Instituto de Investigación Sanitaria La Fe, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain.
Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain; Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain.
Med Clin (Barc). 2018 Oct 23;151(8):308-314. doi: 10.1016/j.medcli.2018.03.013. Epub 2018 Apr 25.
To assess the effect of home based telehealth or structured telephone support interventions with respect to usual care on quality of life, mortality and healthcare utilization in elderly high-risk multiple chronic condition patients.
472 elderly high-risk patients with plurimorbidity in the region of Valencia (Spain) were recruited between June 2012 and May 2013, and followed for 12 months from recruitment. Patients were allocated to either: (a) a structured telephone intervention, a nurse-led case management program with telephone follow up every 15 days; (b) telehealth, which adds technology for remote self-management and the exchange of clinical data; or (c) usual care. Main outcome measures was quality of life measured by the EuroQol (EQ-5D) instrument, cognitive impairment, functional status, mortality and healthcare resource use. Inadequate randomization process led us to used propensity scores for adjusted analyses to control for imbalances between groups at baseline.
EQ-5D score was significantly higher in the telehealth group compared to usual care (diff: 0.19, 0.08-0.30), but was not different to telephone support (diff: 0.04, -0.05 to 0.14). In adjusted analyses, inclusion in the telehealth group was associated with an additional 0.18 points in the EQ-5D score compared to usual care at 12 months (p<0.001), and with a gain of 0.13 points for the telephone support group (p<0.001). No differences in mortality or utilization were found, except for a borderline significant increase in General Practitioner visits.
Telehealth was associated with better quality of life. Important limitations of the study and similarity of effects to telephone intervention call for careful endorsement of telemedicine. Clinicaltrials.gov (identifier: NCT02447562).
评估家庭为基础的远程医疗或结构化电话支持干预措施相对于常规护理对患有多种慢性疾病的老年高危患者的生活质量、死亡率和医疗保健利用的影响。
2012 年 6 月至 2013 年 5 月期间，在西班牙瓦伦西亚地区招募了 472 名患有多种合并症的老年高危患者，并在招募后 12 个月内进行随访。患者被分配到以下三组之一：（a）结构化电话干预组，由护士主导的病例管理计划，每 15 天进行电话随访；（b）远程医疗组，增加了远程自我管理和临床数据交换的技术；或（c）常规护理组。主要观察指标是生活质量，使用 EuroQol（EQ-5D）工具进行测量，包括认知障碍、功能状态、死亡率和医疗资源利用。由于随机化过程不充分，我们使用倾向评分进行调整分析，以控制基线时组间的不平衡。
与常规护理组相比，远程医疗组的 EQ-5D 评分显著更高（差值：0.19，0.08-0.30），但与电话支持组无差异（差值：0.04，-0.05 至 0.14）。在调整分析中，与常规护理组相比，远程医疗组在 12 个月时 EQ-5D 评分增加了 0.18 分（p<0.001），电话支持组增加了 0.13 分（p<0.001）。未发现死亡率或利用率的差异，但全科医生就诊次数略有增加。
远程医疗与更好的生活质量相关。该研究存在重要的局限性，且电话干预的效果相似，因此需要谨慎支持远程医疗。Clinicaltrials.gov（标识符：NCT02447562）。
