Patient Adherence to Scheduled Vital Sign Measurements During Home Telemonitoring: Analysis of the Intervention Arm in a Before and After Trial

Abstract

BackgroundIn a home telemonitoring trial, patient adherence with scheduled vital signs measurements is an important aspect that has not been thoroughly studied and for which data in the literature are limited. Levels of adherence have been reported as varying from approximately 40% to 90%, and in most cases, the adherence rate usually dropped off steadily over time. This drop is more evident in the first few weeks or months after the start. Higher adherence rates have been reported for simple types of monitoring and for shorter periods of intervention. If patients do not follow the intended procedure, poorer results than expected may be achieved. Hence, analyzing factors that can influence patient adherence is of great importance.ObjectiveThe goal of the research was to present findings on patient adherence with scheduled vital signs measurements in the recently completed Commonwealth Scientific and Industrial Research Organisation (CSIRO) national trial of home telemonitoring of patients (mean age 70.5 years, SD 9.3 years) with chronic conditions (chronic obstructive pulmonary disease, coronary artery disease, hypertensive diseases, congestive heart failure, diabetes, or asthma) carried out at 5 locations along the east coast of Australia. We investigated the ability of chronically ill patients to carry out a daily schedule of vital signs measurements as part of a chronic disease management care plan over periods exceeding 6 months (302 days, SD 135 days) and explored different levels of adherence for different measurements as a function of age, gender, and supervisory models.MethodsIn this study, 113 patients forming the test arm of a Before and After Control Intervention (BACI) home telemonitoring trial were analyzed. Patients were required to monitor on a daily basis a range of vital signs determined by their chronic condition and comorbidities. Vital signs included noninvasive blood pressure, pulse oximetry, spirometry, electrocardiogram (ECG), blood glucose level, body temperature, and body weight. Adherence was calculated as the number of days during which at least 1 measurement was taken over all days where measurements were scheduled. Different levels of adherence for different measurements, as a function of age, gender, and supervisory models, were analyzed using linear regression and analysis of covariance for a period of 1 year after the intervention.ResultsPatients were monitored on average for 302 (SD 135) days, although some continued beyond 12 months. The overall adherence rate for all measurements was 64.1% (range 59.4% to 68.8%). The adherence rates of patients monitored in hospital settings relative to those monitored in community settings were significantly higher for spirometry (69.3%, range 60.4% to 78.2%, versus 41.0%, range 33.1% to 49.0%, P<.001), body weight (64.5%, range 55.7% to 73.2%, versus 40.5%, range 32.3% to 48.7%, P<.001), and body temperature (66.8%, range 59.7% to 73.9%, versus 55.2%, range 48.4% to 61.9%, P=.03). Adherence with blood glucose measurements (58.1%, range 46.7% t...

Using eHealth to Support COVID-19 Education, Self-Assessment, and Symptom Monitoring in the Netherlands: Observational Study

“…This feedback, however, consisted of generic messages such as “your body temperature is within a safe range” and is something that needs to be tailored to a patient’s specific context. Moreover, measuring body temperature demands some effort and is not as easy to answer than questions like “do you have a runny nose?” or “do you cough?” Using a smart device with sensor data could overcome this barrier [ 18 , 19 ]. The fact that about 700 users reported to be satisfied with the information in the app (mean 8 out of 10 score) and rated the symptom diary with a mean 8 out of 10 score as well demonstrated user’s willingness to participate in this kind of functionality.…”

Home Monitoring of Age-Related Macular Degeneration

“…At-home telemonitoring is a validated method for monitoring disease states across multiple specialties including cardiology, pulmonology, obstetrics, and ophthalmology. 37 , 38 , 39 , 40 , 41 , 42 , 43 , 34 , 35 Despite this, real-world usage of home monitoring devices can be challenging as evidenced by the current dataset.…”

“…Overall, the results of the current study highlight some of the challenges accompanying home monitoring. 37 , 38 , 39 , 40 , 41 , 42 , 43 Telemonitoring strategies range from simple phone calls with health professionals to complex devices like ForeseeHome. Some monitors, like the Holter device and other cardiac monitors, collect data automatically and over short periods of time.…”

Adherence with blood pressure monitoring wearable device among the elderly with hypertension: The case of rural China

“…The accuracy and reliability of the device were validated. Based on previous studies, the monitor was designed to automatically record BP at 1‐hr interval during awake hours (Celler, Argha, Varnfield, & Jayasena, 2018). The BP monitoring system also included a secure online account to track CVD‐related health factors (Figure 2).…”