Telehealth at scale can improve chronic disease management in the community during a pandemic: An experience at the time of COVID-19

Abstract

Background: During the COVID-19 pandemic, telehealth became a vital resource to contain the virus's spread and ensure continuity of care of patients with a chronic condition, notably arterial hypertension and heart disease. This paper reports the experience based on a telehealth platform used at scale to manage chronic disease patients in the Italian community.

Methods and findings: Patients' health status was remotely monitored through ambulatory blood pressure monitoring (ABPM), resting or ambulatory electrocardiogram (ECG), spirometry, sleep oximetry, and cardiorespiratory polysomnography performed in community pharmacies or general practitioners' offices. Patients also monitored their blood pressure (BP), heart rate (HR), blood oxygen saturation (SpO2), body temperature, body weight, waist circumference, blood glucose, and lipids at home through a dedicated smartphone app. All data conveyed to the web-based telehealth platform were used to manage critical patients by doctors promptly. Data were analyzed and compared across three consecutive periods of 2 months each: i) before the national lockdown, ii) during the lockdown (from March 9 to May 17, 2020), and iii) after the end of the containment measures. Overall, 13,613 patients visited community pharmacies or doctors' offices. The number of overall tests dropped during and rose after the lockdown. The overall proportion of abnormal tests was larger during the outbreak. A significant increase in the prevalence of abnormal ECGs due to myocardial ischemia, contrasted by a significantly improved BP control, was observed. The number of home users and readings exchanged increased during the pandemic. In 226 patients, a significant increase in the proportion of SpO2 readings and a significant reduction in the entries for all other parameters, except BP, was observed. The proportion of abnormal SpO2 and BP values was significantly lower during the lockdown. Following the lockdown, the proportion of abnormal body weight or waist circumference values increased.

Conclusions: Our study results support the usefulness of a telehealth solution to detect deterioration of the health status during the COVID-19 pandemic.

Trial registration: The study is registered with ClinicalTrials.gov at number NCT03781401.

Conflict of interest statement

I have read the journal’s policy and the authors of this manuscript have the following competing interests: SO is scientific consultant of Biotechmed Ltd, provider of telehealth services. The other authors declare no conflicts of interest regarding the publication of this paper.

Figures

Fig 1. Weekly number of professional tests, home data, new visitors to the telemedicine website, and new app subscribers (dashed lines).

The thick continuous line represents the number of positive to SARS-CoV-2 tests. Pre-lockdown, lockdown, and post-lockdown periods are also identified.

Fig 2. Weekly frequency (%) of abnormal tests in pharmacies and general practitioners’ offices or abnormal readings collected at home (striped bars).

The thick continuous line represents the number of positive to SARS-CoV-2 tests. Pre-lockdown, lockdown, and post-lockdown periods are also identified.

Fig 3. Frequency of type of tests, abnormal tests, ECG diagnosis, and diagnosis of hypertension by ABPM before the lockdown (open bars), during the lockdown (full bars), and after the lockdown (striped bars).

P-values of the differences are reported on top of each group of bars. ABPM: Ambulatory Blood Pressure Monitoring; ECG: Electrocardiogram.

Fig 4. Frequency of type of home readings and abnormal readings before the lockdown (open bars), during the lockdown (full bars), and after the lockdown (striped bars).

P-values of the differences are reported on top of each group of bars.