Experience of remote monitoring in patients with chronic non–communicable diseases

Background. Remote follow-up of patients with chronic non-communicable diseases is an increasingly popular and one of the most fast-growing telemedicine branches, mainly due to COVID-19 pandemic. There are certain premises for a wider and more routine use of telemedicine, one of them being coverage of telemedical consultations by the government insurance program.

Aim. To test a remote self-control program for patients with chronic non-infectious diseases who are followed-up by the doctors of the rheumatology department of the Moscow Regional Research Clinical Institute n.a. M.F. Vladimirsky, and to assess patient adherence to this program.

Materials and methods. We enrolled 120 patients with rheumatic diseases. The type of telemedicine technology used was a remote self-control program, where patients keep track of the doctor’s prescriptions and recommendations, how they are feeling, and disease symptoms persistence.

Results. The mean age of patients was 46.8±2.3 years; follow-up time ranged from 1 to 7 months with the mean of 96.2±9.3 days. Mean number of drug prescriptions per patient per day was 7.58 (max — 26 prescriptions, min — 2 prescriptions).

Patients adherence to the studied self-control program was 91.7%. Conclusion. Patients with chronic non-infectious diseases, requiring regular follow-up in outpatient settings, benefit from the use of telemedicine technology allowing for self-control, drug prescriptions tracking and motivating for self-education about the disease.

1. Maksimov IB, Diashev AN, Sinopal’nikov VI, et al. Istoriya, analiz sostoyaniya i perspektivy razvitiya telemediciny. ZHurnal telemediciny i elektronnogo zdravoohraneniya. 2018;3(103-110). (In Russ). https://cyberleninka.ru/article/n/istoriya-analiz-sostoyaniya-i-perspektivy-razvitiya-telemeditsiny.

2. Cleland JGF. The Trans-European Network—Home-Care Management System (TEN-HMS) Study: An Investigation of the Effect of Telemedicine on Outcomes in Europe. Dis. Manag. Health Outcomes. 2006; 14(1): 23-28.

3. Chaudhry SI, Mattera JA, Curtis JP, et al. Telemonitoring in patients with heart failure. N. Engl. J. Med. 2010;363: 2301-2309.

4. Powell LH, Calvin JE Jr, Richardson D, et al. HART Investigators. Self-management counseling in patients with heart failure: the heart failure adherence and retention randomized behavioral trial. JAMA. 2010; 304(12): 1331-8. doi: 10.1001/jama.2010.1362. PMID: 20858878; PMCID: PMC4097083.

5. Koehler F, Winkler S, Schieber M, et al. Impact of remote telemedical management on mortality and hospitalizations in ambulatory patients with chronic heart failure: The telemedical interventional monitoring in heart failure study. Circulation. 2011; 123: 1873-1880.

6. Bokeriya OL, Ispiryan A. YU. Monitoring hronicheskoj serdechnoj nedostatochnosti na domu. Ann. aritm. 2012; 2. (In Russ). https://cyberleninka.ru/article/n/monitoringhronicheskoy-serdechnoy-nedostatochnosti-na-domu.

7. Ong MK, Romano PS, Edgington S, et al. Effectiveness of Remote Patient Monitoring After Discharge of Hospitalized Patients with Heart Failure — The Better Effectiveness After Transition-Heart Failure (BEATHF) Randomized Clinical Trial. JAMA Intern. Med. 2016; 176: 310-318.

8. Andrès E, Talha S, Zulfiqar AA, et al. Current Research and New Perspectives of Telemedicine in Chronic Heart Failure: Narrative Review and Points of Interest for the Clinician. J Clin Med. 2018; 7(12): 544. doi: 10.3390/jcm7120544. PMID:30551588; PMCID: PMC6306809.

9. McManus RJ, Mant J, Bray EP, et al. Telemonitoring and self-management in the control of hypertension (TASMINH2): a randomised controlled trial. Lancet. 2010; 376(9736): 163–72. doi: 10.1016/S0140-6736(10)60964-6.

10. Margolis KL, Kerby TJ, Asche SE, et al. Design and rationale for Home Blood Pressure Telemonitoring and Case Management to Control Hypertension (HyperLink): a cluster randomized trial. ContempClin Trials. 2012; 33(4): 794-803. doi: 10.1016/j.cct.2012.03.014. Epub 2012 Apr 1. PMID:22498720; PMCID: PMC3361626.

11. McKinstry B, Hanley J, Wild S, et al. Telemonitoring based service redesign for the management of uncontrolled hypertension: multicentrerandomised controlled trial. Br Med J. 2013 May 24; 346: f3030. doi: 10.1136/bmj.f3030.

12. Hallberg I, Ranerup A, Kjellgren K. Supporting the self-management of hypertension: Patients’ experiences of using a mobile phone-based system. J Hum Hypertens. 2016 Feb; 30(2): 141-6. doi: 10.1038/jhh.2015.37.

13. Mills KT, Bundy JD, Kelly TN, et al. Global disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries. Circulation. 2016 Aug 9; 134(6): 441-50. doi: 10.1161/CIRCULATIONAHA.115.018912.

14. Liu S, Brooks D, Thomas SG, Eysenbach G, Nolan RP. Effectiveness of user- and expert-driven webbased hypertension programs: an RCT. Am J Prev Med. 2018 Apr; 54(4): 576-83. doi: 10.1016/j.amepre.2018.01.009.

15. Dugelay G, Kivits J, Desse L, Boivin JM. Implementation of home blood pressure monitoring among French GPs: A long and winding road. PLoS One. 2019 Sep 11; 14(9): e0220460. doi: 10.1371/journal.pone.0220460. PMID:31509852; PMCID: PMC6739115.

16. Gorenkov RV, Yakushin MA, Safina DE, et al. The importance of the study of central hemodynamics using volumetric compression oscillometry in clinical practice: resolved and unresolved issues. Cardiometry. 2020; 16: 42-54.

17. Li R, Liang N, Bu F, Hesketh T. The Effectiveness of Self-Management of Hypertension in Adults Using Mobile Health: Systematic Review and Meta-Analysis. JMIR MhealthUhealth. 2020; 8(3): e17776. doi: 10.2196/17776.

18. Greenwood DA, Gee PM, Fatkin KJ, Peeples M. A systematic review of reviews evaluating technologyenabled diabetes self-management education and support. J Diabetes Sci Technol. 2017 Sep; 11(5): 1015-27. doi: 10.1177/1932296817713506.

19. Jeong JY, Jeon JH, Bae KH, et al. Smart Care Based on Telemonitoring and Telemedicine for Type 2 Diabetes Care: Multi-Center Randomized Controlled Trial. Telemed J E Health. 2018 Aug; 24(8): 604-613. doi: 10.1089/tmj.2017.0203. Epub 2018 Jan 17. PMID: 29341843.

20. Mao Y, Lin W, Wen J, Chen G. Impact and efficacy of mobile health intervention in the management of diabetes and hypertension: a systematic review and meta-analysis. BMJ Open Diabetes Res Care. 2020 Sep; 8(1): e001225. doi: 10.1136/bmjdrc-2020-001225. PMID: 32988849; PMCID: PMC7523197.

21. Cross AJ, Elliott RA, Petrie K, Kuruvilla L, George J. Interventions for improving medication-taking ability and adherence in older adults prescribed multiple medications. Cochrane Database Syst Rev. 2020 May 8; 5(5): CD012419. doi: 10.1002/14651858.CD012419.pub2. PMID: 32383493; PMCID: PMC7207012.

22. Yakushin MА, Gorenkov RV, Dvorina OG, Yarotsky SYu, Shukurlaeva G. Personal profile of systemic hemodynamics in solving global public health problems. Cardiometry. 2020; 16: 35-41.

23. Elbert NJ, van Os-Medendorp H, van Renselaar W, et al. Effectiveness and cost-effectiveness of ehealth interventions in somatic diseases: a systematic review of systematic reviews and meta-analyses. J Med Internet Res. 2014; 16(4): e110.

24. Pekmezaris R, Tortez L, Williams M, et al. Home Telemonitoring In Heart Failure: A Systematic Review And Meta-Analysis. Health Affairs. 2018; 37(12): 1983-1989.

25. Knitza J, Simon D, Lambrecht A, et al. Mobile Health Usage, Preferences, Barriers, and eHealth Literacy in Rheumatology: Patient Survey Study. JMIR MhealthUhealth. 2020 Aug 12; 8(8): e19661. doi: 10.2196/19661. PMID: 32678796; PMCID: PMC7450373.