Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Mar 4, 2022
Open Peer Review Period: Mar 4, 2022 - Apr 29, 2022
Date Accepted: Jul 18, 2022
(closed for review but you can still tweet)
Effects of video-based patient education and consultation on unplanned health care utilization and early recovery after coronary artery bypass surgery patients: a randomized controlled trial (IMPROV-ED)
ABSTRACT
Background:
Healthcare utilisation after coronary artery bypass surgery (CABG) is high and is partly of unplanned nature. EHealth applications have been proposed to reduce care consumption and involve and assist patients in their recovery. In this way healthcare expenses could be reduced and quality of care could be improved.
Objective:
To evaluate if an e-Health program can reduce unplanned healthcare utilisation and improve mental and physical health in the first 6 weeks after coronary artery bypass surgery (CABG).
Methods:
A single-blind, randomised controlled trial was conducted for which patients scheduled for non-acute CABG were included. Participants in the intervention group had, alongside standard care, access to an e-Health program consisting of online education videos and video consultations developed in conjunction with the Dutch Heart Foundation. The control group received standard care. The primary outcome was volume and costs of a composite of unplanned healthcare utilisation including emergency department visits, outpatient clinic visits, rehospitalisation, patient-initiated telephone consultations and visits to a general practitioner measured using the Medical Technology Assessment Medical Consumption Questionnaire. Patient-reported anxiety and recovery were also assed. Intention-to-treat and ‘users-only’ analyses were used.
Results:
Between February 2020 and October 2021, 280 patients were enrolled and randomly allocated 1:1 to the intervention or the control group. The intention-to-treat analysis consisted of 136 and 135 patients, respectively. At 6 weeks, the primary endpoint had occurred in 43 of 136 patients (31.6%) in the intervention group and in 61 of 135 patients (45.2%) in the control group (HR 0.56, 95% CI 0.34 – 0.92). Recovery was faster in the intervention group while anxiety was similar between study groups. ‘Users only’ analysis yielded similar results.
Conclusions:
An e-Health strategy comprising of educational videos and video consultations can reduce unplanned healthcare utilisation and can aid in faster patient-reported recovery in CABG patients. Clinical Trial: The study was registered in the Netherlands Trial Registry (www.trialregister.nl, number NL8510).
Citation
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