‘Telebegeleiding laat een duidelijke trend zien in afnamen van het aantal ziekenhuisopnamen wegens hartfalen. Patiënten met een ziektegeschiedenis van korter dan 18 maanden hartfalen, hebben de beste resultaten. Tot slot hebben patiënten met telebegeleiding minder contacten met de hartfalenverpleegkundige. Deze uitkomsten geven aan dat telebegeleiding in staat is om ziekenhuisopnames te voorkomen en contacten met zorgverleners te verminderen.’
Domingo, e.a. (2011). Noninvasive Remote Telemonitoring for Ambulatory Patients With Heart Failure: Effect on Number of Hospitalizations, Days in Hospital, and Quality of Life. CARME (Catalan Remote Management Evaluation) Study. Revista española de cardiología. 64. 277-85.
‘The Motiva telemonitoring system significantly reduced the number of hospitalizations and days in hospital for HF and other cardiac causes in patients controlled in a structured multi- disciplinary HF unit. In order to determine which patients might benefit more from a particular telemonitoring system, a larger sample, allowing for subgroup analysis, is required. Finally, patients significantly improved their perceived QoL, particularly in the physical dimension.’
‘Telemonitoring and home telehealth appear generally effective in reducing heart failure rehospitalization and mortality. Other interventions, including the use of mobile phone-based monitoring and videoconferencing, require further investigation.’
‘In this paper, we provide a critical and an updated review of the current evidence by discussing the most important trials, meta-analyses and systematic reviews. So far, evidence for the CardioMEMS device is most convincing. Other trials regarding invasive and non-invasive telemonitoring and telephone support show divergent results, but several meta-analyses and systematic reviews uniformly reported a beneficial effect. Dutch studies showed predominantly non-significant results, mainly due to underpowered studies or because of a high standard of usual care. There are no conclusive results on cost-effectiveness of telemedicine because of the above shortcomings. The adherence of elderly patients was good in the trials, being essential for the compliance of telemedicine in the entire heart failure population. In the future perspective, telemedicine should be better standardised and evolve to be more than an addition to standard care to improve care and reduce costs.’
Gingele, A.J., Rocca, H.B., Ramaekers, B., Gorgels, A., Weerd, G., De, Kragten, J., Empel, V., Van, Brandenburg, V., Vrijhoef, H., Cleuren, G., Knackstedt, C. & Boyne, J., JJ. Telemonitoring in patients with heart failure: Is there a long-term effect? Journal of telemedicine and Telecare, 25(3) 158-166.
‘Evidence suggests that telemonitoring decreases mortality and heart failure (HF)-related hospital admission in patients with HF. However, most studies follow their patients for only several months. Little is known about the long-term effects of telemonitoring after a period of application. No significant difference in time to first HFrelated hospital admission, all-cause mortality, or DAOOH could be found. However, patients that underwent telemonitoring had significantly fewer HF-related hospital admissions.
Telemonitoring did not significantly influence the long-term outcome in our study. Therefore, extending the follow-up period of telemonitoring studies in HF patients is probably not beneficial.’
Hendy, J., Chrysanthaki, T., Barlow, J., Knapp, M., Rogers, A., Sanders, C., Bower, P., Bowen, R., Fitzpatrick, R., Bardsley, M. & Newman, S. (2012). An organisational analysis of the implementation of telecare and telehealth: the whole systems demonstrator. BMC Health Serv Res. 12 403.
To investigate organisational factors influencing the implementation challenges of redesigning services for people with long term conditions in three locations in England, using remote care (telehealth and telecare). Case-studies of three sites forming the UK Department of Health’s Whole Systems Demonstrator (WSD) Programme. Qualitative research techniques were used to obtain data from various sources. Conclusion: The implementation of a complex innovation such as remote care requires it to organically evolve, be responsive and adaptable to the local health and social care system, driven by support from front-line staff and management. This need for evolution was not always aligned with the imperative to gather robust benefits evidence. This tension needs to be resolved if government ambitions for the evidence-based scaling-up of remote care are to be realised.
This thesis describes how nurses could be prepared with training and education to acquire telehealth competence.
‘Despite favorable effects from telemedicine (TM) on cardiovascular diseases, outcome and comparative impact of TM on heart failure (HF) adults remain controversial. A meta-analysis was conducted to summarize the evidence from existing randomized controlled trials (RCTs) which compared potential impact of TM on HF with conventional healthcare. TM mainly included structure telephone support (STS), involving interactive vocal response monitoring and telemonitoring. A total of 29 RCTs consisting of 10,981 HF adults were selected for meta-level synthesis, with follow-up range of 1–36 months. Compared with conventional healthcare, telemedicine systems with medical support prove to be more effective for HF adults, particularly in reducing allcause hospitalization, cardiac hospitalization, all-cause mortality, cardiac mortality, and length of stay. While further research is required to confirm these observational findings and identify optimal telemedicine strategies and the duration of follow-up for which it confers benefits.’