ISQUA16-2955HOME TELEMONITORING FOR AGED CARE – DO THE ELDERLY COMPLY AND COMPLETE?

Abstract

Objectives: Telehealth services such as home telemonitoring have been reported to improve the management of chronic disease and hence reduce unscheduled admissions to emergency departments and length of stay when admitted to hospitals. The effectiveness of telemonitoring, however, may depend on patients' ability to adhere to schedules of home monitoring and case management. This paper explores how well the elderly comply with monitoring schedules and which factors influence successful completion of a program. We draw on results from the 'Telehealth Home Monitoring for Aged Care' project, Australia's first multi-state, multi-site clinical trial of home-based telehealth services for managing chronic disease in the community [1]. Methods: Patient selection to this trial was based on frequency of admission to hospital for a range of chronic conditions to reflect the population health realities of the healthcare system. Eligibility included those who were 50 years and over, and who had a diagnosis of one or more of the following chronic conditions: Chronic Obstructive Pulmonary Disease, Coronary Artery Disease, Hypertensive Disease, Congestive Heart Failure, Diabetes and Asthma. The study was designed as a dichotomous, prospective, case matched before-after-control-impact (BACI) trial at each of five sites. Test patients were supplied with an in-home telemonitor-ing system for both capturing daily vital sign measurements, and completing online questionnaires. Patient compliance with their monitoring schedule was calculated by comparing the total number of scheduled events with the actual number completed. Reasons for individuals not completing the trial were analysed and tabulated. Results: In May 2013 we commenced recruitment of 114 Test patients (71.1 ± 9.3 years; 64% male) and 173 Control patients (71.9 ± 9.4 years; 56% male). The trial ran up to Dec 2014. Test patients were monitored on average for 276 days, with no significant difference between average monitoring durations for female patients (266 days) and male patients (281 days). 75% of all Test patients were monitored for periods exceeding 6 months. Compliance with the measurement protocols scheduled for each patient 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 their clinical care coordinators and patient compliance. The main reason leading to cessation of monitoring and ultimately withdrawal before completion of the trial included deterioration in health; stress; relocation; and feeling no benefit from the intervention. There was no correltation between age and withdrawal. Conclusion: Our trial has demonstrated high compliance and completion rates with home telemonitoring, 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. Deterioration in health proved to be one of the most noticeable reasons for withdrawing from the trial, suggesting that in clinical practice early detection of declining health should prompt reassessment of patient suitability.