Clinicians' commitment to telemonitoring

By Brian Dolan

Kimmy MooreBy Kimberly Moore, M.P.H.

Patients with chronic diseases make choices that can dramatically affect their health everyday. Those who are able to manage their chronic diseases successfully do so primarily by learning about their disease, mastering self-management techniques and building a relationship with their physician. Disciplined management is important as it is associated with improved health outcomes and longevity.

Although patients and doctors are typically aware of the benefits, disease management is notoriously challenging for both parties. As a result, health innovators are constantly searching for tools that can make disease management less complicated. Telemonitoring is one such aid allowing clinicians to regularly review vital statistics and provide patients' with frequent feedback. Essentially, telemonitoring systems enable patients to input vital statistic information, whether actively or passively, from the comfort of their own home. A clinician can then review the data and make recommendations or respond to a patient's concern from their office, home, or mobile device.

Currently, the effectiveness of telemonitoring is being explored among patients with pulmonary and cardiovascular diseases, as well as, diabetes. Initial results have been positive. One 2003 study of diabetic adolescents demonstrated that telemonitoring was just as effective as traditional clinical visits in helping teens control their blood glucose levels at only a fraction of the cost. The telemonitoring cost was $163 for 6-month trial while one clinical visit ran about $305. Even more recently, telemonitoring was found to decrease mortality rates in diabetic patients when compared with standard care further highlighting the benefits of telemonitoring.

Notably, the benefits of telemonitoring are not simply decreased mortality and morbidity. Telemonitoring has the potential to engage previously marginalized social groups and balance long-standing health disparities. For example, the rural poor unable to manage their chronic disease due to transportation issues would not need to travel as frequently. Men, who are as a whole typically less compliant than women, may feel more empowered and engaged. The uninsured working poor unable to afford doctors visits will not need as many appointments.

Early evidence supports these examples as telemonitoring has been successful in varied socioeconomic groups, races, and age groups. Even if the evidence ultimately suggests that telemonitoring is no more effective than traditional methods of managing chronic disease, the potential for telemonitoring to positively affect these disenfranchised groups and balance health inequities is unparalleled.

Despite this potential, clinicians hoping to utilize telemonitoring technology must proceed cautiously. Telemonitoring is a two-sided partnership. Not only must the patient understand their role but the clinician must also be actively engaged.

It is absolutely necessary that clinicians consider their involvement before telemonitoring is employed. Data collection itself is not enough to improve chronic care. The information collected (typically more than once a day) must be examined and followed by the appropriate recommendations. Failure do so could be devastating for a patient expecting nearly instantaneous feedback. I question whether clinician follow-up is being taken as seriously as it should be.

Anecdotally, just this week, an elderly patient confided in me that she was offered in-home telemonitoring post-coronary bypass surgery but declined. When I asked why she explained that although she had been told the information collected would be used to closely monitor her vitals during her recovery, she was also informed that no one would examine the data until at least three days of data had been amassed. She said she declined because she didn't want her recovery recommendations based on data with a four-day lag time. This example underscores the importance of the clinician's commitment to telemonitoring.

On one hand I was shocked but on the other I saw it as simply another new technology being implemented before it - or rather the clinician - was ready. Telemonitoring is an exciting technology that has the potential to reach previously isolated patients but it must be implemented in conjunction with a well-organized data analysis and feedback delivery system.

Kimberly Moore has a Master of Public Health degree and is a doctoral candidate in epidemiology at the University at Albany, SUNY. She frequently disseminates study results to her academic peers, general public and public health practitioners. Moore has experience consulting with the pharmaceutical industry and serves as contributing columnist to mobihealthnews.

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