Health Professionals' Expectations Versus Experiences of Internet-Based Telemonitoring: Survey Among Heart Failure Clinics

Abstract

BackgroundAlthough telemonitoring is increasingly used in heart failure care, data on expectations, experiences, and organizational implications concerning telemonitoring are rarely addressed, and the optimal profile of patients who can benefit from telemonitoring has yet to be defined.ObjectiveTo assess the actual status of use of telemonitoring and to describe the expectations, experiences, and organizational aspects involved in working with telemonitoring in heart failure in the Netherlands.MethodsIn collaboration with the Netherlands Organization for Applied Scientific Research (TNO), a 19-item survey was sent to all outpatient heart failure clinics in the Netherlands, addressed to cardiologists and heart failure nurses working in the clinics.ResultsOf the 109 heart failure clinics who received a survey, 86 clinics responded (79%). In total, 31 out of 86 (36%) heart failure clinics were using telemonitoring and 12 heart failure clinics (14%) planned to use telemonitoring within one year. The number of heart failure patients receiving telemonitoring generally varied between 10 and 50; although in two clinics more than 75 patients used telemonitoring. The main goals for using telemonitoring are “monitoring physical condition”, “monitoring signs of deterioration” (n=39, 91%), “monitoring treatment” (n=32, 74%), “adjusting medication” (n=24, 56%), and “educating patients” (n=33, 77%). Most patients using telemonitoring were in the New York Heart Association (NYHA) functional classes II (n=19, 61%) and III (n=27, 87%) and were offered the use of the telemonitoring system “as long as needed” or without a time limit. However, the expectations of the use of telemonitoring were not met after implementation. Eight of the 11 items about expectations versus experiences were significantly decreased (P<.001). Health care professionals experienced the most changes related to the use of telemonitoring in their work, in particular with respect to “keeping up with current development” (before 7.2, after 6.8, P=.15), “being innovative” (before 7.0, after 6.1, P=.003), and “better guideline adherence” (before 6.3, after 5.3, P=.005). Strikingly, 20 out of 31 heart failure clinics stated that they were considering using a different telemonitoring system than the system used at the time.ConclusionsOne third of all heart failure clinics surveyed were using telemonitoring as part of their care without any transparent, predefined criteria of user requirements. Prior expectations of telemonitoring were not reflected in actual experiences, possibly leading to disappointment.

Cost-Utility Analysis of the EVOLVO Study on Remote Monitoring for Heart Failure Patients With Implantable Defibrillators: Randomized Controlled Trial

“…Because of increasing patient volumes, routine follow-up contributes a significant burden to already overstrained clinics in terms of time, capital, and human resources required, and to patients and caregivers in terms of travel and time. Remote monitoring allows assessment of device function [3] and patients’ HF-related parameters at home [4], and may represent a safe, effective, and cost-saving way to significantly reduce in-office follow-up visits that are a burden for both hospitals and patients [5]. …”

Health Care Professionals’ Perceptions of Home Telemonitoring in Heart Failure Care: Cross-Sectional Survey (Preprint)

“…In the study of De Vries et al, high expectations for telemonitoring were reported, but HCPs expectations after implementing RTM were not met [1]. This lack of experience with RTM, but at the same time having a positive attitude towards using RTM for patients with HF, places a large responsibility for applying good implementation strategies in the future.…”

“…Remote patient telemonitoring (RTM) is defined as "the remote monitoring of patients including use of audio, video, other telecommunication and electronic information processing to monitor patient status at a distance" [1]. With heart failure (HF) patients, RTM can be used to perform early detection of decompensation at home, prevent unnecessary healthcare utilization, and decrease health care costs [2,3].…”

“…HCPs have an important role in the implementation of RTM in patients care, but until now, their experience with RTM has been studied only in countries with high-technology competency, such as Sweden, Japan and the Netherlands [1,21]. However, RTM is not currently implemented in Sweden and Japan, and only partly in the Netherlands, where insurance and governmental policies are not "friendly" toward implementation.…”

Variability in use of IV nitrates and diuretics in acute HF: a ‘virtual patient’ clinical decision-making study

“…158 Monitoring of fluid accumulation via an implanted device is another approach, but requires further development for routine daily use. 159 A survey of heart failure clinics in the Netherlands showed that telemonitoring did not deliver the anticipated benefits in terms of patient care, reduced workload or lower treatment costs, 160 suggesting that attention should also be paid to how systems are implemented.…”