Should we invest in telemonitoring?

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Ernest Barrett
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Should we invest in telemonitoring? CCNAP Copenhagen 16 March 2012 j.

1 Should we invest in telemonitoring? CCNAP Copenhagen 16 March 2012 No declarations of interest to declare

2 Presentation What is TM and why should we invest in TM? Kind of methods TM and several disease Study reports Review results Summary

3 Why should we invest in telemonitoring? Increasing number of chronically ill patients in combination with a decreasing number of caregivers Increased awareness of illness Changing health care: patients get more responsibility and increased participation

4 Changing health care? Old model of care New model Focus on acute conditions Focus on long term conditions Reactive management Prevention & continuing care Hospital centred Embedded in homes & communities Disjointed episodes Integrated with people s lives Doctor dependent Team based, shared record Patient as passive recipient Patient as partner Self care infrequent Self care encouraged & supported Use of ICT rare Dependent on ICT & devices

5 Telemonitoring Telecare - Structured Telephone Support (STS).. Components Patient Care provider Distance Tool / device (in- or external) Briefly: telehealth is the remote care delivery or monitoring between a healthcare provider and a patient.

6 Systems in detail.. External Telemonitoring: wireless transfer of clinical data as weight, blood pressure, heart rhythm, pulse, oxygen etc. Structured telephone support: daily information about complaints, with or without clinical data (not necessarily wireless) / education Internal Pace maker device with intra-thoracic impedance monitoring

8 The Whole System demonstrator - study The WSD programme was launched in May 2008 Largest randomised control trial of Telehealth and Telecare in the world 6,191 patients and 238 GP practices across three sites Newham, Kent and Cornwall 3,030 people with one of three conditions (diabetes, heart failure and COPD) were included in the Telehealth trial. 45% reduction in mortality rates 20% reduction in emergency admissions 15% reduction in visits 14% reduction in elective admissions 14% reduction in bed days 8% reduction in tariff costs Unpublished data of the WHOLE-study

9 Outcomes 85% of patients agreed or strongly agreed that the Telehealth service had helped them understand their condition. 88% of patients agreed or strongly agreed that it had helped them cope with their symptoms. 81% of patients agreed or strongly agreed that the Telehealth service had helped to reduce anxiety.

10 Hypertension

11 Telemonitoring in hypertension 24 GP in UK, 480 patients y

12 Results: Tasminh study TM UC Differ P-value SBP After 6 months SBP after 12 months

13 Review: Telemonitoring in hypertension 12 studies Mean age 60.4 Systolic BP MD 5.64 mmhg (p<0.001) Diastolic BP MD 2.78 mmhg (p<0.001) Use of TM increased AHD-therapy (p<0.001) Problem of this meta analysis: Heterogeneity (p<0.001) which complicates hard conclusions Large scale RCT are needed to clearly show the usefulness of BP home TM Omboni & Guarda Am j of hypertension 24:9

14 Heart Failure

15 Names Telemonitoring (STS) in heart failure

16 STS in heart failure Mean age 72y, 60% male, 57% NYHA class 2 PE: admission for HF: Statistical ns (p=0,151) 44% less first admissions for heart failure 66% less re-admissions for heart failure Significant less face-to-face contact with HFN Improved level of knowledge and self-care Improved compliance for weighing and fluid intake No effects on all cause admission & mortality J.Boyne e.a. The Tehaf-study: article submitted

17 HF review (1) 25 studies (11TM, 16STS) TM all-cause mortality RR P HF related admissions RR P STS all-cause mortality RR P 0.08 HF related admissions RR P Ingliss e.a. European Journal of Heart Failure (2011) 13,

18 HF-Review (2) 13 studies (no distinction between STS & TM) Clarke e.a. Journal of Telemedicine and telecare 2011;17:17-24

19 Clarke e.a. Journal of Telemedicine and telecare 2011;17:17-24

20 Clarke e.a.journal of Telemedicine and telecare 2011;17:17-24

21 Pace maker with optivol function

22 Intrathoracic impedance measurement Mean age 64y, 86% male, 57% NYHA class 2 40% more admissions for heart failure 58% admissions for HF without optivol alert 66% more f2f contacts with caregivers 35% more cv hospitalisations Prematurely termination of the study DJ Veldhuisen e.a:the DOT-HF study:circulation 2011;124:

23 Review Thoracic impedance Some studies show promising results in terms of improving outcomes, however evidence shows controversial results Implantable hemodynamic monitoring is still investigational on this moment Hassan & Paul European Heart Journal (2011) 32,

24 Quality of life

25 Review QOL 21 studies (1) 5 studies reported a better QoL, higher satisfaction or higher adherence to drug treatment 7 studies reported no significant differences between groups in QoL and patient satisfaction 13 studies included (2) 8 studies with improved QOL (4 ns) Improved knowledge level (1) 6 studies cost effectiveness (4 reduced costs) High level of acceptance (96-98%) (1) Polisena e.a. J Telemed telecare 2010;16(2):68-76 (2) Clarke e.a.journal of Telemedicine and telecare 2011;17:17-24

26 Summary TM-studies mostly show positive effects or a positive trend for mortality and hf-admissions, costs and disease specific knowledge. No effects on cardiovascular and all cause admissions Changeable effects QOL Nothing was found about the best fitting device for an individual patient

28 What is essential to implement telecare? Both health care professionals and patients need to - see telemonitoring as appropriate - see telemonitoring as advantageous to them - be able to change their working practice and organisation of care

29 Any questions? Thank you for your attention

LIVE WEBINAR Boston Scientific External Use. Show and Distribute CRM AA-June 2017

LIVE WEBINAR Boston Scientific External Use. Show and Distribute CRM AA-June 2017 LIVE WEBINAR www.hf-channel.com 1 LIVE WEBINAR AGENDA 2 The use of diagnostics in the management of HF Patients Prof. Martin Cowie 3 The patient journey is complex 4 Remote monitoring Initially, telephone