As the aging population grows and as chronic diseases become increasingly prevalent, healthcare must be accessible beyond hospital walls. Patients living with chronic diseases are often not hospital bound. They can, and typically prefer to, live at home. The boundaries of healthcare must adapt to care for these individuals.
Telemonitoring is Breaking Boundaries
Telemonitoring allows healthcare to answer the call for more widespread care. Many chronic diseases can be effectively managed with telehealth. Telemonitoring programs permit high quality home supervision and therefore limit the increased risk of hospitalization that often accompanies chronic disease. As a result, the patients experience improved outcomes and the healthcare system makes more effective use of its resources.
A Novel Approach to Telehealth Research
A recent study out of Spain examined the effectiveness of a primary care telemonitoring program among patients with a variety of chronic diseases, such as diabetes, high blood pressure, heart failure, and/or COPD. This study takes a novel approach to telehealth research, as it measures a diverse group of patients as opposed to narrowing in on a specific disease population. As a result, the study participants are more representative of patients who are present in everyday clinical practice settings.
The main aim of the study was to evaluate the influence of the program on patients with a wide range of chronic conditions who are at increased risk of emergency visits or hospital readmissions. The program was used across four health centers in Spain and was modeled on progressive chronic care models that take a preventative approach to healthcare, like the Kaiser Permanente model.
Through their participation in the telemonitoring program, patients were expected to measure their vital signs, which were automatically added to their records via a wireless tablet. Patients used biometric monitoring devices that were specific to their conditions, such as scales, blood pressure cuffs, glucometers, and pulse oximeters.
When patients presented with unusual or high risk patterns, an automated alert system was used to engage clinicians to ensure an appropriate response. Additionally, the study participants also received health education about their condition(s) through educational videos on their tablets.
The Results Are in: Telemedicine in Primary Care is Effective
Patient data was collected before and after one year of telehealth intervention. The researchers gathered information on the heart rate of the patients, the proportion of patients with high and poorly controlled blood pressure ( ≥ 140 mmHg systolic and/or ≥ 90 mmHg diastolic), and the proportion of patients with poorly controlled diabetes (HbA1c ≥ 8%).
In addition to measuring changes in biometric data, the researchers tracked utilization of primary care or hospital based services as a result of disease exacerbation. They also recorded ER admissions.
After one year of telehealth intervention, the patients in the study presented with significant weight loss, lower blood pressure, and improved HbA1c levels. The number of patients with high systolic blood pressure dropped by 10%, and the number of patients with high diastolic blood pressure dropped by 44%. Additionally, the proportion of patients with poorly controlled HbA1c levels fell by 44%.
The researchers also found positive results when examining rates of healthcare utilization. The telehealth program resulted in a 51.9% decrease in visits to the primary care emergency department and a 32.3% decrease in visits to the hospital emergency department. Additionally, ER admissions were reduced by 33.2% and hospital admissions attributed to disease exacerbation decreased by 23%.
Healthier Even One Year Later
Despite the fact that patients were a year older and therefore further progressed in their disease state, they required fewer primary care and ER visits after one year of telehealth intervention. This is likely attributed to the preventative approach of the telehealth program.
Continuous patient monitoring facilitates improved patient engagement, communication, and adherence to a prescribed regimen. By maximizing the benefits of patient care, this telemonitoring program allowed clinicians to address patient concerns and disease exacerbations in a timely manner. As a result, patient outcomes improved and excessive healthcare utilization decreased.
In addition to highlighting the importance of outcomes and healthcare efficiency, the researchers demonstrated the value of patient satisfaction by publishing a separate report that measured the patient experience after participating in this program. The report highlights high patient satisfaction rates and reveals that the patients and their families experienced peace of mind from knowing that their healthcare providers were closely monitoring them.
These results demonstrate great potential for the role of telemedicine in primary care. Patients living with chronic disease can experience improved quality of life and fewer disease exacerbations when they are remotely monitored. Additionally, healthcare practices become more efficient when telemedicine is used. As the technology progresses and as patients continue to expect on demand care, healthcare is sure to embrace telemedicine and all it has to offer.
Orozco-Beltran D, Sánchez-Molla M, Sanchez JJ et al. Telemedicine in Primary Care for Patients With Chronic Conditions: The ValCronic Quasi-Experimental Study. J Med Internet Res. 2017 Dec 15;19(12):e400.
Mira-Solves JJ, Orozco-Beltrán D, Sánchez-Molla M. Evaluation of satisfaction with telemedicine devices and with the results of the care received among chronic patients. The ValCrònic program. Aten Primaria. 2014 Jun;46 Suppl 3:16-23.