The purpose of home telehealth for patients with coronary artery disease is usually primary or secondary prevention of myocardial infarction. This is accomplished through lifestyle education and/pr ongoing monitoring for detection of critical events. Technologies used in these interventions include home electrocardiography (ECG) equipment, devices for transmitting ECG readings, and home telehealth units with touch screens for entering data.
The basic model of intervention, used in 6 of the 10 studies retrieved, was designed to facilitate remote monitoring and/or detection of critical events. In 2 of the studies, patients were ICD (implantable cardioverter-defibrillator) recipients (Al-Khatib et al., 2010; Raatikainen et al., 2008). In the other 8 studies, participants were given the training and equipment needed for home electrocardiography (ECG) (Chiantera et al., 2005; Giallauria, 2006; Morguet et al., 2008; Waldmann et al., 2008). Recordings were generally transmitted over home telephone lines and reviewed by providers. In most cases, patients also had ready access to a medical call centre or a member of their care team (Giallauria, 2006; Morguet et al., 2008; Raatikainen et al., 2008; Waldmann et al., 2008). The tendency for patient-provider contact to be initiated by the patient rather than by the provider was an unusual feature of the interventions in this section.
Human Resource Requirements
Few studies provided detailed descriptions of the human resources required for the telehealth intervention. Nurses were involved in virtually all, and it appeared that specialists frequently co-delivered the intervention or acted as consultants. However, multidisciplinary teams and formal care coordination were not prominently featured in any of the studies found. Whether these elements were truly absent from the interventions or simply not emphasized in the corresponding publications is uncertain.
In roughly half of the studies, technical requirements consisted of a 12-lead ECG recording unit or implanted ICD and a trans-telephonic transmission device (Al-Khatib et al., 2010; Chiantera et al., 2005; Giallauria, 2006; Morguet et al., 2008; Raatikainen et al., 2008; Waldmann et al., 2008). Additional patient-provider contact typically took place by telephone.
In 3 studies, patients used a home telehealth unit with a touchscreen and pre-programmed scripts on disease management. These scripts, or ‘disease dialogues’, included a set sequence of questions intended to be answered at regular intervals (Barnason et al., 2006, 2009; Miller et al, 2007). Patients’ responses were uploaded to a provider-accessible server and reviewed by research nurses.
Lindsay et al. (2008, 2009), was atypical. Technical requirements consisted of personal computers and broadband internet access. Patients were provided with this technology upon enrollment.
Departures from Basic Model
Though the majority of interventions were designed to enable remote patient management and detection of critical events, several aimed to improve patient lifestyles and health knowledge. Three studies used the ‘Health Buddy’, a home telehealth unit that provided educational resources and quizzed patients about symptoms and disease management practices (Barnason et al., 2006, 2009; Miller et al., 2007). Nurses reviewed patient uploads on a regular basis and ensured that the device was delivering an appropriate level of information. However, there was little direct contact between patients and providers.
Lindsay et al. (2008, 2009) were unique in their focus on peer support. Participants had access to an online disease management portal, including several discussion forums. While provider support was available, the emphasis appeared to be on patient empowerment and self-management ability. An interesting aspect of this intervention’s design was the inclusion of in-person meetings between intervention participants before the launch of the online discussion forums.