IMPACT OF TELEHOMECARE ON REMOTELY MONITORED CLINICAL PARAMETERS OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND HEART FAILURE PATIENTS

Sunday, January 10, 2016: 09:00
Shaw Auditorium, 1/F (Jockey Club School of Public Health and Primary Care Building at Prince of Wales Hospital)

Valeria E. Rac, MD, PhD, Yeva Sahakyan, MD, MPH, Nida Shahid, HBSc., CCRP, Aleksandra Stanimirovic, MSc, PhD (candidate), Petros Pechlivanoglou, MSc, PhD, Welson Ryan, Lusine Abrahamyan, MD MPH PhD and Murray D Krahn, MD, MSc, FRCPC, Toronto Health Economics and Technology Assessment (THETA) Collaborative, University of Toronto, Toronto, ON, Canada
Purpose:

   The purpose of the quantitative descriptive study included evaluating overall patterns of change observed in the remotely monitored clinical parameters of chronic obstructive pulmonary disease (COPD) and heart failure (HF) patients across Ontario.

Method(s):

   Monitoring parameters such as blood pressure (BP), oxygen levels and weight were analyzed for patients enrolled in the program from July 2012 to March 2015 in the Central West, North East and Toronto Central Local Health Integration Networks (LHINs). Clinical data was extracted from a database managed by the Ontario Telemedicine Network (OTN) and analyzed using repeated measures with generalized linear mixed model procedures in SAS. The outcome measures were estimated for change during participation in Telehomecare.

Result(s):

   Findings show, overall 2470 patients enrolled in Telehomecare and completed at least one month. During the first month of participation, one third of patients (n=810) had an elevated BP, with a monthly average systolic BP (SBP) of 150.2+9.5 mmHg and diastolic BP (DBP) of 78.8+12.5 mmHg, compared with adequately controlled (n=1660) patients who had a mean  SBP of 120.6±12.7 mmHg and mean DBP of 68.3±9.7 mmHg. Authors found clinically and statistically significant reduction in systolic and diastolic BP in initially hypertensive patients, over the seven-month program period when adjusted for age, gender and condition.  For SBP levels, reduction was 10.8 mmHg (95% CI= 9.6-12.0) and DBP reduction was 6.5 mmHg (95% CI=5.6-7.3). Although not clinically meaningful, there was a statistically significant reduction in impaired oxygen saturation levels and weight fluctuations in program participants.  

Conclusion(s):

   The observed changes in monitored patient parameters over the course of time leads us to interpret that hypertensive patients may benefit the most from participating in Telehomecare. This is regardless of their age, gender, condition or geographical area. Further analyses are on the way to confirm our results.

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