TY - JOUR
T1 - A Randomized Controlled Trial Comparing Telehealth Self-Management to Standard Outpatient Management in Underserved Black and Hispanic Patients Living with Heart Failure
AU - Pekmezaris, Renee
AU - Nouryan, Christian N.
AU - Schwartz, Rebecca
AU - Castillo, Stacy
AU - Makaryus, Amgad N.
AU - Ahern, Deborah
AU - Akerman, Meredith B.
AU - Lesser, Martin L.
AU - Bauer, Lorinda
AU - Murray, Lawrence
AU - Pecinka, Kathleen
AU - Zeltser, Roman
AU - Zhang, Meng
AU - Dimarzio, Paola
N1 - Publisher Copyright:
© Renee Pekmezaris et al. 2018; Published by Mary Ann Liebert, Inc. 2018.
PY - 2019/10
Y1 - 2019/10
N2 - Background: Although the American Heart Association promotes telehealth models to improve care access, there is limited literature on its use in underserved populations. This study is the first to compare utilization and quality of life (QoL) for underserved black and Hispanic heart failure (HF) patients assigned to telehealth self-monitoring (TSM) or comprehensive outpatient management (COM) over 90 days. Methods: This randomized controlled trial enrolled 104 patients. Outcomes included emergency department (ED) visits, hospitalizations, QoL, depression, and anxiety. Binary outcomes for utilization were analyzed using chi-square or Fisher's exact test. Poisson or negative binomial regression, repeated-measures analysis of variance, or generalized estimating equations were also used as appropriate. Results: Of 104 patients, 31% were Hispanic, 69% black, 41% women, and 72% reported incomes of <$10,000/year. Groups did not differ regarding binary ED visits (relative risk [RR] = 1.37, confidence interval [CI] = 0.83-2.27), hospitalization (RR = 0.92, CI = 0.57-1.48), or length of stay in days (TSM = 0.54 vs. COM = 0.91). Number of all-cause hospitalizations was significantly lower for COM (TSM = 0.78 vs. COM = 0.55; p = 0.03). COM patients reported greater anxiety reduction from baseline to 90 days (TSM = 50-28%; COM = 57-13%; p = 0.05). Conclusions: These findings suggest that TSM is not effective in reducing utilization or improving QoL for underserved patients with HF. Future studies are needed to determine whether TSM can be effective for populations facing health care access issues.
AB - Background: Although the American Heart Association promotes telehealth models to improve care access, there is limited literature on its use in underserved populations. This study is the first to compare utilization and quality of life (QoL) for underserved black and Hispanic heart failure (HF) patients assigned to telehealth self-monitoring (TSM) or comprehensive outpatient management (COM) over 90 days. Methods: This randomized controlled trial enrolled 104 patients. Outcomes included emergency department (ED) visits, hospitalizations, QoL, depression, and anxiety. Binary outcomes for utilization were analyzed using chi-square or Fisher's exact test. Poisson or negative binomial regression, repeated-measures analysis of variance, or generalized estimating equations were also used as appropriate. Results: Of 104 patients, 31% were Hispanic, 69% black, 41% women, and 72% reported incomes of <$10,000/year. Groups did not differ regarding binary ED visits (relative risk [RR] = 1.37, confidence interval [CI] = 0.83-2.27), hospitalization (RR = 0.92, CI = 0.57-1.48), or length of stay in days (TSM = 0.54 vs. COM = 0.91). Number of all-cause hospitalizations was significantly lower for COM (TSM = 0.78 vs. COM = 0.55; p = 0.03). COM patients reported greater anxiety reduction from baseline to 90 days (TSM = 50-28%; COM = 57-13%; p = 0.05). Conclusions: These findings suggest that TSM is not effective in reducing utilization or improving QoL for underserved patients with HF. Future studies are needed to determine whether TSM can be effective for populations facing health care access issues.
KW - cardiology/cardiovascular disease
KW - home health monitoring
KW - telehealth
KW - telemedicine
UR - http://www.scopus.com/inward/record.url?scp=85072972924&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85072972924&partnerID=8YFLogxK
U2 - 10.1089/tmj.2018.0219
DO - 10.1089/tmj.2018.0219
M3 - Article
C2 - 30418101
AN - SCOPUS:85072972924
SN - 1530-5627
VL - 25
SP - 917
EP - 925
JO - Telemedicine and e-Health
JF - Telemedicine and e-Health
IS - 10
ER -