Assessment of a primary care-based telemonitoring intervention for home care patients with heart failure and chronic lung disease. The TELBIL study Exploring telemonitoring and self-management by patients with chronic obstructive pulmonary disease: a qualitative study embedded in a randomized controlled trial. Evaluation of an Integrated Telemonitoring Surveillance System in Patients with Coronary Heart Disease. Effects of home telemonitoring to support improved care for chronic obstructive pulmonary diseases. Telemonitoring and Protocolized Case Management for Hypertensive Community-Dwelling Seniors With Diabetes: Protocol of the TECHNOMED Randomized Controlled Trial Home telemonitoring and quality of life in stable, optimised chronic obstructive pulmonary disease A randomized controlled trial of telemonitoring in older adults with multiple chronic conditions: the Tele-ERA study Continuity, but at what cost? The impact of telemonitoring COPD on continuities of care: a qualitative study. The Utah Remote Monitoring Project: improving health care one patient at a time. Telemonitoring of medication adherence in patients with schizophrenia. Randomised crossover trial of telemonitoring in chronic respiratory patients (TeleCRAFT trial) Experiences of patients and professionals participating in the HITS home blood pressure telemonitoring trial: a qualitative study Effectiveness of Telemonitoring in Patients with Chronic Obstructive Pulmonary Disease in Taiwan-A Randomized Controlled Trial Impact of telemonitoring at home on the management of elderly patients with congestive heart failure Compliance and effectiveness of 1 year's home telemonitoring. The report of a pilot study of patients with chronic heart failure Results of a telehealth-enabled chronic care management service to support people with long-term conditions at home Impact of telemonitoring home care patients with heart failure or chronic lung disease from primary care on healthcare resource use (the TELBIL study randomised controlled trial)
Background Telemonitoring technology offers one of the most promising alternatives for the provision of health care services at the patient 's home . The primary aim of this study is to evaluate the impact of a primary care-based telemonitoring intervention on the frequency of hospital admissions . Methods / design A primary care-based r and omised controlled trial will be carried out to assess the impact of a telemonitoring intervention aim ed at home care patients with heart failure ( HF ) and /or chronic lung disease ( CLD ) . The results will be compared with those obtained with st and ard health care practice . The duration of the study will be of one year . Sixty patients will be recruited for the study . In-home patients , diagnosed with HF and /or CLD , aged 14 or above and with two or more hospital admissions in the previous year will be eligible . For the intervention group , telemonitoring will consist of daily patient self- measurements of respiratory-rate , heart-rate , blood pressure , oxygen saturation , weight and body temperature . Additionally , the patients will complete a qualitative symptom question naire daily using the telemonitoring system . Routine telephone contacts will be conducted every fortnight and additional telephone contacts will be carried out if the data received at the primary care centre are out of the established limits . The control group will receive usual care . The primary outcome measure is the number of hospital admissions due to any cause that occurred in a period of 12 months post-r and omisation . The secondary outcome measures are : duration of hospital stay , hospital admissions due to HF or CLD , mortality rate , use of health care re sources , quality of life , cost-effectiveness , compliance and patient and health care professional satisfaction with the new technology . Discussion The results of this study will shed some light on the effects of telemonitoring for the follow-up and management of chronic patients from a primary care setting . The study may contribute to enhance the underst and ing of alternative modes of health care provision for medically unstable elderly patients , who bear a high degree of physical and functional deterioration . Trial Registration IS RCT N : IS RCT OBJECTIVE To explore patient and professional views on self-management in the context of telemonitoring in chronic obstructive pulmonary disease ( COPD ) . METHODS Semi-structured interviews with patients with COPD and healthcare professionals participating in a r and omized controlled trial of telemonitoring in Lothian , Scotl and , explored experiences of using telemonitoring , and dynamics in patient-practitioner relationships . Transcribed data were analyzed using the Framework approach . RESULTS 38 patients ( mean age 67.5 years ) and 32 professionals provided 70 interviews . Patients considered that telemonitoring empowered self-management by enhancing their underst and ing of COPD and providing additional justification for their decisions to adjust treatment or seek professional advice . Professionals discussed telemonitoring as promoting compliance with medical advice and encouraged patients to exercise personal responsibility within clinical parameters , but expressed concerns about promoting the sick role and creating dependence on telemonitoring . CONCLUSION Telemonitoring assisted many patients to embrace greater responsibility for their health but the model of service provision remained clinician-centered . A medical model of ' compliant self-management ' may paradoxically have promoted dependence on professionals . PRACTICE IMPLICATION S Patients and professionals shared responsibility for meeting the central objective of prompt management of exacerbations of COPD . Care is needed , however , to minimize the risk in some patients , of telemonitoring increasing dependence on practitioner support OBJECTIVES Cardiovascular diseases are the most frequent cause of death in industrialized countries . Non-adherence with prescribed medication and recommended lifestyle changes significantly increases the risk of major cardiovascular events . The telemonitoring programme MyCor ( Myokardinfarkt und Koronarstent Programm in Tirol ) is a multi-modal intervention programme to improve lifestyle and medication management of patients with coronary heart disease ( CHD ) . It includes patient education , self-monitoring with goal - setting and feedback , and regular clinical visits . We evaluated the MyCor telemonitoring programme regarding technical feasibility , user acceptance , patient adherence , change in health status , and change in quality of life . METHODS A 4½-month study was conducted with two telemonitoring phases and one interim phase . The study comprised patient surveys , st and ardized assessment of quality of life using the MacNew question naire at study entry and after 4 and 18 weeks , analysis of adherence to medication and physical activity during the two telemonitoring phases , and analysis of reached goals regarding health conditions during the telemonitoring phases . RESULTS Twenty-five patients ( mean age : 63 years ) participated in the study . Patients showed a high acceptance of the MyCor telemonitoring programme . Patients reported feelings of self-control , motivation for lifestyle changes , and improved quality of life . Adherence to daily measurements was high with 86 % and 77 % in the two telemonitoring phases . Adherence to medication was also high with up to 87 % and 80 % . Pre-defined goals for physical activity were reached in up to 86 % and 73 % of days , respectively . Quality of life improved from 5.5 at study entry to 6.3 at the end ( p < 0.01 ; MacNew question naire ) . Reductions in blood pressure and heart rate or an improvement in reaching defined goals could not be observed . CONCLUSIONS The MyCor telemonitoring programme Tirol for CHD patients has a high rate of acceptance among included patients . Critical evaluation revealed subjective benefits regarding quality of life and health status as well as high adherence rates to medication and lifestyle changes . Achieving long-term adherence and verifying clinical outcomes , however , remains an open issue . Our findings will promote further studies , addressing different strategies for an optimal mix of patient education , telemonitoring , feedback , and clinical follow-ups OBJECTIVE To assess the impact of a home telemonitoring technology on patients with chronic obstructive pulmonary disease in terms of care satisfaction , patient empowerment , improved quality of life , and utilization of hospital and home care . DESIGN A quasi-experimental retrospective and prospect i ve design was developed with a matched control group to compare the effects of telemonitoring  ( the experimental group , n = 23 ) with the traditional homecare offering  ( the control group , n = 23 ) . MEASUREMENTS Satisfaction , patient empowerment , and quality of life were measured using vali date d Likert scales , whereas the data on care utilization were collected from the participating patients ' medical record . RESULTS Mixed results were observed . The clinical effects of home telemonitoring were very positive in terms of patients ' satisfaction and empowerment . The perceptions of care providers as well as those of patients were congruent in this respect . Also , the study suggests that telemonitoring may have a positive effect on quality of life for patients with chronic obstructive pulmonary diseases . In contrast , the results were disappointing in terms of re source savings for the use of both homecare and hospital care . CONCLUSION Capturing the full potential of these new technologies will require a much more fundamental reorganization of work than just a simple deployment of the technology Background Diabetes and hypertension are devastating , deadly , and costly conditions that are very common in seniors . Controlling hypertension in seniors with diabetes dramatically reduces hypertension-related complications . However , blood pressure ( BP ) must be lowered carefully because seniors are also susceptible to low BP and attendant harms . Achieving “ optimal BP control ” ( ie , avoiding both undertreatment and overtreatment ) is the ultimate therapeutic goal in such patients . Regular BP monitoring is required to achieve this goal . BP monitoring at home is cheap , convenient , widely used , and guideline endorsed . However , major barriers prevent proper use . These may be overcome through use of BP telemonitoring — the secure teletransmission of BP readings to a health portal , where BP data are summarized for provider and patient use , with or without protocol ized case management . Objective To examine the incremental effectiveness , safety , cost-effectiveness , usability , and acceptability of home BP telemonitoring , used with or without protocol ized case management , compared with “ enhanced usual care ” in community-dwelling seniors with diabetes and hypertension . Methods A 300-patient , 3-arm , pragmatic r and omized controlled trial with blinded outcome ascertainment will be performed in seniors with diabetes and hypertension living independently in seniors ’ residences in greater Edmonton . Consenting patients will be r and omized to usual care , home BP telemonitoring alone , or home BP telemonitoring plus protocol ized pharmacist case management . Usual care subjects will receive a home BP monitor but neither they nor their providers will have access to teletransmitted data . In both telemonitored arms , providers will receive telemonitored BP data summaries . In the case management arm , pharmacist case managers will be responsible for review ing teletransmitted data and initiating guideline -concordant and protocol ized changes in BP management . Results Outcomes will be ascertained at 6 and 12 months . Within- study -arm change scores will be calculated and compared between study arms . These include : ( 1 ) clinical outcomes : proportion of subjects with a mean 24-hour ambulatory systolic BP in the optimal range ( 110 - 129 mmHg in patients 65 - 79 years and 110 - 139 mmHg in those ≥80 years : primary outcome ) ; additional ambulatory and home BP outcomes ; A1c and lipid profile ; medications , cognition , health care use , cardiovascular events , and mortality . ( 2 ) Safety outcomes : number of serious episodes of hypotension , syncope , falls , and electrolyte disturbances ( requiring third party assistance or medical attention ) . ( 3 ) Humanistic outcomes : quality of life , satisfaction , and medication adherence . ( 4 ) Economic outcomes : incremental costs , incremental cost-utility , and cost per mmHg change in BP of telemonitoring ± case management compared with usual care ( health payor and societal perspectives ) . ( 5 ) Intervention usability and acceptability to patients and providers . Conclusion The potential benefits of telemonitoring remain largely unstudied and unproven in seniors . This trial will comprehensively assess the impact of home BP telemonitoring across a range of outcomes . Results will inform the value of implementing home-based telemonitoring within supportive living residences in Canada . Trial Registration Clinical trials.gov NCT02721667 ; https:// clinical trials.gov/ct2/show/NCT02721667 ( Archived by Webcite at http://www.webcitation.org/6i8tB20Mc We conducted a six-month r and omised controlled trial of home telemonitoring for patients with chronic obstructive pulmonary disease ( COPD ) . A total of 40 stable patients with moderate to severe COPD who had completed pulmonary rehabilitation took part . They were r and omised to receive st and ard care ( controls ) or st and ard care plus home telemonitoring ( intervention ) . During the monitoring period , patients in the telemonitoring group recorded their symptoms and physical observations twice daily . The data were transmitted automatically at night via the home telephone line . Nurses could access the data through a website and receive alerting email messages if certain conditions were detected . The patients completed the St George 's Respiratory Question naire , Hospital Anxiety and Depression and the EuroQoL EQ-5D quality of life scores before and after pulmonary rehabilitation , and then periodically during the trial . There were significant and clinical ly important improvements in the scores immediately following pulmonary rehabilitation , but thereafter there were no differences in quality of life scores between the groups at any time , or consistently within either group over time . The study showed that telemonitoring was safe but , despite being well used , it was not associated with changes in quality of life in patients who had stable COPD Background Older adults with multiple chronic illnesses are at risk for worsening functional and medical status and hospitalization . Home telemonitoring may help slow this decline . This protocol of a r and omized controlled trial was design ed to help determine the impact of home telemonitoring on hospitalization . The specific aim of the study reads as follows : to determine the effectiveness of home telemonitoring compared with usual care in reducing the combined outcomes of hospitalization and emergency department visits in an at-risk population 60 years of age or older . Methods / Design Two-hundred patients with the highest 10 % Mayo Clinic Elder Risk Assessment scores will be r and omly assigned to one of two interventions . Home telemonitoring involves the use of a computer device , the Intel Health Guide , which records biometric and symptom data from patients in their homes . This information is monitored by midlevel providers associated with a primary care medical practice . Under the usual care scenario , patients make appointments with their providers as problems arise and use ongoing support such as a 24-hour nurse line . Patients will have initial evaluations of gait and quality of life using instruments such as the SF-12 Health Survey , the Kokmen Short Test of Mental Status , and the PHQ-9 health question naire . Patients will be followed for 1 year for primary outcomes of hospitalizations and emergency department visits . Secondary analysis will include quality of life , compliance with the device , and attitudes about telemonitoring . Sample size is based on an 80 % power to detect a 36 % difference between the two groups . The primary analysis will involve Cox proportional time-to-event analysis . Secondary analysis will use t-test comparisons for continuous variables and the chi square test for proportional analysis . Discussion Patients r and omized to home telemonitoring will have daily assessment s of their health status using the device . Registered nurse monitoring will assess any change in status followed by videoconferencing by a mid-level provider . We obtained trial registration and Institutional Review Board approval . Trial registration Trial registration number through http://www . clinical trials.gov:%20NCT01056640 BACKGROUND Continuity of care is widely regarded as an important marker of quality in the management of patients with long-term conditions . New services that integrate telemonitoring into care pathways have potential to change aspects of continuity in both positive and negative ways . AIMS A telemonitoring service for patients with chronic obstructive pulmonary disease ( COPD ) was introduced in Lothian , Scotl and , in 2009 . A qualitative study , nested within the TELESCOT COPD r and omised control trial , was undertaken to explore the views of patients and professionals on  telemonitoring . The perceived impact of telemonitoring on continuity of care was investigated as part of the research . METHODS Semi-structured interviews were undertaken with 38 patients ( 47 % male , mean age 67.5 years ) . A maximum variation sample in relation to age , sex , socio-economic background , disease severity , and compliance with telemonitoring was recruited . Thirty-two stakeholders ( healthcare professionals and managers ) were interviewed . Transcribed coded data were analysed thematically using the framework approach . Interpretation was supported by multidisciplinary discussion . RESULTS Patients and healthcare professionals considered that relationship-based continuity of care was important in the delivery of telemonitoring services . Managers placed emphasis on improved continuity of clinical management as a means of reducing healthcare costs . However , professionals described many operational challenges arising from the ' bolting-on ' of telemonitoring provision to existing usual care provision which , they considered , result ed in the proliferation of additional managerial discontinuities . CONCLUSIONS Managers and healthcare professionals face major challenges in meeting dem and s for both relationship continuity and continuity of clinical management in the development of telemonitoring services BACKGROUND The exp and ing role of technology to augment diabetes care and management highlights the need for clinicians to learn about these new tools . As these tools continue to evolve and enhance improved outcomes , it is imperative that clinicians consider the role of telemonitoring , or remote monitoring , in patient care . This article describes a successful  telemonitoring project in Utah . SUBJECTS AND METHODS This was a nonr and omized prospect i ve observational preintervention-postintervention study , using a convenience sample . Patients with uncontrolled diabetes and /or hypertension from four rural and two urban primary care clinics and one urban stroke center participated in a telemonitoring program . The primary clinical outcome measures were changes in hemoglobin A1C ( A1C ) and blood pressure . Other outcomes included fasting lipids , weight , patient engagement , diabetes knowledge , hypertension knowledge , medication adherence , and patient perceptions of the usefulness of the telemonitoring program . RESULTS Mean A1C decreased from 9.73 % at baseline to 7.81 % at the end of the program ( P<0.0001 ) . Systolic blood pressure also declined significantly , from 130.7 mm Hg at baseline to 122.9 mm Hg at the end ( P=0.0001 ) . Low-density lipoprotein content decreased significantly , from 103.9 mg/dL at baseline to 93.7 mg/dL at the end ( P=0.0263 ) . Other clinical parameters improved nonsignificantly . Knowledge of diabetes and hypertension increased significantly ( P<0.001 for both ) . Patient engagement and medication adherence also improved , but not significantly . Per question naires at study end , patients felt the telemonitoring program was useful . CONCLUSIONS Telemonitoring improved clinical outcomes and may be a useful tool to help enhance disease management and care of patients with diabetes and /or hypertension Nonadherence to medication is a widespread problem in schizophrenia and is associated with poor clinical outcomes and inappropriate management and utilization of re sources . The aim of the current investigation was to assess the impact of telemonitoring of medication adherence on symptomatology and service use in patients with schizophrenia . A total of 108 schizophrenia patients were r and omized into three equal groups according to the approaches used to assess medication adherence ; self-report , pill counting , and telemonitoring . Telementoring was achieved through an innovative new platform called @HOME . This platform offers clinicians early warnings about impeding nonadherence as well as information about the pattern of medication taking . Patient 's adherence was observed over an 8-week period , during which patient 's clinical status and service use were recorded . In comparison to the other two groups , patients using @HOME showed improvement in the Global Clinical Impression Scale and a significant reduction in emergency visits and medical appointments . The @HOME platform was highly acceptable by patients , caregivers , and professionals , and required minimal training for implementation . The results of the study suggest that the use of telemonitoring in psychiatric setting s was both feasible and acceptable and may be associated with significant clinical and service related benefits Objective To assess the impact of home telemonitoring on health service use and quality of life in patients with severe chronic lung disease . Design R and omised crossover trial with 6 months of st and ard best practice clinical care ( control group ) and 6 months with the addition of telemonitoring . Participants 68 patients with chronic lung disease ( 38 with COPD ; 30 with chronic respiratory failure due to other causes ) , who had a hospital admission for an exacerbation within 6 months of r and omisation and either used long-term oxygen therapy or had an arterial oxygen saturation ( SpO2 ) of < 90 % on air during the previous admission . Individuals received telemonitoring ( second-generation system ) via broadb and link to a hospital-based care team . Outcome measures Primary outcome measure was time to first hospital admission for an acute exacerbation . Secondary outcome measures were hospital admissions , general practitioner ( GP ) consultations and home visits by nurses , quality of life measured by EuroQol-5D and hospital anxiety and depression ( HAD ) scale , and self-efficacy score ( Stanford ) . Results Median ( IQR ) number of days to first admission showed no difference between the two groups—77 ( 114 ) telemonitoring , 77.5 ( 61 ) control ( p=0.189 ) . Hospital admission rate at 6 months increased ( 0.63 telemonitoring vs 0.32 control p=0.026 ) . Home visits increased during telemonitoring ; GP consultations were unchanged . Self-efficacy fell , while HAD depression score improved marginally during telemonitoring . Conclusions Telemonitoring added to st and ard care did not alter time to next acute hospital admission , increased hospital admissions and home visits overall , and did not improve quality of life in chronic respiratory patients . Trial registration number NCT02180919 ( Clinical Trials.gov ) Objectives To explore the experiences of patients and professionals taking part in a r and omised controlled trial ( RCT ) of remote blood pressure ( BP ) telemonitoring supported by primary care . To identify factors facilitating or hindering the effectiveness of the intervention and those likely to influence its potential translation to routine practice . Design Qualitative study adopting a qualitative descriptive approach . Participants 25 patients , 11 nurses and 9 doctors who were participating in an RCT of BP telemonitoring .  A maximum variation sample of patients from within the trial based on age , sex and deprivation status of the practice was sought . Setting 6 primary care practice s in Scotl and . Method Data were collected via taped semistructured interviews . Initial thematic analysis was inductive . Multiple strategies were employed to ensure that the analysis was credible and trustworthy . Results Prior to the trial , both patients and professionals were reluctant to increase the medication based on single BP measurements taken in the surgery . BP measurements based on multiple electronic readings were perceived as more accurate as a basis for action . Patients using telemonitoring became more engaged in the clinical management of their condition . Professionals reported that telemonitoring challenged existing roles and work practice s and increased workload . Lack of integration of telemonitoring data with the electronic health record was perceived as a drawback . Conclusions BP telemonitoring in a usual care setting can provide a trusted basis for medication management and improved BP control . It increases patients ’ engagement in the management of their condition , but supporting telemetry and greater patient engagement can increase professional workloads and dem and changes in service organisation . Successful service design in practice would have to take account of how additional roles and responsibilities could be realigned with existing work and data management practice s. The embedded qualitative study was included in the protocol for the HITS trial registered with IS RCT N no. 72614272 Chronic obstructive pulmonary disease ( COPD ) is the leading cause of death worldwide , and poses a substantial economic and social burden . Telemonitoring has been proposed as a solution to this growing problem , but its impact on patient outcome is equivocal . This r and omized controlled trial aim ed to investigate effectiveness of telemonitoring in improving COPD patient outcome . In total , 106 subjects were r and omly assigned to the  telemonitoring  ( n = 53 ) or  usual care ( n = 53 ) group . During the two months following discharge , telemonitoring group patients had to report their symptoms daily using an electronic diary . The primary outcome measure was time to first re-admission for COPD exacerbation within six months of discharge . During the follow-up period , time to first re-admission for COPD exacerbation was significantly increased in the telemonitoring group than in the usual care group ( p = 0.026 ) . Telemonitoring was also associated with a reduced number of all-cause re-admissions ( 0.23 vs. 0.68/patient ; p = 0.002 ) and emergency room visits ( 0.36 vs. 0.91/patient ; p = 0.006 ) . In conclusion , telemonitoring intervention was associated with improved outcomes among COPD patients admitted for exacerbation in a country characterized by a small territory and high accessibility to medical services . The findings are encouraging and add further support to implementation of telemonitoring as part of COPD care We studied the effects of home telemonitoring in elderly patients with congestive heart failure ( CHF ) on mortality and rate of hospitalization , compliance with treatment , quality of life and costs of CHF management , by comparison with a group receiving usual care . Fifty-seven elderly CHF patients were r and omized to st and ard care or to home telemonitoring-based care  and followed for 12 months . In the subjects who were monitored , weekly reports on their clinical status were obtained and their management was modified accordingly . Home telemonitoring was associated with improvements in the composite endpoint of mortality and rate of hospitalizations ( P = 0.006 ) , a better compliance with therapy , more frequent use of beta-blockers and statins , lower total cholesterol level and a better reported health perception score . The improved results with home telemonitoring in CHF were probably due to better compliance and to closer monitoring of the patients Patients with a diagnosis of heart failure , registered at the study practice , were recruited into the study . First , they had a cardiologist 's assessment . They were then r and omised into telemonitored patients who measured pulse , BP , weight and video consulted , and controls Both congestive heart failure and chronic obstructive pulmonary disease are more common among Māori than non-Māori people , and the cultural acceptability of home-based remote monitoring technology has not been tested . We conducted a 12-month pilot trial of home telemonitoring .  Patients were r and omly assigned to the control and intervention groups . Patients in the control group showed no clear differences in quality of life at the end of the trial . The telehealth group showed a consistent trend towards improved quality of life on several instruments , including the SF-36 , the St George Respiratory Question naire and the K10 question naire ; the improvement in the latter was significant . Hospitalizations were reduced in both the control ( −19 % ) and telehealth group ( −25 % ) . Patient interviews indicated that the technology was acceptable to most patients and their families , including the Māori . The results from the pilot trial suggest that wider implementation with a cost benefit evaluation could be worthwhile Background There is growing evidence that home telemonitoring can be advantageous in societies with increasing prevalence of chronic diseases . The main objective of this study is to evaluate the effect of a primary care-based telemonitoring intervention on the number and length of hospital admissions . Methods A r and omised controlled trial was carried out across 20 health centres in Bilbao ( Basque Country , Spain ) to assess the impact of home telemonitoring on in-home chronic patients compared with st and ard care . The study lasted for one year . Fifty-eight in-home patients , diagnosed with heart failure ( HF ) and /or chronic lung disease ( CLD ) , aged 14 or above and with two or more hospital admissions in the previous year were recruited . The intervention consisted of daily patient self- measurements of respiratory-rate , heart-rate , blood pressure , oxygen saturation , weight , body temperature and the completion of a health status question naire using PDAs . Alerts were generated when pre-established thresholds were crossed . The control group ( CG ) received usual care . The primary outcome measure was the number of hospital admissions that occurred at 12 months post-r and omisation . The impact of telemonitoring on the length of hospital stay , use of other healthcare re sources and mortality was also explored . Results The intervention group ( IG ) included 28 patients and the CG 30 . Patient baseline characteristics were similar in both groups . Of the 21 intervention patients followed-up for a year , 12 had some admissions ( 57.1 % ) , compared to 19 of 22 controls ( 86.4 % ) , being the difference statistically significant ( p = 0.033 , RR 0.66 ; 95%CI 0.44 to 0.99 ) . The mean hospital stay was overall 9 days ( SD 4.3 ) in the IG versus 10.7 ( SD 11.2 ) among controls , and for cause-specific admissions 9 ( SD 4.5 ) vs. 11.2 ( SD 11.8 ) days , both without statistical significance ( p = 0.891 and 0.927 , respectively ) . Four patients need to be telemonitored for a year to prevent one admission ( NNT ) . There were more telephone contacts in the IG than in the CG ( 22.6 -SD 16.1- vs. 8.6 -SD 7.2- , p = 0.001 ) , but fewer home nursing visits ( 15.3 -SD 11.6- vs. 25.4 -SD 26.3- , respectively ) , though the difference was not statistically significant ( p = 0.3603 ) . Conclusions This study shows that telemonitoring of in-home patients with HF and /or CLD notably increases the percentage of patients with no hospital admissions and indicates a trend to reduce total and cause-specific hospitalisations and hospital stay .  Home telemonitoring can constitute a beneficial alternative mode of healthcare provision for medically unstable elderly patients .Trial registration Current Controlled Trials IS RCT
RESULTS The magnitude and significance of the telemonitoring effects on patients ' conditions ( e.g. , early detection of symptoms , decrease in blood pressure , adequate medication , reduced mortality ) still remain inconclusive for all four chronic illnesses .
However , the results of this study suggest that regardless of their nationality , socioeconomic status , or age , patients comply with telemonitoring programs and the use of technologies .
Importantly , the telemonitoring effects on clinical effectiveness outcomes ( e.g. , decrease in the emergency visits , hospital admissions , average hospital length of stay ) are more consistent in pulmonary and cardiac studies than diabetes and hypertension .
Home telemonitoring of chronic diseases seems to be a promising patient management approach that produces accurate and reliable data , empowers patients , influences their attitudes and behaviors , and potentially improves their medical conditions .
OBJECTIVE Home telemonitoring represents a patient management approach combining various information technologies for monitoring patients at distance .
This study presents a systematic review of the nature and magnitude of outcomes associated with telemonitoring of four types of chronic illnesses : pulmonary conditions , diabetes , hypertension , and cardiovascular diseases .