IMPACT OF TELEHOMECARE PROGRAM ON PATIENTS' QUALITY OF LIFE AND DISEASE-MANAGEMENT SKILLS

Purpose:

   Telehomecare Program  was introduced in 2007 to patients with chronic obstructive pulmonary disease (COPD) and heart failure (HF).  Literature suggests that similar programs  may improve patients'  quality of life and self-management; however results are not conclusive. This survey evaluates the impact of the Telehomecare Program on patients’ quality of life, disease-management skills and satisfaction.

Methods:

   Longitudinal surveys were conducted with prospectively enrolled patients from June to August 2014. Five validated questionnaires (EQ-5D, SF-12, Stanford Self-Efficacy Scale-33, CSQ-8, TMPQ-17) were administered at baseline, one, two and three months after patients enrolled in the Program. Survey responses at all time points were analyzed using repeated measures with a generalized linear mixed model procedure in SAS.

Results:

   Overall 57 patients  participated in the surveys. Both COPD and HF patients reported high levels of satisfaction and positive perception of the program consistently across time. The average unadjusted physical component summary (PCS) of SF-12 survey varied between 33.3-34.9 for HF and 28.0-31.1 for COPD patients; whereas mental component summary (MCS) scores varied between 48.2-51.9 and 45.3-48.8 for the HF and the COPD patients.  The EQ-5D index score varied between 0.70 - 0.78 for HF and 0.60-0.67 for COPD patients respectively within month-0 to month-3.  There was a difference in quality of life scores (MCS, PCS and EQ 5D index) across the two chronic diseases, but  no longer significant when adjusted for  gender and age. PCS, MCS or EQ 5D index scores did not change significantly over time when adjusted for age, gender, and disease. No differences in self-management scores were found across  diseases, except in the symptom and shortness of breath management domains, which was better for the HF patients (+1.10, p = 0.053 and +1.68 p = 0.007 respectively) when adjusted for age and gender. Although Telehomecare Program  is targeted to enhance patients’ self-management skills, none of the self-management domains improved significantly over time.

Conclusion:

   Our results suggest that the Telehomecare Program has a wide acceptance among patients. However, the survey evaluations failed to detect any significant impact of the Telehomecare Program on the patients’ quality of life or disease management skills. Limitations of short time for follow up and small sample size will be addressed in subsequent phase of patient surveys.