Assessment of a primary care-based telemonitoring intervention for home care patients with heart failure and chronic lung disease. The TELBIL study

Martín-Lesende, Iñaki; Orruño, Estibalitz; Cairo, Carmen; Bilbao, Amaia; Asúa, José M.; Romo, María I; Vergara, Itziar; Bayón, Juan Carlos; Abad, Roberto; Reviriego, Eva; Larrañaga, Jesús

doi:10.1186/1472-6963-11-56

Cited by 33 publications

(40 citation statements)

References 24 publications

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“…Figure 1 outlines the general study design, showing the flow of patients through the trial. Further details concerning the methodology of the trial can be found in the published study protocol [12]. …”

Section: Methodsmentioning

confidence: 99%

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Impact of telemonitoring home care patients with heart failure or chronic lung disease from primary care on healthcare resource use (the TELBIL study randomised controlled trial)

Martín-Lesende

Orruño

Bilbao

et al. 2013

BMC Health Serv Res

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101

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BackgroundThere is growing evidence that home telemonitoring can be advantageous in societies with increasing prevalence of chronic diseases.The main objective of this study is to evaluate the effect of a primary care-based telemonitoring intervention on the number and length of hospital admissions.MethodsA randomised controlled trial was carried out across 20 health centres in Bilbao (Basque Country, Spain) to assess the impact of home telemonitoring on in-home chronic patients compared with standard care. The study lasted for one year. Fifty-eight in-home patients, diagnosed with heart failure (HF) and/or chronic lung disease (CLD), aged 14 or above and with two or more hospital admissions in the previous year were recruited. The intervention consisted of daily patient self-measurements of respiratory-rate, heart-rate, blood pressure, oxygen saturation, weight, body temperature and the completion of a health status questionnaire using PDAs. Alerts were generated when pre-established thresholds were crossed. The control group (CG) received usual care. The primary outcome measure was the number of hospital admissions that occurred at 12 months post-randomisation. The impact of telemonitoring on the length of hospital stay, use of other healthcare resources and mortality was also explored.ResultsThe intervention group (IG) included 28 patients and the CG 30. Patient baseline characteristics were similar in both groups. Of the 21 intervention patients followed-up for a year, 12 had some admissions (57.1%), compared to 19 of 22 controls (86.4%), being the difference statistically significant (p = 0.033, RR 0.66; 95%CI 0.44 to 0.99). The mean hospital stay was overall 9 days (SD 4.3) in the IG versus 10.7 (SD 11.2) among controls, and for cause-specific admissions 9 (SD 4.5) vs. 11.2 (SD 11.8) days, both without statistical significance (p = 0.891 and 0.927, respectively). Four patients need to be telemonitored for a year to prevent one admission (NNT). There were more telephone contacts in the IG than in the CG (22.6 -SD 16.1- vs. 8.6 -SD 7.2-, p = 0.001), but fewer home nursing visits (15.3 -SD 11.6- vs. 25.4 -SD 26.3-, respectively), though the difference was not statistically significant (p = 0.3603).ConclusionsThis study shows that telemonitoring of in-home patients with HF and/or CLD notably increases the percentage of patients with no hospital admissions and indicates a trend to reduce total and cause-specific hospitalisations and hospital stay. Home telemonitoring can constitute a beneficial alternative mode of healthcare provision for medically unstable elderly patients.Trial registrationCurrent Controlled Trials ISRCTN89041993

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Section: Methodsmentioning

confidence: 99%

“…The trial protocol has been published elsewhere [12]. The main objective of the study was to assess the effect of a primary care-based telemonitoring system on the number and length of hospital admissions in patients with HF and/or CLD at 12 months post-randomisation compared with the standard health care practice.…”

Section: Introductionmentioning

confidence: 99%

Impact of telemonitoring home care patients with heart failure or chronic lung disease from primary care on healthcare resource use (the TELBIL study randomised controlled trial)

Martín-Lesende

Orruño

Bilbao

et al. 2013

BMC Health Serv Res

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101

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“…The present study is part of a home telemonitoring clinical trial (the TELBIL study) conducted across 23 health centres of the Bilbao Primary Health Care Region, Basque Country (Spain) [36]. The health region serves a catchment population of 390,000 people, of whom around 27% are over 60 years old.…”

Section: Methodsmentioning

confidence: 99%

Healthcare professional acceptance of telemonitoring for chronic care patients in primary care

Asúa

Orruño

Reviriego

et al. 2012

BMC Med Inform Decis Mak

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BackgroundA pilot experimentation of a telemonitoring system for chronic care patients is conducted in the Bilbao Primary Care Health Region (Basque Country, Spain). It seems important to understand the factors related to healthcare professionals’ acceptance of this new technology in order to inform its extension to the whole healthcare system.This study aims to examine the psychosocial factors related to telemonitoring acceptance among healthcare professionals and to apply a theory-based instrument.MethodsA validated questionnaire, based on an extension of the Technology Acceptance Model (TAM), was distributed to a total of 605 nurses, general practitioners and paediatricians. Logistic regression analysis was performed to test the theoretical model. Adjusted odds ratios (OR) and their 95% confidence intervals (CI) were computed.ResultsA response rate of 44.3% was achieved. The original TAM model was good at predicting intention to use the telemonitoring system. However, the extended model, that included other theoretical variables, was more powerful. Perceived Usefulness, Compatibility, and Facilitators were the significant predictors of intention. A detailed analysis showed that intention to use telemonitoring was best predicted by healthcare professionals’ beliefs that they would obtain adequate training and technical support and that telemonitoring would require important changes in their practice.ConclusionThe extended TAM explained a significant portion of the variance in healthcare professionals' intention to use a telemonitoring system for chronic care patients in primary care. The perception of facilitators in the organisational context is the most important variable to consider for increasing healthcare professionals’ intention to use the new technology.

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“…344,345 A home telehealth programme for patients with severe COPD, implemented as a cluster RCT in the Madrid region. 346 Home enteral nutrition support for children with chronic diseases across Spain.…”

Section: Box 4 Selected Telecare Pilot Projects In Spainmentioning

confidence: 99%

Outpatient services and primary care: scoping review, substudies and international comparisons

Winpenny

Miani

Pitchforth

et al. 2016

Health Serv Deliv Res

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AimThis study updates a previous scoping review published by the National Institute for Health Research (NIHR) in 2006 (Roland M, McDonald R, Sibbald B.Outpatient Services and Primary Care: A Scoping Review of Research Into Strategies For Improving Outpatient Effectiveness and Efficiency. Southampton: NIHR Trials and Studies Coordinating Centre; 2006) and focuses on strategies to improve the effectiveness and efficiency of outpatient services.Findings from the scoping reviewEvidence from the scoping review suggests that, with appropriate safeguards, training and support, substantial parts of care given in outpatient clinics can be transferred to primary care. This includes additional evidence since our 2006 review which supports general practitioner (GP) follow-up as an alternative to outpatient follow-up appointments, primary medical care of chronic conditions and minor surgery in primary care. Relocating specialists to primary care settings is popular with patients, and increased joint working between specialists and GPs, as suggested in the NHS Five Year Forward View, can be of substantial educational value. However, for these approaches there is very limited information on cost-effectiveness; we do not know whether they increase or reduce overall demand and whether the new models cost more or less than traditional approaches. One promising development is the increasing use of e-mail between GPs and specialists, with some studies suggesting that better communication (including the transmission of results and images) could substantially reduce the need for some referrals.Findings from the substudiesBecause of the limited literature on some areas, we conducted a number of substudies in England. The first was of referral management centres, which have been established to triage and, potentially, divert referrals away from hospitals. These centres encounter practical and administrative challenges and have difficulty getting buy-in from local clinicians. Their effectiveness is uncertain, as is the effect of schemes which provide systematic review of referrals within GP practices. However, the latter appear to have more positive educational value, as shown in our second substudy. We also studied consultants who held contracts with community-based organisations rather than with hospital trusts. Although these posts offer opportunities in terms of breaking down artificial and unhelpful primary–secondary care barriers, they may be constrained by their idiosyncratic nature, a lack of clarity around roles, challenges to professional identity and a lack of opportunities for professional development. Finally, we examined the work done by other countries to reform activity at the primary–secondary care interface. Common approaches included the use of financial mechanisms and incentives, the transfer of work to primary care, the relocation of specialists and the use of guidelines and protocols. With the possible exception of financial incentives, the lack of robust evidence on the effect of these approaches and the contexts in which they were introduced limits the lessons that can be drawn for the English NHS.ConclusionsFor many conditions, high-quality care in the community can be provided and is popular with patients. There is little conclusive evidence on the cost-effectiveness of the provision of more care in the community. In developing new models of care for the NHS, it should not be assumed that community-based care will be cheaper than conventional hospital-based care. Possible reasons care in the community may be more expensive include supply-induced demand and addressing unmet need through new forms of care and through loss of efficiency gained from concentrating services in hospitals. Evidence from this study suggests that further shifts of care into the community can be justified only if (a) high value is given to patient convenience in relation to NHS costs or (b) community care can be provided in a way that reduces overall health-care costs. However, reconfigurations of services are often introduced without adequate evaluation and it is important that new NHS initiatives should collect data to show whether or not they have added value, and improved quality and patient and staff experience.FundingThe NIHR Health Services and Delivery Research programme.

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Assessment of a primary care-based telemonitoring intervention for home care patients with heart failure and chronic lung disease. The TELBIL study

Cited by 33 publications

References 24 publications

Impact of telemonitoring home care patients with heart failure or chronic lung disease from primary care on healthcare resource use (the TELBIL study randomised controlled trial)

Impact of telemonitoring home care patients with heart failure or chronic lung disease from primary care on healthcare resource use (the TELBIL study randomised controlled trial)

Healthcare professional acceptance of telemonitoring for chronic care patients in primary care

Outpatient services and primary care: scoping review, substudies and international comparisons

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