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Open Access Highly Accessed Research article

Impact of telemonitoring home care patients with heart failure or chronic lung disease from primary care on healthcare resource use (the TELBIL study randomised controlled trial)

Iñaki Martín-Lesende1*, Estibalitz Orruño2, Amaia Bilbao3, Itziar Vergara4, Mª Carmen Cairo1, Juan Carlos Bayón2, Eva Reviriego2, María Isabel Romo1, Jesús Larrañaga1, José Asua2, Roberto Abad1 and Elizabete Recalde1

Author Affiliations

1 Bilbao Primary Care Health Region, Osakidetza – Basque Health Service, Bizkaia, Spain

2 Basque Office for Health Technology Assessment (OSTEBA), Department of Health and Consumer Affairs, Basque Government, Vitoria-Gasteiz, Araba, Spain

3 Research Unit, Basurto University Hospital, Osakidetza, Health Services Research on Chronic Patients Network (REDISSEC), Bilbao, Bizkaia, Spain

4 Primary Care Research Unit of Gipuzkoa, Osakidetza, REDISSEC, Donostia, Gipuzkoa, Spain

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BMC Health Services Research 2013, 13:118  doi:10.1186/1472-6963-13-118

Published: 28 March 2013

Abstract

Background

There is growing evidence that home telemonitoring can be advantageous in societies with increasing prevalence of chronic diseases.

The main objective of this study is to evaluate the effect of a primary care-based telemonitoring intervention on the number and length of hospital admissions.

Methods

A randomised controlled trial was carried out across 20 health centres in Bilbao (Basque Country, Spain) to assess the impact of home telemonitoring on in-home chronic patients compared with standard care. The study lasted for one year. Fifty-eight in-home patients, diagnosed with heart failure (HF) and/or chronic lung disease (CLD), aged 14 or above and with two or more hospital admissions in the previous year were recruited. The intervention consisted of daily patient self-measurements of respiratory-rate, heart-rate, blood pressure, oxygen saturation, weight, body temperature and the completion of a health status questionnaire using PDAs. Alerts were generated when pre-established thresholds were crossed. The control group (CG) received usual care. The primary outcome measure was the number of hospital admissions that occurred at 12 months post-randomisation. The impact of telemonitoring on the length of hospital stay, use of other healthcare resources and mortality was also explored.

Results

The intervention group (IG) included 28 patients and the CG 30. Patient baseline characteristics were similar in both groups. Of the 21 intervention patients followed-up for a year, 12 had some admissions (57.1%), compared to 19 of 22 controls (86.4%), being the difference statistically significant (p = 0.033, RR 0.66; 95%CI 0.44 to 0.99). The mean hospital stay was overall 9 days (SD 4.3) in the IG versus 10.7 (SD 11.2) among controls, and for cause-specific admissions 9 (SD 4.5) vs. 11.2 (SD 11.8) days, both without statistical significance (p = 0.891 and 0.927, respectively). Four patients need to be telemonitored for a year to prevent one admission (NNT). There were more telephone contacts in the IG than in the CG (22.6 -SD 16.1- vs. 8.6 -SD 7.2-, p = 0.001), but fewer home nursing visits (15.3 -SD 11.6- vs. 25.4 -SD 26.3-, respectively), though the difference was not statistically significant (p = 0.3603).

Conclusions

This study shows that telemonitoring of in-home patients with HF and/or CLD notably increases the percentage of patients with no hospital admissions and indicates a trend to reduce total and cause-specific hospitalisations and hospital stay. Home telemonitoring can constitute a beneficial alternative mode of healthcare provision for medically unstable elderly patients.

Trial registration

Current Controlled Trials ISRCTN89041993

Keywords:
Telemonitoring; Primary care; Effectiveness; Hospital admissions; In-home patients; Chronic diseases; Heart failure; Chronic lung disease; Elderly