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telemonitoring - Top 30 Publications

Acceptance of Telemonitoring Among Patients with Obstructive Sleep Apnea Syndrome: How is the Perceived Interest by and for Patients?

Obstructive sleep apnea syndrome, a chronic respiratory disease, requires regular adherence to Continuous Positive Airway Pressure (CPAP) therapy. Telemonitoring may be relevant to support adherence, but nonetheless this raises ethical issues around the intrusive nature of the daily life of patients Objective: To explore the acceptance of telemonitoring by patients and the impact of this on adherence.

Does remote monitoring change OSA management and CPAP adherence?

It is increasingly recognized that the high prevalence of obstructive sleep apnoea (OSA), and its associated cardio-metabolic morbidities make OSA a burden for society. Continuous positive airway pressure (CPAP), the gold standard treatment, needs to be used for more than 4 h/night to be effective, but suffers from relatively poor adherence. Furthermore, CPAP is likely to be more effective if combined with lifestyle changes. Thus, the remote telemonitoring (TM) of OSA patients in terms of CPAP use, signalling of device problems, following disease progression, detection of acute events and monitoring of daily physical activity is an attractive option. In the present review, we aim to summarize the recent scientific data on remote TM of OSA patients, and whether it meets expectations. We also look at how patient education and follow-up via telemedicine is used to improve adherence and we discuss the influence of the profile of the healthcare provider. Then, we consider how TM might be extended to encompass the patient's cardio-metabolic health in general. Lastly, we explore how TM and the deluge of data it potentially generates could be combined with electronic health records in providing personalized care and multi-disease management to OSA patients.

Assessment of a Business-to-Consumer (B2C) model for Telemonitoring patients with Chronic Heart Failure (CHF).

The purpose of this study is to assess the Business-to-Consumer (B2C) model for telemonitoring patients with Chronic Heart Failure (CHF) by analysing the value it creates, both for organizations or ventures that provide telemonitoring services based on it, and for society.

Innovative Telemonitoring Enhanced Care Programme for Chronic Heart Failure (ITEC-CHF) to improve guideline compliance and collaborative care: protocol of a multicentre randomised controlled trial.

Chronic heart failure (CHF) is a life-threatening chronic disease characterised by periodic exacerbations and recurrent hospitalisations. In the management of CHF, patient compliance with evidence-based clinical guidelines is essential, but remains difficult practically. The objective of this study is to examine whether an Innovative Telemonitoring Enhanced Care Programme for CHF (ITEC-CHF) improves patients' compliance, and associated health and economic outcomes.

Remote consulting with telemonitoring of continuous positive airway pressure usage data for the routine review of people with obstructive sleep apnoea hypopnoea syndrome: A systematic review.

Introduction Telehealth has the potential to offer more convenient care and reduce travel. We aimed to systematically review studies that assessed the effectiveness of teleconsultation plus telemonitoring in the review of people with obstructive sleep apnoea hypopnoea syndrome receiving continuous positive airway pressure therapy versus face-to-face care. Methods Following Cochrane methodology, we searched 10 electronic databases (November 2015), trial registries, and reference lists of included studies, for trials testing interventions that combined remote consultations with telemonitoring of usage/continuous positive airway pressure data. Outcomes measures were: proportion reviewed, continuous positive airway pressure adherence, symptom control, and satisfaction/acceptability and cost effectiveness. Results From 362 potentially relevant papers, we identified five randomised controlled trials ( n = 269 patients): four from North America and one from Spain. Risk of bias was moderate in one, and moderate/high in four trials. Two trials reported number/duration of reviews with inconsistent results. The teleconsultation/telemonitoring improved continuous positive airway pressure adherence in two trials ( n = 19; n = 75); two ( n = 114 and n = 75) reported no between-groups differences. Two studies, both at moderate/high risk of bias, showed no between-group difference in the Epworth Sleepiness Score. Satisfaction was generally reported positively in all five trials; one trial reported that the teleconsultation/telemonitoring patients were 'more likely to continue' with continuous positive airway pressure therapy treatment. One study reported teleconsultation/telemonitoring as cost effective. Discussion The evidence for teleconsultation/telemonitoring in continuous positive airway pressure users is limited; however, no safety concerns have been raised. Adequately powered, well-designed trials are needed to establish whether real-time telemonitoring and remote teleconsultation is a clinically and cost effective option for people using continuous positive airway pressure therapy.

Comparative effectiveness of telemedicine strategies on type 2 diabetes management: A systematic review and network meta-analysis.

The effects of telemedicine strategies on the management of diabetes is not clear. This study aimed to investigate the impact of different telemedicine strategies on glycaemic control management of type 2 diabetes patients. A search was performed in 6 databases from inception until September 2016 for randomized controlled studies that examined the use of telemedicine in adults with type 2 diabetes. Studies were independently extracted and classified according to the following telemedicine strategies: teleeducation, telemonitoring, telecase-management, telementoring and teleconsultation. Traditional and network meta-analysis were performed to estimate the relative treatment effects. A total of 107 studies involving 20,501 participants were included. Over a median of 6 months follow-up, telemedicine reduced haemoglobin A1c (HbA1c) by a mean of 0.43% (95% CI: -0.64% to -0.21%). Network meta-analysis showed that all telemedicine strategies were effective in reducing HbA1c significantly compared to usual care except for telecase-management and telementoring, with mean difference ranging from 0.37% and 0.71%. Ranking indicated that teleconsultation was the most effective telemedicine strategy, followed by telecase-management plus telemonitoring, and finally teleeducation plus telecase-management. The review indicates that most telemedicine strategies can be useful, either as an adjunct or to replace usual care, leading to clinically meaningful reduction in HbA1c.

Utilizing a Homecare Platform for Remote Monitoring of Patients with Idiopathic Pulmonary Fibrosis.

Homecare and home telemonitoring are a focal point of emerging healthcare schemes, with proven benefits for both patients, caregivers and providers, including reduction of healthcare costs and improved patients' quality of life, especially in the case of chronic disease management. Studies have evaluated solutions for remote monitoring of chronic patients based on technologies that allow daily symptom and vital signs monitoring, tailored to the needs of specific diseases. In this work, we present an affordable home telemonitoring system for patients with idiopathic pulmonary fibrosis (IPF), based on an application for mobile devices and Bluetooth-enabled sensors for pulse oximetry and blood pressure measurements. Besides monitoring of vital signs, the system incorporates communication via videoconferencing and emergency response, with support from a helpdesk service. A pilot study was conducted, in order to verify the proposed solution's feasibility. The results support the utilization of the system for effective monitoring of patients with IPF.

Telemedicine for Facio-Scapulo-Humeral Muscular Dystrophy: A multidisciplinary approach to improve quality of life and reduce hospitalization rate?

Facio-Scapulo-Humeral Muscular Dystrophy (FSHD) is an autosomal dominant inherited disorder characterized by a variable and asymmetric involvement of facial, trunk, upper and lower extremity muscles. Although respiratory weakness is a relatively unknown feature of FSHD, it is not rare. Telemedicine has been used in a variety of health care fields, but only recently, with the advent of sophisticated technology, its interest among health professionals became evident, even in such diseases.

Effectiveness of Telemonitoring in Obstetrics: Scoping Review.

Despite reported positive results of telemonitoring effectiveness in various health care domains, this new technology is rarely used in prenatal care. A few isolated investigations were performed in the past years but with conflicting results.

Optimal Signal Quality Index for Photoplethysmogram Signals.

A photoplethysmogram (PPG) is a noninvasive circulatory signal related to the pulsatile volume of blood in tissue and is typically collected by pulse oximeters. PPG signals collected via mobile devices are prone to artifacts that negatively impact measurement accuracy, which can lead to a significant number of misleading diagnoses. Given the rapidly increased use of mobile devices to collect PPG signals, developing an optimal signal quality index (SQI) is essential to classify the signal quality from these devices. Eight SQIs were developed and tested based on: perfusion, kurtosis, skewness, relative power, non-stationarity, zero crossing, entropy, and the matching of systolic wave detectors. Two independent annotators annotated all PPG data (106 recordings, 60 s each) and a third expert conducted the adjudication of differences. The independent annotators labeled each PPG signal with one of the following labels: excellent, acceptable or unfit for diagnosis. All indices were compared using Mahalanobis distance, linear discriminant analysis, quadratic discriminant analysis, and support vector machine with leave-one-out cross-validation. The skewness index outperformed the other seven indices in differentiating between excellent PPG and acceptable, acceptable combined with unfit, and unfit recordings, with overall F 1 scores of 86.0%, 87.2%, and 79.1%, respectively.

Comparative Effectiveness of Telemonitoring Versus Usual Care for Heart Failure: a Systematic Review and Meta-Analysis.

This study aimed to evaluate the effectiveness of telemonitoring (TM) in the management of patients with heart failure (HF).

Development and feasibility of a web application to monitor patients' cancer-related pain.

In the outpatient setting, pain management is often inadequate in patients with cancer-related pain, because of patient- and professional-related barriers in communication and infrequent contacts. The internet may provide new opportunities for monitoring these patients.

Impact of At-Home Telemonitoring on Health Services Expenditure and Hospital Admissions in Patients With Chronic Conditions: Before and After Control Intervention Analysis.

Telemonitoring is becoming increasingly important for the management of patients with chronic conditions, especially in countries with large distances such as Australia. However, despite large national investments in health information technology, little policy work has been undertaken in Australia in deploying telehealth in the home as a solution to the increasing demands and costs of managing chronic disease.

Telemonitoring in fasting individuals with Type 2 Diabetes Mellitus during Ramadan: A prospective, randomised controlled study.

We determined the impact of a remote blood glucose telemonitoring program with feedback in type 2 diabetes mellitus patients fasting during Ramadan compared to conventional self-monitoring method. A twelve-week cluster randomised study, with 85 participants who wish to fast for at least 15 days during Ramadan was conducted. Self-measurement and transmission of blood glucose results were performed six times daily during Ramadan. Results were transmitted to a secure website for review with feedback from case manager if necessary. The control group received usual care. The main outcome was the number of participants experiencing hypoglycaemia during Ramadan and at the end of the study. During Ramadan, the number of participants reporting hypoglycaemia was significantly lower in the telemonitoring group [Odds ratio (OR): 0.186, 95% confidence interval: 0.04-0.936; p = 0.04]. Similarly, the proportion of participants reporting symptomatic hypoglycaemia at the end of the study was significantly lower in the telemonitoring group (OR: 0.257, 95% CI: 0.07-0.89; p = 0.03). A reduction of 1.07% in glycated haemoglobin levels was observed in the telemonitoring group compared to 0.24% in the control group (p < 0.01). Overall, telemonitoring was a useful adjunct to reduce the risk of hypoglycaemia during Ramadan with no deterioration in glycaemic control.

Effect of Telemedicine Education and Telemonitoring on CPAP Adherence: The Tele-OSA Randomized Trial.

Rationale- Automated telemedicine interventions could potentially improve adherence to continuous positive airway pressure therapy (CPAP). Objective-Examining the effects of telemedicine-delivered obstructive sleep apnea (OSA) education and CPAP telemonitoring with automated patient feedback messaging on CPAP adherence. Methods-This 4-arm, randomized, factorial-design clinical trial enrolled 1455 patients (51.0% women, age 49.1±12.5 years) referred for suspected OSA. 956 underwent home sleep apnea testing and 556 were prescribed CPAP. Two telemedicine interventions were implemented: (a) web-based OSA education (Tel-Ed); (b) CPAP telemonitoring with automated patient feedback (Tel-TM). Patients were randomized to (1) Usual Care, (2) Tel-Ed added, (3) Tel-TM added, or (4) Tel-Ed and Tel-TM added (Tel-Both). Measurements-Primary endpoint was 90-day CPAP usage. Secondary endpoints included attendance to OSA evaluation, and change in Epworth Sleepiness Scale score. Main Results- CPAP average daily use at 90 days was 3.8±2.5, 4.0±2.4, 4.4±2.2 and 4.8±2.3 hours in Usual Care, Tel-Ed, Tel-TM and Tel-Both groups. Usage was significantly higher in the Tel-TM and Tel-Both groups versus Usual Care (p=0.0002 for both) but not for Tel-Ed (p=0.10). Medicare adherence rates were 53.5%, 61.0%, 65.6% and 73.2% in Usual Care, Tel-Ed, Tel-TM and Tel-Both groups (Tel-Both vs Usual Care, p=0.001; Tel-TM vs Usual Care, p=0.003; Tel-Ed vs Usual Care, p=0.07). Telemedicine education improved clinic attendance compared to no telemedicine education (show rate 68.5% vs 62.7%; p=0.02). Conclusions-The use of CPAP telemonitoring with automated feedback messaging improved 90-day adherence in OSA patients. Telemedicine-based education did not significantly improve CPAP adherence but did increase clinic attendance for OSA evaluation. Clinical trial registration available at www.clinicaltrials.gov, ID NCT02279901.

Telemonitoring via Self-Report and Video Review in Community Palliative Care: A Case Report.

Continuous monitoring and management of a person's symptoms and performance status are critical for the delivery of effective palliative care. This monitoring occurs routinely in inpatient settings; however, such close evaluation in the community has remained elusive. Patient self-reporting using telehealth offers opportunities to identify symptom escalation and functional decline in real time, and facilitate timely proactive management. We report the case of a 57-year-old man with advanced non-small cell lung cancer who participated in a telehealth trial run by a community palliative care service. This gentleman was able to complete self-reporting of function and symptoms via iPad although at times he was reticent to do so. Self-reporting was perceived as a means to communicate his clinical needs without being a bother to the community palliative care team. He also participated in a videoconference with clinical staff from the community palliative care service and his General Practitioner. Videoconferencing with the nurse and GP was highly valued as an effective way to communicate and also because it eliminated the need for travel. This case report provides important information about the feasibility and acceptability of palliative care telehealth as a way to better manage clinical care in a community setting.

Legal considerations of telemedical care.

Telemedical methods are on the rise in patient care. In addition to the actual changes for both sides in the physician-patient relationship, the use of information and communication technology also involves legal challenges. This article deals with the legal framework of telemedical care. Thereby the article discusses the prohibition of remote treatment (§ 7 Abs. 4 MBO-Ä) and the question to what extent the omission of a telemedical method of treatment can fulfill a medical breach of duty. A distinction must be drawn between the question as to whether telemedical monitoring shall be executed and the question how to use telemedical systems, in order to mitigate liability risks for the physicians. The physician can for example violate his/her medical duties by not sufficiently informing the patient about all essential circumstances concerning the consent, by not adequately monitoring the functioning of the telemedical devices, or by not reacting fast enough to telemedical occurrence reports. All this may lead to a case of liability.

Current status and future of telemonitoring : Scenarios for telemedical care in 2025.

Telemonitoring is an already realized implementation of digital transformation in the healthcare system. It has the potential to support and secure a sustainable and comprehensive provision of healthcare for a rising number of chronically ill patients, e. g. patients with chronic heart failure. Remote regions in particular can profit from the benefits of telemonitoring; however, so far telemonitoring services have not become truly established in the German healthcare market. Together with experts from politics, science and practice, a scenario analysis "Health Care System 2025 - A Place for Telemonitoring?" was carried out with the aim to examine the future development of the healthcare market and to draw conclusions for providers of telemonitoring services or devices. The scenario analysis contained two workshops and an expert survey and was supported by a scenario software. The current drivers and barriers of the diffusion of telemonitoring were identified and the most relevant factors that influence the future development of the healthcare market were discussed. Based on those influencing factors, three different scenarios were determined: (1) administrating rather than shaping, (2) safely into the future and (3) interconnected and digital world. In the subsequent consequence analysis activities were defined, which describe the necessary infrastructure, software instruments, organizational structures and provision of services and discuss possible activities, which prepare telemonitoring solutions for the future.

The telemedical service centre as an essential element of the conceptual approach for telemonitoring of cardiac patients : Requirements on the service, quality, and technical realization of telemonitoring.

Telemonitoring as part of a treatment strategy supports and facilitates the monitoring, disease management and education of patients with heart failure and cardiac arrhythmias. Therefore, telemonitoring affects quality and success of the therapy. Thus, meeting the needs of the patients and of the involved health care professionals is important for the success of the telemonitoring service. Moreover, a high quality of the service has to be ensured. The following article describes several configuration options for telemonitoring services considering technical as well as quality- and service-related aspects.

Active cardiac implantable electronic devices: What is possible in ambulatory health care in 2017?

Telemonitoring (TM) features are implemented in nearly all cardiac implantable electronic devices (CIEDs) that have recently been released to the market. In combination with pacemakers, defibrillators and systems for cardiac resynchronization it is a safe and efficient method for routine technical aftercare of the devices as well as for monitoring heart failure and arrhythmias. Using TM has the potential to optimize patient care with regard to economic, clinical and safety aspects. Despite the good availability of existing data and clear recommendations of the responsible scientific societies, it is often seen as an isolated solution which is not fully integrated into standard care, although it has its own EBM number for implantable cardioverter-defibrillators and cardiac resynchronization therapy systems. The reasons are not only the unsatisfactory reimbursement of costs, different IT structures and the borders between clinics and medical practices, but also acceptance problems of physicians and legal aspects. The compensation of cardiac pacemakers and 'event recorders' is unsolved. TM provides the prospect for optimal and cross-sectoral patient care. Furthermore it has the potential to become the standard method for the care for patients with a CIED.

Non-device-based telemonitoring : Toy or tool?

Non-device-based telemedical management can be useful to prevent decompensation and death in patients suffering from easily disequilibrated conditions like diabetes mellitus, chronic obstructive pulmonary disease and heart failure (HF). This article summarizes current knowledge on non-device-based telemedical care for patients with HF. Several parameters (heart rate, heart rate variability, systolic blood pressure, pulse pressure, body weight, physical activity as derived from accelerometry, and occurrence of atrial and ventricular arrhythmias) have been identified as being associated with imminent clinical deterioration of HF patients. Structured telephone-based support and noninvasive telemonitoring with integrated electronic transfer of physiological data have been applied to care for HF patients and have been evaluated in multiple studies. The impact of telemedical care on clinical outcome appears to depend on the applied telemedical configuration and on the disease severity of targeted populations. The exclusive use of an automated telephone response system has not been successful. In patients with optimal medical therapy and relatively low decompensation risk noninvasive telemonitoring did not significantly reduce mortality. Nevertheless meta-analyses of structured telephone support and of noninvasive telemonitoring combining knowledge from available randomized trials suggest that both of these telemedical approaches may reduce the mortality risk of HF patients by 13-20%. The results of the Telemedical Interventional Management in Heart Failure II (TIM-HF II) trial on noninvasive telemonitoring versus usual care in 1500 high-risk HF patients are awaited in 2018 and will further clarify the usefulness of telemedical care in this field.

Acceptance and usability of a home-based monitoring tool of health indicators in children of people with dementia: a Proof of Principle (POP) study.

Large-scale cohort studies are needed to confirm the relation between dementia and its possible risk factors. The inclusion of people with dementia in research is a challenge, however, children of people with dementia are at risk and are highly motivated to participate in dementia research. For technologies to support home-based data collection during large-scale studies, participants should be able and willing to use technology for a longer period of time.

Effects of telemonitoring on glycaemic control and healthcare costs in type 2 diabetes: A randomised controlled trial.

Introduction This study examined the effect of a telehealth intervention on the control of type 2 diabetes and subsequent potential cost-savings to the health system. Methods This prospective randomised controlled trial randomised adults with type 2 diabetes to the intervention (diabetes program) or control (usual care) arm. Key eligibility criteria included an HbA1c level of at least 58 mmol/mol (7.5%) without severe or unstable comorbidities. All participants continued their usual healthcare, but participants in the intervention arm received additional diabetes care from a diabetes care coordinator via a home monitor that captured clinical measures. Data collected included biomedical, quality of life measures and healthcare (GP, outpatient and inpatient) costs. The primary outcome was HbA1c collected at baseline and 6 months. Analysis was conducted on a complete case intention-to-treat basis. The healthcare system perspective was taken to calculate the incremental cost per percentage-point reduction in HbA1c. Results Results from 63 participants from each study arm were analysed. HbA1c in the intervention group decreased from a median 68 mmol/mol (8.4%) to 58 mmol/mol (7.5%), and remained unchanged in the control group at median 65 mmol/mol (8.1%) at the 6-month endpoint. The intervention effect on HbA1c change was statistically significant ( p = .004). Total healthcare costs in the intervention group, including the intervention costs, were lower (mean $3781 vs. $4662; p < .001) compared with usual care. Discussion There was a clinically meaningful and statistically significant benefit from the telehealth intervention at a lower cost; thus, telehealth was cost-saving and produced greater health benefits compared with usual care.

Telehealth pulmonary rehabilitation: A review of the literature and an example of a nationwide initiative to improve the accessibility of pulmonary rehabilitation.

Several different applications of telehealth technologies have been used in the care of respiratory patients, including telemonitoring, teleconsultations, tele-education, and telehealth-pulmonary rehabilitation (PR). Telehealth technology provides an opportunity to assist in the management of chronic respiratory diseases and improve access to PR programs. While there is inconclusive evidence as to the effectiveness of telemonitoring to reduce healthcare utilization and detection of exacerbations, teleconsultations have been shown to be an effective means to assess patients' disease prior to the initiation of PR, and telehealth PR has been shown to be as effective as institution-based PR at improving functional exercise capacity and health-related quality of life. To improve PR access across Canada and ensure a high standard of program quality, a team of clinicians and researchers has developed and begun to implement a national standardized PR program that can be delivered across different settings of practice, including remote satellite sites via telehealth PR. The program has adapted the "Living Well with COPD" self-management program and includes standardized reference guides and resources for patients and practitioners. A progressive and iterative process will evaluate the success of program implementation and outcomes. This initiative will address nationwide accessibility challenges and provide PR content as well as evaluations that are in accordance with clinical standards and established self-management practices.

A qualitative study to explore the perception and behavior of patients towards diabetes management with physical disability.

This study aimed to determine self-monitoring practices, awareness to dietary modifications and barriers to medication adherence among physically disabled type 2 diabetes mellitus patients.

Implantable cardiac monitors in high-risk post-infarction patients with cardiac autonomic dysfunction and moderately reduced left ventricular ejection fraction: Design and rationale of the SMART-MI trial.

Most deaths after myocardial infarction (MI) occur in patients with left ventricular ejection fraction (LVEF) >35%, for whom no specific prophylactic strategies exist. Deceleration capacity (DC) of heart rate and periodic repolarization dynamics (PRD) are noninvasive electrophysiological markers depending on the vagal and sympathetic tone. The combination of abnormal DC and/or PRD identifies a new high-risk group among postinfarction patients with LVEF 36%-50%. This new high-risk group has similar characteristics with respect to prognosis and patient numbers to those of the established high-risk group identified by LVEF ≤ 35%.

The future of telemedicine for the management of heart failure patients: a Consensus Document of the Italian Association of Hospital Cardiologists (A.N.M.C.O), the Italian Society of Cardiology (S.I.C.) and the Italian Society for Telemedicine and eHealth (Digital S.I.T.).

Telemedicine applied to heart failure patients is a tool for recording and providing remote transmission, storage and interpretation of cardiovascular parameters and/or useful diagnostic images to allow for intensive home monitoring of patients with advanced heart failure, or during the vulnerable post-acute phase, to improve patient's prognosis and quality of life. Recently, several meta-analyses have shown that telemedicine-supported care pathways are not only effective but also economically advantageous. Benefits seem to be substantial, with a 30-35% reduction in mortality and 15-20% decrease in hospitalizations. Patients implanted with cardiac devices can also benefit from an integrated remote clinical management since all modern devices can transmit technical and diagnostic data. However, telemedicine may provide benefits to heart failure patients only as part of a shared and integrated multi-disciplinary and multi-professional 'chronic care model'. Moreover, the future development of remote telemonitoring programs in Italy will require the primary use of products certified as medical devices, validated organizational solutions as well as legislative and administrative adoption of new care methods and the widespread growth of clinical care competence to remotely manage the complexity of chronicity. Through this consensus document, Italian Cardiology reaffirms its willingness to contribute promoting a new phase of qualitative assessment, standardization of processes and testing of telemedicine-based care models in heart failure. By recognizing the relevance of telemedicine for the care of non-hospitalized patients with heart failure, its strategic importance for the design of innovative models of care, and the many challenges and opportunities it raises, ANMCO and SIC through this document report a consensus on the main directions for its widespread and sustainable clinical implementation.

Using telehealth in the management of hypertension.

Telehealth is a recent concept in hypertension management, and involves using electronic technology to monitor patients' vital signs, such as blood pressure, in their homes. This article presents the findings of a literature review that explored the issues associated with implementing telehealth in the primary care setting. It outlines the challenges associated with telehealth, as well as the potential benefits in terms of improving hypertension management. Aim To explore the usefulness of, and evidence for, telehealth in the management of hypertension in the primary care setting. Method The population, intervention, comparison and outcome (PICO) tool was used to define the research question for the literature review, which was: 'Do adults with hypertension being monitored with telehealth/telemonitoring have a higher quality of life and improved management compared with standard care?' Findings The literature review identified that a common challenge in implementing telehealth in patients with hypertension was the requirement to improve patients' compliance with and participation in telehealth systems. Conclusion Ongoing challenges with the implementation of telehealth include suboptimal feedback, and reduced patient interest in and compliance with telehealth systems. It was also noted that patients involved in longer trials had a higher withdrawal rate than those enrolled on shorter intense studies. In addition, patient lifestyle choices, including outdoor working, and lack of Wi-Fi proved a challenge to self-monitoring. If not resolved, such challenges could adversely affect the widespread use of telehealth.

Subgroup analysis of telehealthcare for patients with chronic obstructive pulmonary disease: the cluster-randomized Danish Telecare North Trial.

Results from the Danish cluster-randomized trial of telehealthcare to 1,225 patients with chronic obstructive pulmonary disease (COPD), the Danish Telecare North Trial, concluded that the telehealthcare solution was unlikely to be cost-effective, by applying international willingness-to-pay threshold values. The purpose of this article was to assess potential sources of variation across subgroups, which could explain overall cost-effectiveness results or be utilized in future economic studies in telehealthcare research.

Health promotion interventions for community-dwelling older people with mild or pre-frailty: a systematic review and meta-analysis.

Mild or pre-frailty is common and associated with increased risks of hospitalisation, functional decline, moves to long-term care, and death. Little is known about the effectiveness of health promotion in reducing these risks. This systematic review aimed to synthesise randomised controlled trials (RCTs) evaluating home and community-based health promotion interventions for older people with mild/pre-frailty.