JMIR Publications

ABSTRACT

Background:

Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are responsible for a significant amount of the economic and chronic disease burden which impacts the Ontario health system. Telehomecare (THC), a home self-management program launched by the Ontario Telemedicine Network, was created to improve access to quality care and limit healthcare utilization. However, data on patient, caregiver and provider-reported outcomes of THC are underreported.

Objective:

The aim of this study was to evaluate the impact of THC on HF and COPD patients’ health-related quality of life (HRQoL), disease-management skills, and satisfaction; informal caregiver strain index, and nurse satisfaction with THC.

Methods:

This study utilized a prospective longitudinal cohort design, including patients with HF and COPD enrolled in Ontario’s THC program, caregivers of patients in the program, and nurses providing services in THC. Patients and caregivers were administered telephone surveys at Baseline, Month 3, Month 6, and Month 12 follow-up from July 2016 to December 2019. The outcomes for the longitudinal surveys were patient-perceived HRQoL, disease-management skills, perception of THC, satisfaction with THC, and caregiver-perceived strain. Cross-sectional surveys were conducted with nurses to assess nurse perception and satisfaction with THC. Participant data was analyzed using general linear mixed models in SAS 9.4.

Results:

Overall, 194 patients (117 HF and 77 COPD), 62 caregivers and 24 nurses were enrolled in the program, with an overall response rate of 51%. The average age of HF and COPD patients was 71 ± 11.3 years and 70 ± 11.1 years, respectively, with 52% being men. The results demonstrated a significant improvement in HF patients’ Overall HRQoL through Month 12 (-18.37, p = < 0.001). Minimal clinically important differences (MCID) were reported for HF patients HRQoL across all domains, indicating a clinical improvement in health over the study period. COPD patients did not see any statistical improvement in their HRQoL throughout the study, but MCIDs were observed in the physical functioning dimension. Patients reported being confident self-managing their diseases throughout the study, but as patients aged their perception and satisfaction of THC was shown to decrease (p = 0.002; p = 0.002, respectively). Caregivers reported relatively low strain scores (10.3 ± 5.9) throughout the program and nurses reported moderate levels of satisfaction (6.7 ± 1.5) with THC.

Conclusions:

THC has been found to be an intervention with a lot of promise in terms of improving the HRQoL of HF and COPD patients. However, the long-term sustainability of HRQoL improvements in HF and COPD patients following THC requires further investigation. Furthermore, THC has been shown to decrease informal caregiver perceived strain and nurses described moderate levels of satisfaction and perceived quality of care with THC.