None listed
Conditions
Brief summary
Chronic heart failure (CHF) is a complex medical condition characterised by recurrent exacerbations and a high rate of co-morbidities. An estimated 11,250 patients with CHF live within the South Metropolitan Health Service (SMHS) catchment area. The cost of CHF to the WA Health system is significant. According to the Epidemiology Branch, Department of Health (2011), from 2000 to 2010 (financial years from 2000/01-2009/10) CHF resulted in an average of 5,168 bed days per year in SMHS hospitals alone. A recent consensus statement by the National Heart Foundation and Cardiac Society of Australia and New Zealand conceded that outcomes for patients diagnosed with CHF “remain poor, often due to late diagnosis and inadequate disease management and support”. Many CHF patients are managed in primary care by their GP. However, there is currently limited support provided for GPs to conduct this challenging role, resulting in an overreliance on costly hospitalisations and use of tertiary health care when patients experience exacerbations. Moreover, in many cases, patients miss early warning signs and don’t engage GP care early when their changing condition can be managed effectively in a primary care setting. The aim of this study is to investigate a novel intervention that involves a community nursing model that is complemented by the use of telehealth to monitor patients remotely through online software. The core component of this approach will be a multifactorial telehealth intervention, facilitated by a CHF nurse. The telehealth intervention will be patient-centred, providing patients with education and support for self-management and have a strong focus on coordination of care through feedback of clinical information to GPs to help them implement timely medical follow up.
Interventions
This study will employ a novel 6 months telehealth intervention to complement community-based, nurse-support for CHF management. Central to this process will be the utilisation of Medtech 32, a modular practice management software. Medtech has a secure internet health portal (VitelMed) that enables individuals to upload daily clinical information, to allow them to engage electronically with the nurse to support self-management and more focussed patient care. The study’s nurse will review patient
This study will employ a novel 6 months telehealth intervention to complement community-based, nurse-support for CHF management. Central to this process will be the utilisation of Medtech 32, a modular practice management software. Medtech has a secure internet health portal (VitelMed) that enables individuals to upload daily clinical information, to allow them to engage electronically with the nurse to support self-management and more focussed patient care. The study’s nurse will review patients’ online records on a weekly basis and alerts will be set up on the system to highlight when a patient’s data suggests clinical changes and the requirement for the patient to seek medical advice. Patients without internet access will not be excluded from the study. They will be able to engage a family member to upload their clinical information, or will be provided with a diary to record clinical information that can be posted to the study’s Project Officer who will upload information on their behalf. To support the telehealth intervention participants will receive CHF education and have a telehealth heart failure management plan developed during an initial face to face appointment (2 hours) with the project’s CHF nurse. If a face to face appointment is not possible a telephone conference will be arranged. Participants will be provided with a computer tablet and three devices that monitor their health; scales, a blood pressure monitor and physical activity monitor and will be orientated to this equipment and software at the initial appointment. These devices stream data automatically to the computer tablet which then gets uploaded to VitelMed, so that it can be accessed remotely by the study’s nurse. Participants will be phoned once a week (15 minutes) for the first month to provide support for ongoing self-management and using the telehealth devices. Participants’ will also enter their self-management observations into the self-management database through a secure online portal for ongoing review by the project’s nurse. The nurse will undertake surveillance of participant’s recorded details and use these to guide self-management and link the participant to their GP/Cardiologist in the event of clinical deterioration.
Sponsors
Associate Professor Andrew Maiorana
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
prior hospital admission with a primary or secondary diagnosis of CHF
Exclusion criteria
1. Lack of fluency in English 2. Unable to give informed consent 3. Terminal illness such as metastatic cancer or severe hepatic/renal failure, significant cognitive impairment or physical inability to engage in self-care behaviours 4. Patients with severe end-stage CHF who are receiving palliative therapy
Outcome results
None listed