Telemedicine in Primary Care for Patients With Chronic Conditions: The ValCrònic Quasi-Experimental Study

Domingo Orozco-Beltran, Manuel Sánchez-Molla, Julio Jesus Sanchez, José Joaquin Mira, ValCrònic Research Group, Domingo Orozco-Beltran, Manuel Sánchez-Molla, Julio Jesus Sanchez, José Joaquin Mira, ValCrònic Research Group

Abstract

Background: The increase of chronic diseases prevalence has created the need to adapt care models and to provide greater home supervision.

Objective: The objective of our study was to evaluate the impact of telemonitoring on patients with long-term conditions at high risk for rehospitalization or an emergency department visit, in terms of target disease control (diabetes, hypertension, heart failure, and chronic obstructive pulmonary disease).

Methods: We conducted a quasi-experimental study with a before-and-after analysis to assess the effectiveness of the ValCrònic program after 1 year of primary care monitoring. The study included high-risk patients with 1 or more of the following conditions: diabetes, high blood pressure, heart failure, and chronic obstructive pulmonary disease. We assessed risk according to the Community Assessment Risk Screen. Participants used an electronic device (tablet) to self-report relevant health information, which was then automatically entered into their eHealth record for consultation.

Results: The total sample size was 521 patients. Compared with the preintervention year, there were significant reductions in weight (82.3 kg before vs 80.1 kg after; P=.001) and in the proportion of people with high systolic (≥140 mmHg; 190, 36.5% vs 170, 32.6%; P=.001) and diastolic (≥90 mmHg; 72, 13.8% vs 40, 7.7%; P=.01) blood pressures, and hemoglobin A1c ≥8% (186, 35.7% vs 104, 20.0%; P=.001). There was also a decrease in the proportion of participants who used emergency services in primary care (68, 13.1% vs 33, 6.3%; P<.001) and in hospital (98, 18.8% vs 67, 12.8%; P<.001). Likewise, fewer participants required hospital admission due to an emergency (105, 20.2% vs 71, 13.6%; P<.001) or disease exacerbation (55, 10.5% vs 42, 8.1%; P<.001).

Conclusions: The ValCrònic telemonitoring program in patients at high risk for rehospitalization or an emergency department visit appears to be useful to improve target disease control and to reduce the use of resources.

Keywords: chronic disease; primary health care; telemedicine.

Conflict of interest statement

Conflicts of Interest: JJS is employed by Telefonica España SA.

©Domingo Orozco-Beltran, Manuel Sánchez-Molla, Julio Jesus Sanchez, José Joaquin Mira, Domingo ValCrònic Research Group. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 15.12.2017.

Figures

Figure 1
Figure 1
Telemonitoring program devices, according to a patient’s disease: scales, blood pressure monitor, glucometer, and pulse oximeter. COPD: chronic obstructive pulmonary disease.
Figure 2
Figure 2
Interface display on the tablet.
Figure 3
Figure 3
Study flowchart. COPD: chronic obstructive pulmonary disease.
Figure 4
Figure 4
Comparison between preintervention year and intervention (ValCrònic program) year regarding study outcomes: proportion of patients with poor blood pressure and hemoglobin A1c (HbA1c) control; and proportion of patients who visited primary care- (PC) or hospital-based emergency services due to an exacerbation or were hospitalized. DBP: diastolic blood pressure; SBP: systolic blood pressure.

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