Down to the Fundamentals of Telehealth and Home Healthcare Nursing:

A Remote Medication Monitoring System for Chronic Heart Failure Patients to Reduce Readmissions: A Two-Arm Randomized Pilot Study

Background

Heart failure (HF) is a chronic condition affecting nearly 5.7 million Americans and is a leading cause of morbidity and mortality. With an aging population, the cost associated with managing HF is expected to more than double from US $31 billion in 2012 to US $70 billion by 2030. Readmission rates for HF patients are high—25% are readmitted at 30 days and nearly 50% at 6 months. Low medication adherence contributes to poor HF management and higher readmission rates. Remote telehealth monitoring programs aimed at improved medication management and adherence may improve HF management and reduce readmissions.

Objective

The primary goal of this randomized controlled pilot study is to compare the MedSentry remote medication monitoring system versus usual care in older HF adult patients who recently completed a HF telemonitoring program. We hypothesized that remote medication monitoring would be associated with fewer unplanned hospitalizations and emergency department (ED) visits, increased medication adherence, and improved health-related quality of life (HRQoL) compared to usual care.

Methods

Participants were randomized to usual care or use of the remote medication monitoring system for 90 days. Twenty-nine participants were enrolled and the final analytic sample consisted of 25 participants. Participants completed questionnaires at enrollment and closeout to gather data on medication adherence, health status, and HRQoL. Electronic medical records were reviewed for data on baseline classification of heart function and the number of unplanned hospitalizations and ED visits during the study period.

Results

Use of the medication monitoring system was associated with an 80% reduction in the risk of all-cause hospitalization and a significant decrease in the number of all-cause hospitalization length of stay in the intervention arm compared to usual care. Objective device data indicated high adherence rates (95%-99%) among intervention group participants despite finding no significant difference in self-reported adherence between study arms. The intervention group had poorer heart function and HRQoL at baseline, and HRQoL declined significantly in the intervention group compared to controls.

Conclusions

The MedSentry medication monitoring system is a promising technology that merits continued development and evaluation. The MedSentry medication monitoring system may be useful both as a standalone system for patients with complex medication regimens or used to complement existing HF telemonitoring interventions. We found significant reductions in risk of all-cause hospitalization and the number of all-cause length of stay in the intervention group compared to controls. Although HRQoL deteriorated significantly in the intervention group, this may have been due to the poorer HF-functioning at baseline in the intervention group compared to controls. Telehealth medication adherence technologies, such as the MedSentry medication monitoring system, are a promising method to improve patient self-management,the quality of patient care, and reduce health care utilization and expenditure for patients with HF and other chronic diseases that require complex medication regimens.

Trial Registration

ClinicalTrials.gov NCT01814696; https://clinicaltrials.gov/ct2/show/study/NCT01814696 (Archived by WebCite® at http://www.webcitation.org/6giqAVhno)

Effectiveness of an e-learning curriculum on occupational health for music performers

OBJECTIVE

The purpose of this study was (1) to evaluate the effectiveness of the e-learning curriculum and (2) to explore the type of questions raised by students through the "Health Promotion for Music Performers" (HPMP) e-learning curriculum.

MATERIALS AND METHODS

This study was primarily a pedagogical research composed of a pre- and postintervention design coupled with a 1-month longitudinal knowledge retention measurement. The intervention, the HPMP e-learning curriculum, was implemented over 14 weeks, once a week, for a total of 14 classes. Each class consisted of a 60-min prerecorded lecture followed by a 40-min real-time interactive discussion. The interdisciplinary faculty panel consisted of experts from the field of music and medicine. The Self-Assessment Questionnaire (SAQ) was used to evaluate knowledge changes concerning (1) Practice and Performance issues and (2) Health and Life Style issues.

RESULTS

Fifteen graduate-level music students participated in the study. The SAQ scores on the 1-month follow-up test for Practice and Performance issues were significantly higher than the pretest (t=2.731, p<0.05). On the other hand, no significant differences were found between the posttest and pretest or between the follow-up test and posttest. Regarding Health and Life Style issues, comparison at all three measurement points did not reveal any significant difference. Questions raised by students fell into four major categories: performance injury (45%), performance anxiety (22%), general physiology (22%), and general psychology (11%).

CONCLUSIONS

The findings suggest that the HPMP e-learning course enhanced student awareness of Practice and Performance issues but did not have as significant an impact on student awareness of Health and Lifestyle issues.

Nurse tele-consultations with discharged COPD patients reduce early readmissions--an interventional study

INTRODUCTION

Exacerbations of chronic obstructive pulmonary disease (ECOPD) are the most common cause for admissions and readmissions to medical wards worldwide.

OBJECTIVES

To investigate the effect on early readmissions of telemedicine video consultations (TVCs) between respiratory nurses placed at the hospital and COPD patients in their homes after a discharge from the hospital, which was caused by ECOPD.

METHODS

This study was an interventional study in which all ECOPD were consecutively allocated into two groups (TVC or control) depending on their home municipality. The patient received daily TVC at home with a nurse based at the hospital for approximately one week. Thereafter, the patient received at least one follow-up call and they could call the nurse for the rest of the study period of 28 days. The telemedicine equipment was composed of a computer with a web camera, a microphone and measurement equipment.

RESULTS

Within each of the two groups, TVC (n = 50) and control (n = 50), 12% and 22%, respectively, were readmitted [differences between rates -10% (95% confidence interval -25;5)] because of ECOPD. The multivariate Cox regression model showed the TVC assignment as a significant protective factor for early readmission [hazard ratio (HR) 0.25 (0.09-0.69)]. High age [HR 3.94 (1.46-10.6)] and male gender [HR 2.97 (0.99-8.97)] were associated with high hazard. Patient satisfaction was high.

CONCLUSIONS

In a hospitalised population with ECOPD, a nurse TVC assignment is protective against early readmission and reduces the days of readmission.