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Telehomecare for patients with multiple chronic illnesses: Pilot study.

OBJECTIVE
To examine the feasibility and efficacy of integrating home health monitoring into a primary care setting.


DESIGN
A mixed method was used for this pilot study. It included in-depth interviews, focus groups, and surveys.


SETTING
A semirural family health network in eastern Ontario comprising 8 physicians and 5 nurses caring for approximately 10 000 patients.


PARTICIPANTS
Purposeful sample of 22 patients chosen from the experimental group of 120 patients 50 years old or older in a larger randomized controlled trial (N = 240). These patients had chronic illnesses and were identified as being at risk based on objective criteria and physician assessment.


INTERVENTIONS
Between November 2004 and March 2006, 3 nurse practitioners and a pharmacist installed telehomecare units with 1 or more peripheral devices (eg, blood-pressure monitor, weight scale, glucometer) in patients' homes. The nurse practitioners incorporated individualized instructions for using the unit into each patient's care plan. Patients used the units every morning for collecting data, entering values into the system either manually or directly through supplied peripherals. The information was transferred to a secure server and was then uploaded to a secure Web-based application that allowed care providers to access and review it from any location with Internet access. The devices were monitored in the office on weekdays by the nurse practitioners.


MAIN OUTCOME MEASURES
Acceptance and use of the units, patients' and care providers' satisfaction with the system, and patients' demographic and health characteristics.


RESULTS
All 22 patients, 12 men and 10 women with an average age of 73 years (range 60 to 88 years), agreed to participate. Most were retired, and a few were receiving community services. Common diagnoses included hypertension, diabetes, cardiovascular disease, and chronic obstructive pulmonary disease. All patients had blood pressure monitors installed, 11 had wired weight scales,5 had glucometers, and 5 had pulse oximeters. The units were in place for 9 to 339 days. Three patients asked to have the systems removed early because they did not use them or found them inconvenient. The other patients and their informal caregivers found the technology user-friendly and useful. Health care providers were satisfied with the technology and found the equipment useful. They thought it might reduce the number of office visits patients made and help track long-term trends.


CONCLUSION
These pilot results demonstrate that telehomecare monitoring in a collaborative care community family practice is feasible and well used, and might improve access to and quality of care.