Marlien Varnfield1, Branko Celler2, Jane Li3, Rajiv Jayasena4
1 Australian e-Health Research Centre, Level 5 UQ Building, RBWH, QLD, 4029 firstname.lastname@example.org
2 Biomedical Systems Research Laboratory, University of NSW, NSW, 2052, email@example.com
3 Australian e-Health Research Centre, Cnr Vimiera & Pembroke Roads, Marsfield, NSW, 2122, firstname.lastname@example.org
4 Australian e-Health Research Centre, 343 Royal Parade, Parkville, VIC, 316, email@example.com
One of the major global epidemiologic trends of the current century is the rise of chronic diseases. Australia’s hospital-centric public health system is unnecessarily burdened by the management of these diseases. Telehealth services such as home-telemonitoring have the potential to improve the management of chronic conditions and hence reduce unscheduled admissions to emergency departments and hospitals. The effectiveness of home-telemonitoring, however, may depend on a number of factors such as users’ perceptions and ability to adhere to schedules of monitoring. Furthermore, successful integration of new models of care with long established service models requires substantial change in workplace culture and capacity for organisational change management. This paper draws on the results of a large Australian multi-site Telehealth Trial and reports on user perceptions and compliance, and organizational challenges.
The study design was a dichotomous, prospective, case matched before-after-control-impact (BACI) trial at each of five sites. Patient selection was based on frequency of hospital admission for a range of chronic conditions to reflect the population realities of the healthcare system. Test patients were supplied with an in-home telemonitoring system to both capture daily vital sign measurements and to complete online questionnaires. Control patients received normal care. Test patients completed an Evaluation Questionnaire at the end of the trial and their compliance with monitoring schedules was evaluated through extracting data from the telemonitoring server. Challenges in capacity to accommodate change and the flexibility of existing processes and systems were documented.
We recruited 114 Test patients (71.1±9.3 years; 64% male) and 173 Control patients (71.9±9.4 years; 56% male) to the trial. Responses to the Evaluation Questionnaire were received from 56 Test patients. Majority of patients found the telemonitoring device easy to use (87.5%) and felt confident in using it (85.7%). Most found that telemonitoring could be incorporated in their daily routine (80.4%), fits in with their daily life (71.4%) and the way they would like to manage their health (76.8%). Compliance with the measurement protocols scheduled was generally high with patients carrying out their scheduled measurements and questionnaires at least once every two days. A strong correlation was found between the level of involvement of clinical care coordinators and patient compliance. We identified that successful deployment of remote telemonitoring requires a new clinical care coordination role, strong support and leadership from the health service management team, the formation of clear clinical governance for the service and strong alignment of workplace culture and values with the objectives of the service.
At all trial sites the telemonitoring service was well accepted by patients. Our trial demonstrated high compliance rates, independent of age and gender, suggesting that this could be an appropriate approach for chronic disease management for a large population. Close involvement of clinical carers gives the greatest benefit to patient compliance. The key barriers related to integration of telemonitoring into existing models of care were at the services provider level. These barriers included the capacity to implement/participate in new programs within health organisations.