Telemonitoring fails to cut hospitalizations, ED visits in elderly
MedWire News: Home telemonitoring for elderly patients with multiple illnesses does not lead to fewer hospitalizations or emergency department (ED) visits or reduced mortality, according to the results of a randomized controlled trial.
Telemonitoring systems use asynchronous and real-time biometrics tracking to easily transmit data from patients to healthcare providers. In previous studies, home telemonitoring helped to reduce ED visits, hospital admissions, and hospital stays in patients with chronic illnesses, although results have been mixed in single-disease trials.
Paul Takahashi (Mayo Clinic, Rochester, Minnesota, USA) and colleagues hypothesized that home telemonitoring could be beneficial in elderly patients with multiple chronic conditions.
They randomly assigned 205 patients, aged 60 years or older and at high risk for hospitalization owing to factors including comorbid conditions (stroke, dementia, heart disease, diabetes mellitus, and chronic obstructive pulmonary disease), to receive usual care or a telemonitoring device that had videoconferencing capability and several peripheral measures. Baseline characteristics did not differ between groups.
The patients given telemonitoring devices had symptoms and biometrics assessed daily, and the recorded data were downloaded to a website reviewed by the investigators. A registered nurse was available for phone calls or videoconferences if there were any alerts. Those in the usual care group had access to primary care physicians and specialists as well as the ED and urgent care facilities.
Results were reported in Archives of Internal Medicine. A greater proportion of patients given telemonitoring had ED visits and hospital admissions than those given usual care (63.7 vs 57.3%). The telemonitoring group also had a significantly greater mortality rate. No significant differences in hospitalizations were noted between the groups.
The investigators note that the trial enrollment was small and the patients' ethnicity was fairly homogenous. In addition, patients given usual care had access to a tertiary care hospital and case management programs for treatment of diabetes and heart failure.
Takahashi and colleagues conclude that in addition to the potential increase in some adverse events with home telemonitoring, there are also "potentially greater costs for support and equipment. This implies that investments in telemedicine may not provide better outcomes in its current delivery of case management."
By Stephanie Leveene