Nurse-Led Telemonitoring for Chronic Conditions
Recruiting in Palo Alto (17 mi)
+3 other locations
Age: 18+
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: University Health Network, Toronto
Disqualifiers: Long-term care admission
No Placebo Group
Approved in 3 Jurisdictions
Trial Summary
What is the purpose of this trial?In Canada, 3 out of 4 Canadians aged 65 and older have at least one chronic condition, while 1 in 4 seniors reported having three or more. Caring for complex patients who usually have multiple chronic conditions (MCC) is one of the biggest challenges facing our healthcare system. For patients, the lack of coordination and continuity of care as they transfer between healthcare settings and healthcare providers (HCPs) often results in a higher risk of readmission, suboptimal and fragmented care plans, delays in required medical intervention, inadequate self-care, and confusion on whom they should contact when they have questions. For the patient's care team, they often have no indication how patients are doing between clinic visits unless the patient can provide a log of their home measurements (e.g., blood pressure). Therefore, they are unable to detect and intervene if their patient's health is worsening between visits.
In order to address this increasing need to bridge the current gap in clinical management and self-care of complex patients during their transition from healthcare settings to home care, our team aims to design, implement and evaluate the SMaRT (Safe, Managed, and Responsive Transitions) Clinic, a nurse-led integrated care model facilitated by telemonitoring (TM). Specifically, the SMaRT Clinics aim to meaningfully introduce a nurse (or nurse practitioner) role to improve clinical coordination across patient care teams and reinforce proper self-care education through the use of telemonitoring. This project will be conducted in two phases across four years; Phase I: Design and Development, and Phase II: Implementation and Effectiveness Evaluation. Phase II research activities include enrolling 350 patients with complex chronic conditions in the SMaRT clinics across four study sites. The implementation and effectiveness of the SMaRT clinics will be evaluated through a mix of semi-structured interviews, ethnographic observation, patient questionnaires, and analyses of health utilization outcomes using propensity-matched controls from the ICES provincial database.
Will I have to stop taking my current medications?
The trial information does not specify whether you need to stop taking your current medications. It seems likely that you can continue your medications, as the trial focuses on telemonitoring for chronic conditions.
What data supports the effectiveness of the treatment Nurse-Led Telemonitoring for Chronic Conditions?
Research shows that nurse-led telemonitoring can improve outcomes for patients with chronic conditions. For example, a study on diabetes patients found that those using home telemonitoring had a lower death rate compared to those who did not use it. Additionally, patients with asthma reported high satisfaction and reliable results with nurse-led telemonitoring, indicating its feasibility and effectiveness.
12345Is nurse-led telemonitoring safe for managing chronic conditions?
Nurse-led telemonitoring for chronic conditions, like asthma, has been shown to be feasible and satisfying for patients, with high compliance and low dropout rates, indicating it is generally safe for use in humans.
34678How does the Nurse-Led Telemonitoring treatment differ from other treatments for chronic conditions?
Nurse-Led Telemonitoring is unique because it allows patients to record their vital signs at home and send this information to nurses who can quickly respond to any health issues, potentially preventing hospital visits. This approach is different from traditional treatments as it emphasizes remote monitoring and timely nurse intervention, which can improve patient outcomes and is particularly beneficial for older adults with long-term conditions.
4591011Eligibility Criteria
The SMaRT Study is for adults over 18 who have recently been discharged from certain hospitals in Canada and have at least one chronic condition like heart failure, COPD, high blood pressure, diabetes, or depression. Participants need to be able to use the telemonitoring app and devices (like a weight scale) and speak English or have someone who can communicate for them.Inclusion Criteria
Discharged from hospital or seen within 48 hours of discharge at Health Sciences North (HSN), William Osler Health Systems (WOHS), Women's College Hospital (WCH), and Markham Stouffville Hospital (MSH)
I have a chronic condition like heart failure or diabetes that could improve with telemonitoring.
Able to comply with use of the telemonitoring application and applicable peripheral devices (e.g., able to stand on the weight scale, able to answer symptom questions, etc.)
+3 more
Exclusion Criteria
Patients who are discharged from hospital with the intent to be admitted to a long-term care facility will be excluded
Trial Timeline
Design and Development
Design and development of the SMaRT Clinic model and telemonitoring system
2 years
Implementation and Effectiveness Evaluation
Implementation of the SMaRT Clinics and evaluation of their effectiveness through various research activities
2 years
Follow-up
Participants are monitored for safety and effectiveness after treatment
1 year
Participant Groups
This study tests the SMaRT Clinic model which uses nurse-led care coordinated through telemonitoring to manage patients with multiple chronic conditions after they leave the hospital. It aims to improve self-care education and clinical coordination across patient care teams.
2Treatment groups
Experimental Treatment
Active Control
Group I: Telemonitoring (Medly MCC)Experimental Treatment1 Intervention
Medly is a smartphone application allows patients with heart failure, diabetes, depression, hypertension, and/or COPD to measure and record their daily self-reported symptoms. This monitoring information is then transmitted wirelessly to a data server where an algorithm is used to generate an alert to a healthcare provider as necessary. The patient also receives an automated self-care message based on their measurements and reported symptoms.
Group II: ControlActive Control1 Intervention
Control groups will be compared to 350 patients who received standard of care via propensity-matched controls from the ICES provincial database.
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
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Who Is Running the Clinical Trial?
University Health Network, TorontoLead Sponsor
Markham Stouffville HospitalCollaborator
Health Sciences NorthCollaborator
William Osler Health SystemCollaborator
Women's College HospitalCollaborator
References
Telemonitoring with case management for seniors with heart failure. [2022]To assess the impact of supplementing nurse case management with Internet-connected telemonitoring on clinical outcomes in an elderly heart failure (HF) population.
Mortality risk for diabetes patients in a care coordination, home-telehealth programme. [2009]We assessed a home monitoring/care coordination programme for veterans with diabetes. Patients enrolled in the programme (n = 387) were followed for four years and compared with a retrospective control group (n = 387). Each patient in the intervention group used a messaging device in the home that was connected by a conventional telephone line. Care coordinators monitored the answers from the devices daily so that early interventions could be made. There were significantly more deaths in the control group (n = 102, 26%) compared with the intervention group (n = 75, 19%). There was longer survival for the intervention group versus the control group (mean survival time 1348 vs 1278 days; P = 0.015). A multivariate analyses indicated that the telemonitoring programme was associated with reduced 4-year all-cause mortality (hazard ratio = 0.7, 95% CI 0.5-0.9, P = 0.013). The results suggest that daily management of patients with diabetes through home monitoring by a registered nurse reduces mortality.
Process evaluation of a nurse-led telemonitoring programme for patients with asthma. [2007]We performed a process evaluation of a nurse-led telemonitoring programme for patients with asthma. The indicators used to evaluate the programme were feasibility, consistency of peak expiratory flow (PEF) tests, compliance and patient satisfaction. Patients in the intervention group received a home monitor in which spirometry results and symptoms could be recorded. They were asked to measure PEF in the morning and evening. A nurse studied the home monitoring data and took stepwise actions in accordance with the intervention protocol. During a 12-month study period, 55 patients were allocated to the intervention group (26 adults and 29 children). Although technical and logistical problems did occur, the dropout rate was low. At least 75% of the PEF manoeuvres were valid for two-thirds of the patients. Compliance with the study protocol was high. The average number of recorded PEF tests was 1.5 per day, which was less than the two tests per day that were required by the protocol. Patient satisfaction was high and, after one year, less than 20% of the participants chose to discontinue their participation. The results indicate that nurse-led telemonitoring for a motivated group of patients with mild to moderate asthma is feasible and reliable, and satisfying to patients.
Nursing interventions in a telemonitoring program. [2021]The use of telemonitoring of patients with chronic illness in their homes is growing. Current literature does not describe what types of patient problems are addressed by nurses in these programs and what actions are taken in response to identified problems. This study defined and analyzed patient problems and nursing actions delivered in a telemonitoring program focused on chronic disease management.
Telehomecare communication and self-care in chronic conditions: moving toward a shared understanding. [2022]Remote telemonitoring of patients' vital signs is a rapidly increasing practice. Although methods of communication in remote electronic monitoring differ from those in traditional home health care, the understanding shared by the nurse, patient, and family members remains the same: patients' self-care behaviors affect exacerbations of chronic health conditions. The purpose of this paper is to examine the relationship between communication and information integration into the daily lives of patients with chronic illnesses and offer best practice recommendations for telehomecare nurses (THN).
Benefits and Challenges of Remote Patient Monitoring as Perceived by Health Care Practitioners: A Systematic Review. [2023]Background Remote patient monitoring (RPM), or telemonitoring, offers ways for health care practitioners to gather real-time information on the physiological conditions of patients. As telemedicine, and thus telemonitoring, is becoming increasingly relevant in today's society, understanding the practitioners' opinions is crucial. This systematic review evaluates the perspectives and experiences of health care practitioners with telemonitoring technologies. Methods A database search was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for the selection of articles measuring health care practitioners' perspectives and experiences with RPM technologies published between 2017 and 2021. Only articles written in English were included. No statistical analysis was performed and thus this is a qualitative review. Results A total of 1605 studies were identified after the initial search. After applying the inclusion and exclusion criteria of this review's authors, 13 articles were included in this review. In all, 2351 practitioners' perspectives and experience utilizing RPM technology in a variety of medical specialties were evaluated through close- and open-ended surveys. Recurring themes emerged for both the benefits and challenges. Common benefits included continuous monitoring of patients to provide prompt care, improvement of patient self-care, efficient communication, increased patient confidence, visualization of health trends, and greater patient education. Challenges comprised increased workload, higher patient anxiety, data inaccuracy, disorienting technology, financial issues, and privacy concerns. Conclusion Health care practitioners generally believe that RPM is feasible for application. Additionally, there is a consensus that telemonitoring strategies will become increasingly relevant. However, there are still drawbacks to the technology that need to be considered.
Home telehealth: facilitators, barriers, and impact of nurse support among high-risk dialysis patients. [2019]The value of home telehealth self-monitoring with nurse oversight has been demonstrated; however, there is a dearth of objective documentation of patients' experiences with such a model. We used a mixed methods approach to examine the value of home telehealth monitoring with remote care nurse (RCN) support from the perspective of participants in our study.
Use of telemonitoring in patient self-management of chronic disease: a qualitative meta-synthesis. [2023]Telemonitoring for the remote patient self-management of chronic conditions can be a cost-effective method for delivering care in chronic disease; nonetheless, its implementation in clinical practice remains low. The aim of this meta-synthesis is to explore barriers and facilitators associated with the use of remote patient monitoring of chronic disease, drawing on qualitative research, and assessing participant interactions with this technology.
Benefits of telemonitoring in the care of patients with heart failure. [2016]Telemonitoring involves remotely monitoring patients' vital signs. It is an innovative and promising development in the care of people with heart failure that may reduce hospital admissions and the burden on the NHS, as well as improve patients' quality of life and clinical outcomes. This article describes what telemonitoring is and explores the evidence base for its use. The role of the nurse in telemonitoring is also discussed, with particular reference to dealing with and responding to alerts. The development and implementation of new technology is essential to improve the delivery of healthcare and optimise patient outcomes, and telemonitoring may play an important role in the future of heart failure services.
The role of telemonitoring in caring for older people with long-term conditions. [2016]Long-term conditions have a negative effect on the lives of older people and those who care for them. As the population ages, so the prevalence of long-term conditions increases, which presents substantial challenges to providers of health and social care. This article examines how telemonitoring could help to meet some of these challenges. Telemonitoring involves patients at home recording vital signs, for example, blood pressure and pulse, and transmitting this information electronically to nurses based elsewhere. Nurses can then use these data to identify signs of deterioration, intervene promptly and prevent admission to hospital. There is some evidence that this form of care is popular with patients and can improve clinical outcomes. However, nurses should ensure that they understand the opportunities and difficulties presented by telemonitoring, develop the skills necessary to use it effectively and put themselves at the forefront of this innovative method of supporting care provision.
Telephone Support and Telemonitoring for Low-Income Older Adults. [2018]The objective of the current pilot study was to determine whether nurse-led telephone counseling improves health behavior, self-care, and physiological indices for low-income older adults using a telemonitoring system. The control group (n = 15) was provided with weekly health education only, and the intervention group (n = 20) was given additional telephone support by nurses. At baseline and 8 weeks, data on health and self-care behaviors were collected using a self-reported questionnaire, and blood pressure and fasting blood glucose levels were assessed. Nurse-led telephone support had a medium effect on improving health behavior (Cohen's d = 0.58, 95% confidence interval [CI] [-0.10, 1.27]), reducing systolic blood pressure (Cohen's d = -0.61, 95% CI [-1.29, 0.08]), and improving self-care behavior for hypertension (Cohen's d = 1.16, 95% CI [0.05, 2.27]). Findings support that nurse-led telephone support may be effective for improvements in health behavior, systolic blood pressure, and hypertension self-care in disadvantaged older adults under remote monitoring. Further studies are needed to obtain a powered sample size and investigate the long-term effects of personalized elements surrounding telehealth in community-based settings. [Res Gerontol Nurs. 2018; 11(4):198-206.].