JMIR Publications

ABSTRACT

Background:

The increasingly population of patients with chronic heart failure (CHF) brings up the need for new healthcare strategies that can access medical service more conveniently and effectively, especially in remote areas. Tele-health is getting more and more attention, which may offer a glimmer of light for them.

Objective:

The present study was conducted attempting to evaluate the feasibility of the Hospital-Community-Family (HCF)-based Tele-health program which was designed to implement remote hierarchical management in CHF patients.

Methods:

This was a single-arm prospective study in which 70 CHF patients participated in the HCF-based Tele-health program for remote intervention at least 4 months. In the program, participants were educated on the use of smart health-tracking devices and mobile application (APP) to collect and upload comprehensive data elements related to the risk of CHF self-care management, such as symptom and sign changes, medication adherence, and etc. They were also instructed to send text messages, view notifications, and receive individualized guidance on the mobile APP. The general practitioners viewed index of each participant on mobile APP and provided primary care periodically, and cardiologists in regional central hospital offered remote guidance and management if necessary. Outcomes assessed included accomplishments of the program, usability and satisfaction, engagement with the intervention, and changes of heart failure-related health behaviors.

Results:

A total of 66 individuals, aged 40-79 years, completed the 4-month study. Throughout the study period, 294 electronic medical records were formed on the remote monitoring service platform. And there were 89 times of remote consultation and 196 times of remote ward round in total. Participants manifested they were generally satisfied with the intervention for its ease of use and usefulness. Almost all the physicians (21/23, 91. 30%) believed the program was effective, and 20/23 (87.00%) stated their professional knowledge can always be refreshed and enhanced through library on the platform and remote consultation. Over 60% (40/66) of study participants showed great adherence to care plan in the study period, and 78.79% (52/66) of patients maintained a consistent pattern of reporting and viewing their data over the course of the 4-month follow-up period. The program showed positive effect on self-management for patients (diet, monitoring of weigh and blood pressure, medicine adherence).

Conclusions:

The HCF-based Tele-health program is feasible, and it provided researchers with evidence of remote hierarchical management for CHF patients that can enhance participants and their families' access and motivation to engage in self-management. Further prospective study with a larger sample size is necessary to confirm the effect of this program. Clinical Trial: ClinicalTrials.gov NCT02029287. Registered on 7 January 2014.