Evaluation of a National Broadband Network-enabled Telehealth trial for older people with chronic disease
Susan Nancarrow A C , Annie Banbury A and Jennene Buckley B
+ Author Affiliations
- Author Affiliations
A Southern Cross University, School of Health and Human Sciences, Military Road East Lismore, Lismore, NSW 2483, Australia. Email: annie.banbury@scu.edu.au
B Feros Care, The Strand at Coolangatta, 72/80 Marine Parade, Coolangata, Qld 4225, Australia. Email: JenneneBuckley@feroscare.com.au
C Corresponding author. Email: susan.nancarrow@scu.edu.au
Australian Health Review 40(6) 641-648 https://doi.org/10.1071/AH15201
Submitted: 28 October 2015 Accepted: 16 December 2015 Published: 31 March 2016
Journal Compilation © AHHA 2016
Abstract
Objective The aim of the present study was to evaluate the effect of a high-speed telemonitoring project for older people with chronic disease in a regional Australian town. Participants’ vital signs were monitored and triaged daily by a telehealth nurse.
Methods A prospective, uncontrolled study design evaluated the effect of home-based telemonitoring on older people with chronic disease. Evaluation included surveys (including the Stanford Chronic Disease Self-Efficacy tool and the Self-Rated Health Questionnaire), self-reported health service use and interviews and focus groups exploring client experiences.
Results Participants reported an improved understanding of their vital signs monitoring (48%) and consequently better self-management of health (48%) and that they were better informed (44%) and more confident (25%) to discuss health with their doctor. Patients also reported making medication changes (17%), positive dietary changes (34%) and increasing their physical activity (33%). Overall, patients’ self-rated general health improved (mean (± s.d.) improvement 0.30 ± 0.80; 95% confidence interval (CI) 0.16–0.45; 118 d.f.; P < 0.001), with more participants reporting that their health is ‘excellent’ or ‘very good’ at the end of the trial. Patients also reported fewer doctor visits (P < 0.001), fewer visits to the local hospital emergency department (P = 0.021) and fewer non-local hospital admissions (P < 0.001) compared with the preceding year. There was no significant reduction in local hospital admissions (P = 0.171).
Conclusions The findings of the present study suggest that telemonitoring with videoconferencing empowers older people to better understand and manage their own health, and is associated with improved health outcomes and reduced service use. Having regular, daily access to a Telehealth nurse reassured participants, and triggered changes to services and behaviour that are likely to have positively affected patient outcomes.
What is known about this topic? Telehealth is increasingly being used in the care of older people with chronic conditions and can reduce health service use. Previous research has indicated that telehealth has the potential to provide patients with greater knowledge and understanding of their condition.
What this paper adds? Our research demonstrates that older people with limited experience of technology can be taught to successfully use telehealth equipment. We observed regular contact with telehealth nurses enables health promoting behaviour messages to be tailored to patients’ needs.
What are the implications for practitioners? Providing older people with tailored health support alongside an understanding of vital signs readings can enhance self-efficacy.
Additional keywords: health behaviour, health service use, patient outcomes, remote monitoring.
References
[1] Feros Care. Supporting people to live safely and independently at home: An Australian pilot program. Coolangatta: Feros Care; 2010.[2] Sharma S, Ward EC, Burns C, Theodoros D, Russell T. Assessing swallowing disorders online: a pilot telerehabilitation study. Telemed J E Health 2011; 17 688–95.
| Assessing swallowing disorders online: a pilot telerehabilitation study.Crossref | GoogleScholarGoogle Scholar | 21882996PubMed |
[3] Smith AC, Caffery LJ, Saunders R, Bradford NK, Gray LC. Generating new telehealth services using a whole of community approach: experience in regional Queensland. J Telemed Telecare 2014; 20 365–9.
| Generating new telehealth services using a whole of community approach: experience in regional Queensland.Crossref | GoogleScholarGoogle Scholar | 25399996PubMed |
[4] Crotty M, Killington M, van den Berg M, Morris C, Taylor A, Carati C. Telerehabilitation for older people using off-the-shelf applications: acceptability and feasibility. J Telemed Telecare 2014; 20 370–6.
| Telerehabilitation for older people using off-the-shelf applications: acceptability and feasibility.Crossref | GoogleScholarGoogle Scholar | 25399997PubMed |
[5] Steventon A, Bardsley M, Billings J, Dixon J, Doll H, Hirani S, Cartwright M, Rixon L, Knapp M, Henderson C, Rogers A, Fitzpatrick R, Newman S. Effect of telehealth on use of secondary care and mortality: findings from the Whole System Demonstrator cluster randomised trial. BMJ 2012; 344 e3874
| Effect of telehealth on use of secondary care and mortality: findings from the Whole System Demonstrator cluster randomised trial.Crossref | GoogleScholarGoogle Scholar | 22723612PubMed |
[6] Darkins A, Ryan P, Kobb R, Foster L, Edmonson E, Wakefield B, Lancaster AE. Care coordination/home telehealth: the systematic implementation of health informatics, home telehealth, and disease management to support the care of veteran patients with chronic conditions. Telemed J E Health 2008; 14 1118–26.
| Care coordination/home telehealth: the systematic implementation of health informatics, home telehealth, and disease management to support the care of veteran patients with chronic conditions.Crossref | GoogleScholarGoogle Scholar | 19119835PubMed |
[7] Barnett TE, Chumbler NR, Vogel WB, Beyth RJ, Qin H, Kobb R. The effectiveness of a care coordination home telehealth program for veterans with diabetes mellitus: a 2-year follow-up. Am J Manag Care 2006; 12 467–74.
| 16886889PubMed |
[8] Inglis SC, Clark RA, McAlister FA, Stewart S, Cleland JG. Which components of heart failure programmes are effective? A systematic review and meta‐analysis of the outcomes of structured telephone support or telemonitoring as the primary component of chronic heart failure management in 8323 patients: abridged Cochrane review. Eur J Heart Fail 2011; 13 1028–40.
| Which components of heart failure programmes are effective? A systematic review and meta‐analysis of the outcomes of structured telephone support or telemonitoring as the primary component of chronic heart failure management in 8323 patients: abridged Cochrane review.Crossref | GoogleScholarGoogle Scholar | 21733889PubMed |
[9] Purcell R, McInnes S, Halcomb EJ. Telemonitoring can assist in managing cardiovascular disease in primary care: a systematic review of systematic reviews. BMC Fam Pract 2014; 15 43
| Telemonitoring can assist in managing cardiovascular disease in primary care: a systematic review of systematic reviews.Crossref | GoogleScholarGoogle Scholar | 24606887PubMed |
[10] Chaudhry SI, Phillips CO, Stewart SS, Riegel B, Mattera JA, Jerant AF, Krumholz HM. Telemonitoring for patients with chronic heart failure: a systematic review. J Card Fail 2007; 13 56–62.
| Telemonitoring for patients with chronic heart failure: a systematic review.Crossref | GoogleScholarGoogle Scholar | 17339004PubMed |
[11] Kairy D, Lehoux P, Vincent C, Visintin M. A systematic review of clinical outcomes, clinical process, healthcare utilization and costs associated with telerehabilitation. Disabil Rehabil 2009; 31 427–47.
| A systematic review of clinical outcomes, clinical process, healthcare utilization and costs associated with telerehabilitation.Crossref | GoogleScholarGoogle Scholar | 18720118PubMed |
[12] Barlow J, Singh D, Bayer S, Curry R. A systematic review of the benefits of home telecare for frail elderly people and those with long-term conditions. J Telemed Telecare 2007; 13 172–9.
| A systematic review of the benefits of home telecare for frail elderly people and those with long-term conditions.Crossref | GoogleScholarGoogle Scholar | 17565772PubMed |
[13] Polisena J, Tran K, Cimon K, Hutton B, McGill S, Palmer K. Home telehealth for diabetes management: a systematic review and meta‐analysis. Diabetes Obes Metab 2009; 11 913–30.
| Home telehealth for diabetes management: a systematic review and meta‐analysis.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD1MnisVWjtA%3D%3D&md5=1f618b407eff32dd026ece942005cd6aCAS | 19531058PubMed |
[14] Chumbler NR, Chuang H-C, Wu SS, Wang X, Kobb R, Haggstrom D, Jia H. Mortality risk for diabetes patients in a care coordination, home-telehealth programme. J Telemed Telecare 2009; 15 98–101.
| Mortality risk for diabetes patients in a care coordination, home-telehealth programme.Crossref | GoogleScholarGoogle Scholar | 19246611PubMed |
[15] Dinesen B, Haesum LK, Soerensen N, Nielsen C, Grann O, Hejlesen O, Toft E, Ehlers L. Using preventive home monitoring to reduce hospital admission rates and reduce costs: a case study of telehealth among chronic obstructive pulmonary disease patients. J Telemed Telecare 2012; 18 221–5.
| Using preventive home monitoring to reduce hospital admission rates and reduce costs: a case study of telehealth among chronic obstructive pulmonary disease patients.Crossref | GoogleScholarGoogle Scholar | 22653618PubMed |
[16] Paré G, Jaana M, Sicotte C. Systematic review of home telemonitoring for chronic diseases: the evidence base. J Am Med Inform Assoc 2007; 14 269–77.
| Systematic review of home telemonitoring for chronic diseases: the evidence base.Crossref | GoogleScholarGoogle Scholar | 17329725PubMed |
[17] LaFramboise LM, Todero CM, Zimmerman L, Agrawal S. Comparison of Health Buddy® with traditional approaches to heart failure management. Fam Community Health 2003; 26 275–88.
| Comparison of Health Buddy® with traditional approaches to heart failure management.Crossref | GoogleScholarGoogle Scholar | 14528134PubMed |
[18] Finch TL, Mort M, Mair FS, May CR. Future patients? Telehealthcare, roles and responsibilities. Health Soc Care Community 2008; 16 86–95.
| Future patients? Telehealthcare, roles and responsibilities.Crossref | GoogleScholarGoogle Scholar | 18181818PubMed |
[19] Atkin P, Barrett D. Benefits of telemonitoring in the care of patients with heart failure. Nurs Stand 2012; 27 44–8.
| Benefits of telemonitoring in the care of patients with heart failure.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3s%2FosVagug%3D%3D&md5=9664aea787ae45c9bcef5c4db83ff1b4CAS | 23101298PubMed |
[20] Seto E, Leonard KJ, Cafazzo JA, Barnsley J, Masino C, Ross HJ. Perceptions and experiences of heart failure patients and clinicians on the use of mobile phone-based telemonitoring. J Med Internet Res 2012; 14 e25
| Perceptions and experiences of heart failure patients and clinicians on the use of mobile phone-based telemonitoring.Crossref | GoogleScholarGoogle Scholar | 22328237PubMed |
[21] Bujnowska-Fedak MM, Puchała E, Steciwko A. The impact of telehome care on health status and quality of life among patients with diabetes in a primary care setting in Poland. Telemed J E Health 2011; 17 153–63.
| The impact of telehome care on health status and quality of life among patients with diabetes in a primary care setting in Poland.Crossref | GoogleScholarGoogle Scholar | 21375410PubMed |
[22] Ciere Y, Cartwright M, Newman SP. A systematic review of the mediating role of knowledge, self-efficacy and self-care behaviour in telehealth patients with heart failure. J Telemed Telecare 2012; 18 384–91.
| A systematic review of the mediating role of knowledge, self-efficacy and self-care behaviour in telehealth patients with heart failure.Crossref | GoogleScholarGoogle Scholar | 23019605PubMed |
[23] Banbury A, Parkinson L, Nancarrow S, Dart J, Gray L, Buckley J. Multi-site videoconferencing for home-based education of older people with chronic conditions: the Telehealth Literacy Project. J Telemed Telecare 2014; 20 353–9.
| Multi-site videoconferencing for home-based education of older people with chronic conditions: the Telehealth Literacy Project.Crossref | GoogleScholarGoogle Scholar | 25399994PubMed |
[24] Mossey JM, Shapiro E. Self-rated health: a predictor of mortality among the elderly. Am J Public Health 1982; 72 800–8.
| Self-rated health: a predictor of mortality among the elderly.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaL383ivVansw%3D%3D&md5=259e62b903ab7e87032b5597a3a102cbCAS | 7091475PubMed |
[25] Lorig K, Sobel D, Ritter P, Laurent D, Hobbs M. Self-efficacy for managing chronic disease 6-item scale. Palo Alto: Stanford Patient Education Research Centre; 2001. Available at: http://patienteducation.stanford.edu/research/secd6.html [verified 3 March 2015].
[26] DeSalvo KB, Bloser N, Reynolds K, He J, Muntner P. Mortality prediction with a single general self‐rated health question. J Gen Intern Med 2006; 21 267–75.
| Mortality prediction with a single general self‐rated health question.Crossref | GoogleScholarGoogle Scholar | 16336622PubMed |
[27] Lorig K. Outcome measures for health education and other health care interventions. Thousand Oaks, CA: Sage; 1996.
[28] Cartwright C, Wade R, Shaw K. The impact of telehealth and telecare on clients of the transition care program (TCP). Lismore: Southern Cross University, Australian Department of Health and Ageing; 2011.
[29] Chen Y-H, Lin Y-H, Hung C-S, Huang C-C, Yeih D-F, Chuang P-Y, Ho Y-L, Chen M-F. Clinical outcome and cost-effectiveness of a synchronous telehealth service for seniors and nonseniors with cardiovascular diseases: quasi-experimental study. J Med Internet Res 2013; 15 e87
| 23615318PubMed |
[30] Moore J. Primary care heart failure services. Br J Cardiol 2008; 15 6
[31] Botsis T, Demiris G, Pedersen S, Hartvigsen G. Home telecare technologies for the elderly. J Telemed Telecare 2008; 14 333–7.
| Home telecare technologies for the elderly.Crossref | GoogleScholarGoogle Scholar | 18852311PubMed |
[32] Terschüren C, Fendrich K, van den Berg N, Hoffmann W. Implementing telemonitoring in the daily routine of a GP practice in a rural setting in northern Germany. J Telemed Telecare 2007; 13 197–201.
| Implementing telemonitoring in the daily routine of a GP practice in a rural setting in northern Germany.Crossref | GoogleScholarGoogle Scholar | 17565776PubMed |
[33] Botsis T, Hartvigsen G. Current status and future perspectives in telecare for elderly people suffering from chronic diseases. J Telemed Telecare 2008; 14 195–203.
| Current status and future perspectives in telecare for elderly people suffering from chronic diseases.Crossref | GoogleScholarGoogle Scholar | 18534954PubMed |
[34] MacNeill V, Sanders C, Fitzpatrick R, Hendy J, Barlow J, Knapp M, Rogers A, Bardsley M, Newman SP. Experiences of front-line health professionals in the delivery of telehealth: a qualitative study. Br J Gen Pract 2014; 64 e401–7.
| Experiences of front-line health professionals in the delivery of telehealth: a qualitative study.Crossref | GoogleScholarGoogle Scholar | 24982492PubMed |
[35] Barrett D. The role of telemonitoring in caring for older people with long-term conditions. Nurs Older People 2012; 24 21–5.
| The role of telemonitoring in caring for older people with long-term conditions.Crossref | GoogleScholarGoogle Scholar | 23008916PubMed |
[36] Schwarzer R. Modeling health behavior change: how to predict and modify the adoption and maintenance of health behaviors. Appl Psychol 2008; 57 1–29.
[37] Schwarzer R, Antoniuk A, Gholami M. A brief intervention changing oral self‐care, self‐efficacy, and self‐monitoring. Br J Health Psychol 2015; 20 56–67.
| A brief intervention changing oral self‐care, self‐efficacy, and self‐monitoring.Crossref | GoogleScholarGoogle Scholar | 24471473PubMed |
[38] Greenwood DA, Young HM, Quinn CC. Telehealth remote monitoring systematic review: structured self-monitoring of blood glucose and impact on A1c. J Diabetes Sci Technol 2014; 8 378–89.
| Telehealth remote monitoring systematic review: structured self-monitoring of blood glucose and impact on A1c.Crossref | GoogleScholarGoogle Scholar | 24876591PubMed |
[39] Duke C. The frail elderly community-based case management project. Geriatr Nurs 2005; 26 122–7.
| The frail elderly community-based case management project.Crossref | GoogleScholarGoogle Scholar | 15824728PubMed |
[40] Segar J, Rogers A, Salisbury C, Thomas C. Roles and identities in transition: boundaries of work and inter‐professional relationships at the interface between telehealth and primary care. Health Soc Care Community 2013; 21 606–13.
| 23656381PubMed |
[41] van den Berg N, Schumann M, Kraft K, Hoffmann W. Telemedicine and telecare for older patients: a systematic review. Maturitas 2012; 73 94–114.
| Telemedicine and telecare for older patients: a systematic review.Crossref | GoogleScholarGoogle Scholar | 22809497PubMed |
[42] Shea K, Chamoff B. Telehomecare communication and self‐care in chronic conditions: moving toward a shared understanding. Worldviews Evid Based Nurs 2012; 9 109–16.
| Telehomecare communication and self‐care in chronic conditions: moving toward a shared understanding.Crossref | GoogleScholarGoogle Scholar | 22409374PubMed |
[43] Essén A. The two facets of electronic care surveillance: an exploration of the views of older people who live with monitoring devices. Soc Sci Med 2008; 67 128–36.
| The two facets of electronic care surveillance: an exploration of the views of older people who live with monitoring devices.Crossref | GoogleScholarGoogle Scholar | 18396367PubMed |
[44] Giamouzis G, Mastrogiannis D, Koutrakis K, Karayannis G, Parisis C, Rountas C, Adreanides E, Dafoulas GE, Stafylas PC, Skoularigis J, Giacomelli S, Olivari Z, Triposkiadis F. Telemonitoring in chronic heart failure: a systematic review. Cardiol Res Pract 2012; 2012 410820
| Telemonitoring in chronic heart failure: a systematic review.Crossref | GoogleScholarGoogle Scholar | 22720184PubMed |
[45] Milligan C, Roberts C, Mort M. Telecare and older people: who cares where? Soc Sci Med 2011; 72 347–54.
| Telecare and older people: who cares where?Crossref | GoogleScholarGoogle Scholar | 20880624PubMed |
