A prospective evaluation of telemonitoring use by seniors with chronic heart failure: Adoption, self-care, and empowerment

Jaana, Mirou; Sherrard, Heather; Paré, Guy

doi:10.1177/1460458218799458

Cited by 28 publications

(28 citation statements)

References 34 publications

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“…More recently, Risling et al [ 15 ] found that patients in a digital study identified the relational and informational elements of empowerment and recommended that these key areas should shape the focus of the evolution of patient empowerment in digital research. Telemonitoring has been found to be effective as a confidence, decision-making, and self-care enhancer in older persons with chronic heart failure [ 16 , 17 ]. Telemonitoring surveillance systems have left patients with feelings of greater self-control, heightened motivation for lifestyle changes, and improved quality of life [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

Patient Empowerment Using Electronic Telemonitoring With Telephone Support in the Transition to Insulin Therapy in Adults With Type 2 Diabetes: Observational, Pre-Post, Mixed Methods Study

McGloin¹,

O'Connell²,

Glacken³

et al. 2020

J Med Internet Res

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Background Initiation of insulin therapy for the management of type 2 diabetes can be an unwelcome and distressful development for patients. Current evidence suggests that telemonitoring can help improve glycemic control in type 2 diabetes and can support empowerment to self-manage diabetes. This telemonitoring intervention was underpinned by an empowerment approach. Objective This study aimed to evaluate the clinical effectiveness and feasibility and the patients’ and health care providers’ experiences of a 12-week telemonitoring intervention with telephone support for patients commencing insulin therapy. This paper focuses on the impact on patient empowerment. Methods An observational, pre-post, multimethod, and triangulation design was employed to study a 12-week automated electronic telemonitoring intervention with telephone support from a diabetes clinical nurse specialist (CNS). Forty patients were recruited from the clinic as they were about to commence insulin therapy. In the quantitative arm, biometric data (hemoglobin A1c [HbA1c] and weight) and psychosocial data (diabetes empowerment scale [DES] scores and diabetes distress scale [DDS] scores) were gathered by the research team at baseline (T1), the end of the intervention (T2), and 3 months postintervention (T3). Data on hospital admission and general practitioner (GP) visits were collected for the duration of the study. In the qualitative arm, separate focus group interviews were conducted with the CNS team supporting the intervention (n=2) and patients (n=16). Results Of 39 patients who completed the intervention, 23 (59%) were male. The mean age of the sample was 62.4 years (range 37-80 years). The mean HbA1c (mmol/mol) decreased significantly between T1 and T2 (mean difference [MD] −17.13; P<.001) and T1 and T3 (MD −18.16; P<.001), with no significant impact on weight. In the focus groups, patients reported an increased awareness to self-manage diabetes and feelings of safety and comfort. There were 13% (5/39) of patients who had hypoglycemia on two or more occasions. A significant increase in the mean DES score occurred between T1 and T2 (MD 0.62; P=.001) and T1 and T3 (MD 0.72; P<.001). The mean DDS score decreased between T1 and T2 (MD −0.64; P=.002) and T1 and T3 (MD −0.6; P=.002). The mean patient satisfaction with the intervention was above 4 out of possible 5 on all items on the Telemedicine Satisfaction and Usefulness Questionnaire. We observed a reduction in diabetes clinic attendances and GP visits. A significant increase in workload was reported by the CNS team. Conclusions This intervention had an empowering effect for patients in the self-management of type 2 diabetes and has the potential to meet the need for safer and more effective care in insulin initiation in the community setting. We observed a significant increase in workload for health care staff. Telemonitoring needs to be streamlined with health care delivery and accompanied by adequate support services.

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Section: Introductionmentioning

confidence: 99%

Patient Empowerment Using Electronic Telemonitoring With Telephone Support in the Transition to Insulin Therapy in Adults With Type 2 Diabetes: Observational, Pre-Post, Mixed Methods Study

McGloin¹,

O'Connell²,

Glacken³

et al. 2020

J Med Internet Res

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“…Yet, patients performed less self-care maintenance activities, and the capability of involvement in the decision-making related to their condition decreased. 29 Despite the increasing confidence of patients in identifying and evaluating their own symptoms, self-care behaviors have been reduced. The reasons for this can be a small sample size (23 patients) and a lack of control group.…”

Section: Enrollmentmentioning

confidence: 99%

Evaluating the Effect of Monitoring through Telephone (Tele-Monitoring) on Self-Care Behaviors and Readmission of Patients with Heart Failure after Discharge

et al. 2019

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Background Heart failure is one of the serious cardiovascular diseases, which poses a global pandemic and places a heavy burden on health care systems worldwide. The incidence of this disease in Iran is higher than in other Asian countries. To reduce patients' complications, readmission rates, and health care expenditures, it is necessary to design interventions, which are culturally appropriate and based on community needs. Methods In 2016, a randomized clinical trial (IRCT2017010731804N1) was initiated to compare tailored tele-monitoring intervention with usual care. In total, 80 patients completed the study after a follow-up period of 8 weeks. The primary end point was heart failure self-care, which was measured using the Iranian version of the European Heart Failure self-care questionnaire. Secondary end points were heart failure related readmission rates. Results The mean scores for self-care behaviors of the two groups showed significant difference at the baseline (p = 0.045). The results of the analysis of covariance that was used to control the differences in the pretest scores of self-care behaviors showed that the difference between both groups after the intervention was still significant (p < 0.001). The percentage of patients' readmissions in the intervention group (20%) was less than that in the control group (42.2%); however, the results were not statistically significant (p = 0/066). Conclusion This study showed that tele-monitoring improved self-care behaviors in Iranian patients with heart failure but did not reduce their readmission rates.

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“…Various studies have reported the effectiveness of telemonitoring in reducing mortality, [2][3][4] hospitalizations and emergency department visits, 4,5 as well as improving patient perceived quality of life, 6 evidence-based prescribing and overall management of disease. 7,8 While the effectiveness of home telemonitoring on clinical outcomes and health care costs have been widely explored, the evaluation of home telemonitoring has been expanded to include user experience, 9,10 perceived impact and organizational analysis. 2,11 Telemonitoring does not just "work" or "not work" 12 as the success of telemonitoring depends on many factors, including organization of the telemonitoring program, technology complexity, patients' compliance, and how clinicians and patients are engaged.…”

Section: Introductionmentioning

confidence: 99%

Home telemonitoring for chronic disease management: Perceptions of users and factors influencing adoption

Li¹,

Varnfield²,

Jayasena

et al. 2021

Health Informatics J

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Home telemonitoring has been used as a solution to support the care of individuals living with chronic disease. While effectiveness of telemonitoring have been widely studied, more research is needed to understand the perceptions among patients and clinicians in incorporating telemonitoring into their daily routine and practices. This paper presents an investigation of patients’ and clinicians’ experiences in a care augmenting telemonitoring service, their perceived impact delivered through the service, and clinicians’ perceptions on how the service was introduced in their organizations. This work was embedded in a large multi-site trial of home telemonitoring using a mixed method approach for evaluation. Interviews with clinicians involved in the study were conducted at multiple time points during the trial. Questionnaires were administered to clinicians and patients at the end of the trial. Results showed that both patients and clinicians recognized the benefits of patient empowerment through telemonitoring, and patient-clinician interactions. Results identified the needs of a dedicated telemonitoring clinical care coordinator role, guidelines that translate telemonitoring services into clinical pathways and engagement of different healthcare providers, especially general practitioners, to support the integration of telemonitoring into chronic disease management programs and long-term organizational strategic plans.

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A prospective evaluation of telemonitoring use by seniors with chronic heart failure: Adoption, self-care, and empowerment

Cited by 28 publications

References 34 publications

Patient Empowerment Using Electronic Telemonitoring With Telephone Support in the Transition to Insulin Therapy in Adults With Type 2 Diabetes: Observational, Pre-Post, Mixed Methods Study

Patient Empowerment Using Electronic Telemonitoring With Telephone Support in the Transition to Insulin Therapy in Adults With Type 2 Diabetes: Observational, Pre-Post, Mixed Methods Study

Evaluating the Effect of Monitoring through Telephone (Tele-Monitoring) on Self-Care Behaviors and Readmission of Patients with Heart Failure after Discharge

Home telemonitoring for chronic disease management: Perceptions of users and factors influencing adoption

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