Visiting Nursing Association cuts back on hospitalization with telemonitoring

“The Visiting Nurses Association of Western New York has announced a plan to use telemonitoring technology to help care for chronically ill patients and prevent re-hospitalizations.
The VNA has selected Cardiocom Multi-Disease Management’s Commander Home Telemonitoring System, an interactive home monitoring device for diseases such as CHF, diabetes, COPD, asthma and hypertension.”
Article
Molly Merrill, Healthcare IT News, 22 January 2008

Web-based or paper-based self-management tools for Asthma – patients’ opinions and quality of data in a randomized crossover study

Ricardo Cruz-Correia a,b, João Fonseca a,b,c, Luís Lima a, Luís Araújo c, Luís Delgado c,d, Maria Graça Castel-Branco c, Altamiro Costa-Pereira a,b
a Department of Biostatistics and Medical Informatics
b CINTESIS – Center of Research in Health Information Systems and Technologies
c Division of Immunoallergology, Hospital S. Joao
d Department of Immunology
Faculty of Medicine of University of Porto

Abstract.

The use of communication technologies may overcome some of the difficulties of conventional, paper-based, self-management of chronic diseases. This paper aims to describe and evaluate the use of P’ASMA – a web based asthma self-management support tool regarding the opinion of patients and their adherence to monitoring in comparison to standard paper-based tools. System description: P’ASMA allows the collection of asthma monitoring data and provides, to both patient and doctor, immediate feedback about patient’s condition. For each patient a set of forms and scheduling options can be chosen. Evaluation methods: Twenty-one adults with previous medical diagnosis of asthma were included in an exploratory randomized crossover study. Patients used P’ASMA or a paper asthma diary and action-plan each during 4 weeks in a random sequence. Results: The number of patients who wrote negative remarks regarding P’ASMA was 2 and regarding paper-tools was 11; positive comments were 6 and 1 respectively for P’ASMA and Paper-based. Twelve patients were very interested to continue to monitor their asthma using P’ASMA whereas only 2 with Paper-based (p=0.002). Of the 19 problems reported with P’ASMA, 9 were related to the Internet connection, 5 to the user interface, 3 to internal system errors and 2 to the questions interpretation. The completeness of paper diary records was better; however, 10 patients reported filling it several days at once which was not allowed in P’ASMA. Conclusions: The intervention was feasible, safe and the problems detected in the web-application can be corrected. With P’ASMA data quality improved as the integrity features increase the reliability of the data. Moreover, patients preferred the web-based application to monitor their asthma.

SMASHING: Self-Management of Asthma Supported by Hospitals, ICT, Nurses and General practitioners

Jacob K. Sont
Department of Medical Decision Making, J10-86, Leiden University Medical Center, The Netherlands. Tel +31-71-5264578, j.k.sont@lumc.nl

Abstract:

Asthma is a chronic disease which leads to recurrent episodes of wheezing, breathlessness, chest tightness and cough particularly at night and/or in the early morning. Due to the episodic nature of an asthma attack, individuals must maintain control of their disease with appropriate use of their medications and with proper self-management. Despite the introduction of asthma guidelines the current level of asthma control in many patients falls far short of the goals for long-term asthma management. Patients tend to underestimate the severity of their condition and overestimate control, thereby tolerating, as an acceptable degree of control, a much higher rate of symptoms than recommended by medical professionals. Poor inhaler technique and repeated non-attendance for practice/hospital appointments are associated with an increased risk of asthma death.

The SMASHING programme is specifically designed to support self-management of asthma by adolescent and adult patients in order to improve asthma control and quality of life. The programme includes group sessions on asthma self-management education and training by a specialised nurse. A dedicated internet site provides information, and facilitates ongoing goal-setting, behaviour change efforts and problem-solving. In addition, discussion groups and communication with the nurse is facilitated. Monitoring of symptoms and lung function can be done via the web application as well as by short message services (SMS) on telephones. A pilot study in 100 adolescents showed that home monitoring of symptoms and lung function is feasible and provides reliable data. After data processing the computer server gives direct feedback via an algorithm that is based on international guidelines for asthma action plans, which is supervised by the nurse. The system can provide an overview of monitoring data that can be printed by the patient or their physician before a follow-up visit. Furthermore, the system can send reminders about monitoring, taking medication and doctor visit dates to the patients. Finally, the system supports the design of a written and individualised action plan. The nurse can be alerted by SMS in case of severe symptoms and/or airways obstruction as shown by self-monitoring. The information and communication technology is aimed to support all components of asthma self-management, thereby lowering the barriers to participate in disease management, empower patients, and establish an effective partnership between patients and doctors. The cost-effectiveness of the programme will be evaluated in two randomised parallel trials with 1 year follow-up in adolescent and adult patients with asthma, respectively.