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Because of the low nurse-to-patient ratio on surgical wards and the intermittent nature of blood pressure spot-checks, there is increasing evidence that hemodynamic deterioration may be overlooked for hours. Several non-obtrusive systems have recently been developed to monitor blood pressure continuously and non-invasively. They may help to free nurses from time-consuming and repetitive tasks and to detect clinical deterioration earlier, decrease the number of rapid response team interventions, ICU admissions, cardiac arrests, and deaths. From a sensor standpoint, wireless wearables are emerging as the ideal solution for monitoring on the wards because they are patient friendly and they enable early mobilization, which is a key element of enhanced recovery programs. Clinical studies are needed to clarify what are the best strategies to effectively respond to early deterioration alerts. Such strategies may include the quick assessment of cardiac function with a POCUS device. Future trials will also have to investigate what is the impact on key outcome variables such as ICU admission and hospital length of stay, and which patients may benefit the most from recent mobile monitoring and ultrasound innovations.
Because of the low nurse-to-patient ratio on surgical wards and the intermittent nature of blood pressure spot-checks, there is increasing evidence that hemodynamic deterioration may be overlooked for hours. Several non-obtrusive systems have recently been developed to monitor blood pressure continuously and non-invasively. They may help to free nurses from time-consuming and repetitive tasks and to detect clinical deterioration earlier, decrease the number of rapid response team interventions, ICU admissions, cardiac arrests, and deaths. From a sensor standpoint, wireless wearables are emerging as the ideal solution for monitoring on the wards because they are patient friendly andenable early mobilization,a key element of enhanced recovery programs. Clinical studies are needed to clarify what are the best strategies to effectively respond to early deterioration alerts. Such strategies may include the quick assessment of cardiac function with a POCUS device.
A literature review concerning the economic evaluation of telemonitoring was requested by the authority in charge of health evaluation in France, in a context of deployment of remote patient monitoring and identification of its financing. Due to the heterogeneity of existing telemonitoring solutions, it was necessary to stratify the evaluation according to patient involvement. Three levels of patient involvement are considered: weak (automated monitoring), medium (monitoring supported by a professional), and strong (active remote participation).
Objectives
We performed a scoping review to provide a comprehensive overview of different systems of telemonitoring and their reported cost-effectiveness.
Methods
Following PRISMA-ScR guidelines, a search was performed in four databases: PubMed, MEDLINE, EMBASE, and Cochrane Library between January 1, 2013 and May 19, 2020. Remote patient monitoring should include the combination of three elements: a connected device, an organizational solution for data analysis and alert management, and a system allowing personalized interactions, and three degrees of involvement.
Results
We identified 61 eligible studies among the 489 records identified. Heart failure remains the pathology most represented in the studies selected (n = 24). The cost-utility analysis was chosen in a preponderant way (n = 41). Forty-four studies (72 percent) reported that the intervention was expected cost-effective. Heterogeneity has been observed in the remote monitoring solutions but all systems are reported cost-effective. The small number of long-term studies does not allow conclusions to be drawn on the transposability.
Conclusions
Remote patient monitoring is reported to be cost-effective whatever the system and patient involvement.
Atrial Fibrillation (AF) is one of the most prevalent cardiac diseases in the world. How might we design patient journeys improving quality of life using wearable cardiac devices for continuous out of hospital monitoring and support? Most of the studies to date have emphasised the technical aspects of implementing such devices with less focus on human factors. As such, remote cardiac monitoring appears to be burdened by poor patient adherence. This research study proposed a journey map based on Roger's technology adoption model to understand the challenges faced by AF patients and non/asymptomatic patients in using wearable devices to monitor their health. Data from semi-structured interviews conducted in Denmark with 12 participants aged 24 to 65 years was used. Interview results show that citizens prefer tracking heart activity only in conjunction with other measures such as steps or sleep and do not feel motivated to track their heart activity on a daily basis. Patients view wearables as a valuable tool to check if their health is all right, although apprehension that devices can cause unnecessary worry can lead to their rejection. Finally, recommendations for the design of patient journeys when using wearables were made.
Remote patient monitoring (RPM) has emerged as a viable and valuable care delivery method to improve chronic disease management. In light of the high prevalence and substantial economic burden of cardiovascular disease (CVD), this systematic review examines the cost and cost-effectiveness of using RPM to manage CVD in the United States.
Methods
We systematically searched databases to identify potentially relevant research. Findings were synthesized for cost and cost-effectiveness by economic study type with consideration of study perspective, intervention, clinical outcome, and time horizon. The methodological quality was assessed using the Joanna Briggs Institute Checklist for Economic Evaluations.
Results
Thirteen articles with fourteen studies published between 2011 and 2021 were included in the final review. Studies from the provider perspective with a narrow scope of cost components identified higher costs and similar effectiveness for the RPM group relative to the usual care group. However, studies from payer and healthcare sector perspectives indicate better clinical effectiveness of RPM relative to usual care, with two cost-utility analysis studies suggesting that RPM relative to usual care is a cost-effective tool for CVD management even at the conservative $50,000 per Quality-Adjusted Life-Year threshold. Additionally, all model-based studies revealed that RPM is cost-effective in the long run.
Conclusions
Full economic evaluations identified RPM as a potentially cost-effective tool, particularly for long-term CVD management. In addition to the current literature, rigorous economic analysis with a broader perspective is needed in evaluating the value and economic sustainability of RPM.
Norway is interested in implementing remote patient monitoring (RPM) within primary health services. This systematic review will first identify the types of RPM that are of interest to Norwegian health authorities, then synthesize the effects of RPM on clinical health and health service utilization outcomes among adults with chronic diseases.
Methods:
We will perform systematic literature searches in multiple databases, using RPM-related searches, such as telemedicine, telemonitoring, and eHealth. Based on what research exists, the review will be selected from a cascading menu of review types. Methodological quality will be assessed through appropriate checklists, while the quality of the evidence will be assessed through Grading of Recommendations Assessment, Development, and Evaluation.
Discussion:
This flexible protocol specifies the production of different possible types of reviews of RPM. It is anticipated that the results of the review will inform the development of effective RPM programs to the most appropriate chronic disease groups.
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