Detailed descriptions of the human resource requirements of home telehealth interventions for the management of coronary artery disease are difficult to obtain. Nurses are involved in virtually all interventions, with specialists frequently acting as co-implementers or consultants. Multi-disciplinary teams and formal care coordination appear to be a rarity, although it is possible that this aspect of home telehealth is simply not emphasized in the published literature.
Lack of information makes the effects of home telehealth on workflow difficult to determine. Management of coronary artery disease differs from most of the other chronic disease in this review in its emphasis on detecting critical events. As a result of this emphasis, there is a tendency for patient-provider contact to be initiated by the patient rather than the provider. This may complicate health human resource planning. However, it may also have benefits: one study found that providers were able to respond to clinical events significantly more quickly when a remote monitoring system was used. As this study was retrieved in a final scan of 2011-2012 literature and was not subject to the same level of analysis as the other studies included in this review, we will not attempt to extrapolate beyond the conclusions provided by its authors. See Crossley et al. (2011) for more details.
Another study found significant time savings when a remote monitoring system was implemented. Reduced appointment time was the main reason. Reviewing patients’ data transmissions took roughly one-third the time of in-office follow-up.
Little information was available on provider uptake or satisfaction with home telehealth.
Uptake and Use of Technology
Summary: Uptake and use of technology outcomes were measured in 1 study. It appears possible to achieve high levels of provider satisfaction with home telehealth interventions. More research is needed to establish the robustness of this finding.
Study Details: Raatikainen et al. (2008) carried out a satisfaction survey that showed that the majority of physicians were ‘satisfied’ or ‘very satisfied’ with the telehealth system.
Effects on Practice and Patient Care
Summary: Effects on practice and patient care were reported in 1 study. Findings indicate that use of home telehealth may alter physician assessment of medication needs and/or prescribing practices. The generalizability of this finding remains to be determined.
Study Details: Intervention group patients in Al-Khatib et al. (2010) were significantly less likely than control group patients to receive angiotensin receptor blockers at 6 months (11% vs. 24%; p=.04;) and at 12 months (9% vs. 23%; p=.05). They were also significantly less likely to receive potassium-sparing diuretics at 6 months (19% v. 34%, p=.02). There was no significant difference between groups in use of other medications at 6 months or at 12 months.
Recent Developments: A scan of material from 2011-2012, a time period not covered by our initial searches, found 1 additional article that addressed effects on practice and patient care (Crossley et al., 2011). In this study, a remote monitoring intervention enabled providers to respond to clinical events significantly more quickly. A significant reduction in mean length of hospital stay was found in patients. As this study was not subject to the same level of analysis as the other studies included in this review, we will not attempt further analysis. See Crossley et al. (2011) for more details.
Cost and Time Savings
Summary: Cost and time savings are reported in 1 study. Home telehealth was found to significantly reduce appointment time and time demands on other health facility staff. More research is needed to determine whether this holds true for most home telehealth intervention.
Study Details: Raatikainen et al. (2008) reports that physician time for reviewing transmitted patient data averaged 8.4 ±4.5 minutes (range 2-30), compared with a mean of 25.8 ± 18.0 minutes (range 5-90) for in-office follow-up. In addition, the time commitment for ‘additional hospital staff’ was significantly less when using remote monitoring (9.3±15.0 minutes vs. 45.3±30.6 minutes; p<.001).