Telemonitoring in-home complex chronic patients from primary care in routine clinical practice: Impact on healthcare resources use

Figures & data

Figure 1. Study design and flow of participants through the study. IG: intervention group; RCT: randomized controlled trial; HF: heart failure; CLD: chronic lung disease; GP: General Practitioner.

Table 1. Parameters and initial thresholds.

Parameter	Thresholds	Observations
Systolic blood pressure (SBP)	100/150 mmHg	for HF patients
Diastolic blood pressure (DBP)	50/90 mmHg	for HF patients
Oxygen saturation (O2 sat)	<94% for HF patients <93% for CLD patients with or without HF	for all patients
Heart-rate	50/90 bpm	for all patients
Respiratory-rate	12/26 breaths/min.	for all patients
Weight gain	>1 kg/48 h.	for HF patients
Questionnaire
Compared to yesterday, do you feel the same, better or worse?	worse	for all patients
Compared to yesterday, do you breathe similarly/better/worse?	worse	for all patients
Have you taken all your medicines?		for all patients
Do you follow an appropriate and low salt diet?		for all patients
Is the swelling of your ankles the same as before,has it decreased or increased?	higher	for HF patients
Do you get up more often at night to urinate?Yes/no	yes	for HF patients;not applicable if usingincontinence pads
Compared to yesterday, do you cough more often?Yes/no	yes	for CLD patients
Compared to yesterday, do you have moreexpectoration? Yes/no	yes	for CLD patients
Compared to yesterday, is the colour of your sputum more greenish/yellowish? Yes/no	yes	for CLD patients
Lack of transmission in seven days with no hospital admission or other justified cause		generates an alert
Alert levelsRed alert Oxygen saturation or heart-rate for HF and CLD patients. Weight gain or DBP for HF patients. Increased cough or expectoration for CLD patients. A worsening of the functional and clinical status (questionnaire) together with an alert related to any of the clinical parameters. The red alerts generated during the weekend activate the following message on the smartphone: ‘remember that if your condition worsens, you should contact the emergency service’ Yellow alert: the remaining alerts.

HF: heart failure; CLD: chronic lung disease (COPD, asthma); DBP: diastolic blood pressure.

Table 2. Patients’ baseline characteristics.

	Total (n = 42)	Patients of the IGof TELBIL RCT(n = 15)	Newly recruitedpatients(n = 27)	P-value
Sociodemographic variables
Gender				0.853
Male, n (%)	19 (45.3%)	6 (40%)	13 (48.2%)
Female, n (%)	23 (54.7%)	9 (60%)	14 (51.8%)
Age, mean (SD)	78.9 (7.5)	80.5 (6.8)	77.9 (7.8)	0.103
Living with				0.654
Alone, n (%)	6 (14.3%)	2 (13.3%)	4 (14.8%)
Spouse/partner, n (%)	17 (40.5%)	7 (46.7%)	10 (37%)
Other relative, n (%)	12 (28.6%)	5 (33.3%)	7 (26%)
Others, n (%)	7 (16.6%)	1 (6.7%)	6 (22.2%)
Caregiver				0.097
Spouse/partner, n (%)	15 (35.7%)	6 (40%)	9 (33.3%)
Daughter, n (%)	14 (33.3%)	7 (46.7%)	7 (26%)
Son, n (%)	8 (20%)	0 (0%)	8 (29.6%)
Other relative, n (%)	4 (9.5%)	2 (13.3%)	2 (7.4%)
Others, n (%)	1 (2.4%)	0 (0%)	1 (3.7%)
Clinical and functional variables
Disease for inclusion				0.922
Heart failure, n (%)	6 (14.3%)	3 (20%)	3 (11.1%)
Chronic lung disease, n (%)	10 (23.8%)	3 (20%)	7 (25.9%)
Both, n (%)	24 (57.1%)	9 (60%)	15 (55.6%)
Another condition with CLD and Barthel <60	1 (2.4%)	0 (0%)	1 (3.7%)
Another condition with HF and Barthel <60	1 (2.4%)	0 (0%)	1 (3.7%)
Barthel index score, mean (SD)	68.3 (32)	72 (27.9)	66.3 (34.3)	0.843
Use of healthcare resources mean (SD)
Regularly taken medicines/day	12.3 (3.9)	11.5 (2.5)	12.8 (4.4)	0.299
All-cause hospital admissions/patient/year	2.6 (1.5)	3.1 (1.4)	2.4 (1.5)	0.108
Condition-specific^a hospital admissions/patient/year	2 (1.2)	2.2 (0.9)	1.8 (1.3)	0.199
Length of hospital stay (days)	10.7 (5.2)	10.8 (5.8)	10.6 (5)	0.807
Emergency department attendances/patient/year	4.1 (2.3)	4.5 (2.1)	3.8 (2.4)	0.288
EDA not followed by hospital admission/patient/year	1.4 (1.7)	1.4 (1.7)	1.4 (1.7)	0.989
% of EDA without hospital admission	60/170 (35.3%)	21/67 (31.3%)	39/103 (37.9%)	0.481

IG: intervention group; RCT: randomized controlled trial; SD: standard deviation; EDA: emergency department attendances;

^a Hospital admissions caused by respiratory, heart-related or another inclusion condition problems.

Table 3. Results of the before and after analysis on healthcare resources use (n = 28 patients).

	Before	After	P-value
All-cause hospital admissions, mean/patient/year (SD)	2.6 (1.6)	1.1 (1.5)	<0.001
Condition-specific hospital admissions^a, mean/patient/year (SD)	1.9 (1.2)	0.6 (1.2)	<0.001
Length of hospital stay, mean/patient/year (SD)	11.4 (6.9)	7.9 (3.3)	0.074
Emergency department attendances, mean/patient/year (SD)	4.2 (2.6)	2.11 (2.6)	<0.001
Emergency department attendances not followed by hospital admissions, mean/patient/year (SD)	1.7 (1.9)	1 (1.4)	0.034
Proportion of emergency department attendances not followed by hospital admission	60/170 (35.3%)	29/59 (49.1%)	0.084

^a Hospital admissions caused by respiratory or heart-related exacerbations.

SD: standard deviation.