ABSTRACT
Background: Telemonitoring is an innovative model of care being implemented to address thegrowing burden of chronic and complex disease. Objectives: This paper explores the perceptions of community dwelling older people withchronic and complex conditions towards a general practice nurse-led telemonitoring interven-tion. Method: A pre-test post-test intervention study was conducted with consumer surveys adminis-tered before and after the intervention. The telemonitoring intervention consisted of a periodof home monitoring during which daily vital signs and symptoms were transmitted to the generalpractice nurse. Results: 21 participants completed both pre and post-test surveys. There was a significant dif-ference between pre and post ratings on the survey item ''the use of telemonitoring equipmentseems difficult to me'' (p = 0.013), and ''telemonitoring will be a standard way of health caredelivery in the future'' (p = 0.032). Approximately half of the participants reported that tele-monitoring provided them with a sense of security and peace of mind, assisted them to managetheir health, in addition to improving their confidence in managing their care. Most participants felt more involved and expressed that daily monitoring helped them to understand changes intheir condition. Conclusion: Telemonitoring is acceptable to Australian community dwelling older persons withchronic conditions. Prior experience with computers and technology may not be a meditatingfactor in acceptability. The use of telemonitoring not only provided important physiological infor-mation to health professionals but also has the potential to empower older people by allowingthem to better understand their own health.
ABSTRACT
BACKGROUND: There has been growing interest regarding the impact of telemonitoring and its ability to reduce the increasing burden of chronic diseases, including chronic cardiovascular disease (CVD), on healthcare systems. A number of randomised trials have been undertaken internationally and synthesised into various systematic reviews to establish an evidence base for this model of care. This study sought to synthesise and critically evaluate this large body of evidence to inform clinicians, researchers and policy makers. METHODS: A systematic review of systematic reviews investigating the impact of telemonitoring interventions in the primary care management of CVD was conducted. Reviews were included if they explored primary care based telemonitoring in either CVD, heart failure or hypertension, were reported in the English language and were published between 2000 and 2013. Data was extracted by one reviewer and checked by a second reviewer using a standardised form. Two assessors then rated the quality of each review using the Overview Quality Assessment Questionnaire (OQAQ). RESULTS: Of the 13 included reviews, four focused on telemonitoring interventions in hypertension or CVD management and the remaining 9 reviews investigated telemonitoring in HF management. Seven reviews scored a five or above on the OQAQ evidencing good quality reviews. Findings suggest that telemonitoring can contribute to significant reductions in blood pressure, decreased all-cause and HF related hospitalisations, reduced all-cause mortality and improved quality of life. Telemonitoring was also demonstrated to reduce health care costs and appears acceptable to patients. CONCLUSION: Telemonitoring has the potential to enhance primary care management of CVD by improving patient outcomes and reducing health costs. However, further research needs to explore the specific elements of telemonitoring interventions to determine the relative value of the various elements. Additionally, the ways in which telemonitoring care improves health outcomes needs to be further explored to understand the nature of these interventions.
