities: in-person visits alone (Control), inperson visits and a telephone intervention (Telephone), and in-person visits and telemonitoring (Telemonitoring). Patients were randomized to the three groups. There were 112 patients in the Control group, 93 in the Telephone group and 98 in the Telemonitoring group. During the first 60 days, 10% of the Control group were rehospitalized, 17% of the Telephone group and 16% of the Telemonitoring group. Having heart failure and receiving more in-person visits were significantly related to readmission and time to readmission. However, after adjusting for diagnosis and visits, the differences between the three groups were non-significant. There was a trend for increased risk of readmission for the Telephone group compared to Control alone (P= 0.07, risk ratio 2.2, 95% CI: 0.9 to 5.2) and for readmission sooner (P=0.02, risk ratio 2.3, 95% CI: 1.2 to 4.6). Patient rehospitalization and emergency department visit rates were lower than the national average, making it difficult to detect a difference between groups. Previous rehospitalization was a consistent predictor of those who were rehospitalized, suggesting that it may be a useful indicator for identifying patients likely to need additional attention.

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“…Os sistemas podem ser somente de formação de arquivo ou resposta não imediata ou imediata. Estudos utilizando estratégias não invasivas de telemonitoramento não têm demonstrado benefício quanto à mortalidade, tendo dois estudos incluído número elevado de pacientes (Tele-HF com 1.653 e TIM-HF com 710 pacientes) [35][36][37] . A baixa adesão pode ter contribuído para os resultados neutros.…”

Business models for telemedicine services: a literature review

“…Remote observation of a patient's condition has been acknowledged particularly in the management of chronic diseases to improve the quality of healthcare, reduce hospitalization and emergency visits (Scherr et al, 2009;Mortara et al, 2009;Takahashi et al, 2010;Bowles et al, 2009;Winkler et al, 2010;Martin-Lesende et al, 2011;Seto et al, 2012;Baig et al, 2013;Chronaki and Vardas, 2013).…”

Cuidado de enfermagem no domicílio ao paciente com insuficiência cardíaca: revisão integrativa Nursing care at home patient with heart failure: integrative review

“…17 The nursing care at home is oriented for the improvement of patient's functional status, with the purpose to maintain his/her Independence and avoid unnecessary hospital admissions. 17,18,25 Obstacles to the full care and proposals for more quality in care…”

“…17,18 A comparative study between home visits strategies, patient follow-up through phone calls and remote monitoring showed better results of the visits as regards the behavior change in health by the patients. 25 Another study also mentions improvement in self-care as a result of home care.…”