Marlien Varnfield

Design of a multi-site multi-state clinical trial of home monitoring of chronic disease in the community in Australia

BackgroundTelehealth services based on at-home monitoring of vital signs and the administration of clinical questionnaires are being increasingly used to manage chronic disease in the community, but few statistically robust studies are available in Australia to evaluate a wide range of health and socio-economic outcomes. The objectives of this study are to use robust statistical methods to research the impact of at home telemonitoring on health care outcomes, acceptability of telemonitoring to patients, carers and clinicians and to identify workplace cultural factors and capacity for organisational change management that will impact on large scale national deployment of telehealth services. Additionally, to develop advanced modelling and data analytics tools to risk stratify patients on a daily basis to automatically identify exacerbations of their chronic conditions.Methods/DesignA clinical trial is proposed at five locations in five states and territories along the Eastern Seaboard of Australia. Each site will have 25 Test patients and 50 case matched control patients. All participants will be selected based on clinical criteria of at least two hospitalisations in the previous year or four or more admissions over the last five years for a range of one or more chronic conditions. Control patients are matched according to age, sex, major diagnosis and their Socio-Economic Indexes for Areas (SEIFA). The Trial Design is an Intervention control study based on the Before-After-Control-Impact (BACI) design.DiscussionOur preliminary data indicates that most outcome variables before and after the intervention are not stationary, and accordingly we model this behaviour using linear mixed-effects (lme) models which can flexibly model within-group correlation often present in longitudinal data with repeated measures. We expect reduced incidence of unscheduled hospitalisation as well as improvement in the management of chronically ill patients, leading to better and more cost effective care. Advanced data analytics together with clinical decision support will allow telehealth to be deployed in very large numbers nationally without placing an excessive workload on the monitoring facility or the patients own clinicians.Trial registrationRegistered with Australian New Zealand Clinical Trial Registry on 1st April 2013. Trial ID: ACTRN12613000635763

Telehealth Monitoring of Patients in the Community

Abstract This article outlines a decision support system that seeks to help community nurses monitor the well-being of their chronically ill patients. It is designed for nurses to stay in contact with their patients without spending unnecessary time on less productive aspects of community nursing, such as avoidable driving to and from patients’ houses and taking measurements of vital signs to assess their health condition. It therefore allows the nurse to spend more time on managing the factors that could lead to a healthier patient. The decision support system is developed for two levels of mathematical capability. Nurses with a statistical background are provided with in-depth information allowing them to detect changes in mean, mean square error (and hence variation), and correlations using a variation on dynamic principle components. Less mathematically inclined nurses are offered information about trends, change points, and a simpler multivariate view of a patient’s well-being involving parallel coordinate plots.

Information and communication technology-based cardiac rehabilitation homecare programs

License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php Smart Homecare Technology and TeleHealth 2015:3 69–79 Smart Homecare Technology and TeleHealth Dovepress

Care assessment platform: An ICT-enabled home care model for secondary prevention of cardiovascular diseases

Background: Cardiovascular disease (CVD) is the leading chronic diseases affecting developed countries. Traditional approach to secondary prevention of CVD through hospital-based cardiac rehabilitation (CR) is hampered by the lack of uptake and adherence.

A study on the implementation of large-scale home telemonitoring service

We present the early findings from a longitudinal study of a multi-site home telemonitoring program for chronic disease management. The study aims to find out how the telehealth service is integrated into existing models of care at each site and how it impacts on practices and care processes within each particular setting. We identified potential implementation barriers perceived by clinicians. We highlight differences in healthcare settings and various ways that structures and practices have been configured in these sites. Our study seeks to expend the focus of research longitudinally and across different local settings and contributes to recent research in large-scale and home care applications.

Telehealth for chronic disease management: do we need to RE-AIM?

An increasing number of individuals are living with long term health conditions which they manage most of the time by themselves. This paper evaluates the use of information and communications technology platforms to provide evidence-based programs to help people with chronic disease to self-management these. It describes two different self-management strategies for chronic conditions, and the evaluation of their implementation in clinical trials, specifically in terms of reach, implementation fidelity, adoption and user perceptions. It also discusses the challenges in replicating trial findings in the real world, using the RE-AIM framework.

Mobile applications towards prevention and management of chronic diseases

Chronic disease is the leading cause of death and disability, and poses a major burden to heathcare systems in Australia and other western countries. To alleviate this burden, we developed three mobile phone based solutions to address primary and secondary prevention of the leading chronic diseases such as cardiovascular diseases and chronic obstructive pulmonary diseases. This paper focuses on how the mobile solutions could address the clinical problems, and briefly discusses some of the preliminary findings.

USE OF MOBILE PHONE BASED HEALTH APPLICATIONS IN HOME CARE DELIVERY OF CARDIAC REHABILITATION

Cardiovascular disease is the leading cause of death and one of the greatest burdens to economies worldwide. Cardiac rehabilitation can effectively address risk factors prevalent to cardiovascular disease, as well as reduce morbidity and mortality. In spite of documented benefits, poor rates of referral, uptake and utilization of cardiac rehabilitation programs continue. The Care Assessment Platform (CAP) is an innovative home care model which provides an alternative delivery approach to rehabilitation for cardiac patients, utilising a mobile phone platform. This paper reports results on use and user acceptance of mobile phone applications utilised in the CAP model and evaluated in a randomized controlled trial. The implementation of mobile applications in the CAP model showed high usage and acceptance by patients (>85%). Mobile applications, such as a health diary and step counter, show promise in supporting self monitoring and management of lifestyle related health risk factors in the management of other chronic diseases.

A Multidisciplinary Smartphone-Based Application to Empower Patients with Acute Coronary Syndromes: A Qualitative Study on Healthcare Providers Perspectives (Preprint)

Background Postdischarge interventions are limited in patients with acute coronary syndrome (ACS) due to few scheduled visits to outpatient clinics and travel from remote areas. Smartphones have become a viable lifestyle technology to deliver educational and health interventions following discharge from hospital. Objective The purpose of this study was to identify the requirements for the delivery of a mobile health intervention for the postdischarge management of patients with ACS via a multidisciplinary focus group. Methods We conducted a focus group among health care professionals (n=10) from a large metropolitan hospital in May 2017. These participants from a multidisciplinary team contributed to a 1-hour discussion by responding to 8 questions relating to the applicability of smartphone-based educational and health interventions. Descriptive statistics of the focus group data were analyzed using SPSS. The qualitative data were analyzed according to relevant themes extracted from the focus group transcription, using a qualitative description software program (NVivo 11) and an ontology-based concept mapping approach. Results The mean age of the participants was 47 (SD 8) years: 3 cardiologists; 2 nurse practitioners; 2 clinical nurses; 2 research scientists; and 1 physiotherapist. Of these participants, 70% (7/10) had experience using electronic health intervention during their professional practice. A total of 7 major themes and their subthemes emerged from the qualitative analysis. Health care providers indicated that comprehensive education on diet, particularly providing daily meal plans, is critical for patients with ACS. In terms of ACS symptoms, a strong recommendation was to focus on educating patients instead of daily monitoring of chest pain and shortness of breathing due to subjectivity and insufficient information for clinicians. Participants pointed that monitoring health measures such as blood pressure and body weight may result in increased awareness of patient physical health, yet may not be sufficient to support patients with ACS via the smartphone-based intervention. Therefore, monitoring pain and emotional status along with other health measures was recommended. Real-time support via FaceTime or video conferencing was indicated as motivational and supportive for patient engagement and self-monitoring. The general demographics of patients with ACS being older, having a low educational level, and a lack of computer skills were identified as potential barriers for engagement with the smartphone-based intervention. Conclusions A smartphone-based program that incorporates the identified educational materials and health interventions would motivate patients with ACS to engage in the multidisciplinary intervention and improve their health outcomes following discharge from hospital.