Skip to main content

Advertisement

SpringerLink
Log in

Implementing Telemonitoring in Heart Failure Care: Barriers from the Perspectives of Patients, Healthcare Professionals and Healthcare Organizations

  • Self-Care and Health Outcomes (T Jaarsma, Section Editor)
  • Published:
Current Heart Failure Reports Aims and scope Submit manuscript

Abstract

The increasing prevalence of chronic diseases, such as heart failure, presents a substantial challenge to healthcare systems. Telemonitoring is believed to be a useful instrument in the delivery of heart failure care. However, a widespread use of telemonitoring is currently failing for various reasons. This article provides an overview of the barriers for the implementation of telemonitoring in heart failure patients from the perspectives of its users: patients, healthcare professionals and healthcare organisations. In doing so, identified barriers are grouped according to the perceived attributes of innovation by Rogers. Recommendations are provided as to how research can improve the implementation of telemonitoring in heart failure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Luttik ML, Jaarsma T, Veeger N, Tijssen J, et al. Caregiver burden in partners of Heart Failure patients; limited influence of disease severity. Eur J Heart Fail. 2007;9:695–701.

    Article  PubMed  Google Scholar 

  2. O’Connell. The economic burden of heart failure. Clin Cardiol. 2000;23(Suppl HI):111-6–111-10.

    Google Scholar 

  3. McMurray JJV, Stewart S. The burden of heart failure. Eur Heart J Suppl. 2002;4(Suppl D):D50–8.

    Article  Google Scholar 

  4. Wagner EH, Austin B, Davis C, et al. Improving Chronic Illness Care: Translating Evidence Into Action. Heal Aff. 2001;20:64–78.

    Article  CAS  Google Scholar 

  5. http://www.oecd-ilibrary.org/sites/health_glance-2009-en/03/index.html?contentType=&itemId=/content/chapter/health_glance-2009-31-en&containerItemId=/content/serial/19991312&accessItemIds=/content/book/health_glance-2009-en&mimeType=text/html. Accessed on March 23, 2013.

  6. Mosterd A, Hoes AW. Clinical epidemiology of heart failure. Heart. 2007;93(9):1137–46.

    Article  PubMed  Google Scholar 

  7. Griffith L, Raina P, Wu H, Zhu B. Stathokostas. Population attributable risk for functional disability associated with chronic conditions in Canadian older adults. Age Ageing. 2010;39:738–45.

    Article  PubMed  Google Scholar 

  8. http://www.touchpointcare.com/telehealth_definition.php . Accessed on March 23, 2013.

  9. Klersy C, De Silvestri A, Gabutti G, Regoli F, Auricchio A. A meta-analysis of remote monitoring of heart failure patients. J Am Coll Cardiol. 2009;54:1683–94.

    Article  PubMed  Google Scholar 

  10. Inglis SC, Clark RA, McAlister FA, Ball J, et al. Structured telephone support or telemonitoring programmes for patients with chronic heart failure. Cochrane Database Syst Rev. 2010;8, CD007228. doi:10.1002/14651858.CD007228.pub2.

    PubMed  Google Scholar 

  11. Clark RA, Inglis S, Mc Allister F, et al. Telemonitoring or structures telephone support programmes for patients with chronic heart failure: systematic review and meta-analysis. BMJ. 2007;334:942–5.

    Article  PubMed  Google Scholar 

  12. •• Steventon A, Bardsley M, Billings J, et al. Effect of telehealth on use of secondary care and mortality: findings from the Whole System Demonstrator cluster randomised trial. BMJ 2012;344:e3874. This outstanding extensive study highlights the effects of telemonitoring on patients with various chronic diseases.

  13. Dendale P, De Keulenaer G, Troisfontaines P, et al. Effect of a telemonitoring-facilitated collaboration between general practitioner and heart failure clinic on mortality and rehospitalization rates in severe heart failure: the TEMA-HF 1 (Telemonitoring in the MAnagement of Heart Failure) study. Eur J Heart Fail. 2012;14:333–40.

    Article  PubMed  Google Scholar 

  14. Boyne JJJ, Vrijhoef HJM, Crijns HJGM, et al. Tailored Telemonitoring in patients with heart failure: Results of a multicenter randomized controlled Trial. Eur J Heart Fail. 2012;14:791–801.

    Article  PubMed  Google Scholar 

  15. Chaudhry S, Mattera J, Curtis J, et al. Telemonitoring in patients with heart failure. N Engl J Med. 2010;363:2301–9.

    Article  PubMed  CAS  Google Scholar 

  16. Koehler F, Winkler S, Schieber M, et al. Impact of Remote Telemedical Management on Mortality and Hospitalizations in Ambulatory Patients With Chronic Heart Failure. Circulation. 2011;123:1873–80.

    Article  PubMed  Google Scholar 

  17. Oudshoorn N. Diagnosis at a distance: the invisible work of patients and healthcare professionals in cardiac telemonitoring technology. Sociol Health Illn. 2008;30(2):272–88.

    Article  PubMed  Google Scholar 

  18. Rogers EM. Diffusion of innovations (5th ed). New York: Free Press; 2003.

    Google Scholar 

  19. Artinian NT, Harden JK, Kronenberg MW, et al. Pilot study of a Web-based compliance monitoring device for patients with congestive heart failure. Heart Lung. 2003;32:226–33.

    Article  PubMed  Google Scholar 

  20. Boyd CM, Darer J, Boult C. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases implications for pay for performance. JAMA. 2005;294:6.

    Article  Google Scholar 

  21. Vrijhoef HJM, Janssen-Boyne JJJ, Engering G, et al. The Health Buddy: telemonitoring system for patients with heart failure. Eur J Heart Fail. 2006; Supplement vol. 5(1): p. 174

    Google Scholar 

  22. Boyne JJ, Vrijhoef HJ, de Wit R, et al. Telemonitoring in patients with heart failure, the TEHAF-study: Study protocol of an ongoing prospective randomised trial. Int J Nurs Stud. 2011;48:94–9.

    Article  PubMed  Google Scholar 

  23. Kane RL, Kane RA. Ageism in healthcare and long term care. Generations. 2005;29:49–54.

    Google Scholar 

  24. Anhoj J, Nielsen L. Quantitative and qualitative usage data of an Internet-based asthma monitoring tool. J Med Internet Res. 2004;6:e23.

    Article  PubMed  Google Scholar 

  25. Gruber HG, Wolf B, Reihe M. Innovation Barriers for Telemonitoring. IFMBE Proceedings. 2009;25:48–50.

    Article  Google Scholar 

  26. Jimison H, Gorman P, Woods S, et al. Barriers and Drivers of Health Information Technology Use for the Elderly, Chronically III, and Underserved. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Nov. (Evidence Reports/Technology Assessments, No. 175.) Available from: http://www.ncbi.nlm.nih.gov/books/NBK38653/ Accessed on March 23, 2013.

  27. Kaufman DR, Patel VL, Hilliman C, et al. Usability in the real world: Assessing medical information technologies in patients’ homes. J Biomed Inform. 2003;36:45–60.

    Article  PubMed  Google Scholar 

  28. Stoop AP, Van ’t Riet A, Berg M. Using information technology for patient education: Realizing surplus value? Patient Educ Couns. 2004;54:187–95.

    Article  PubMed  Google Scholar 

  29. Or CKL, Karsh BT. A Systematic Review of Patient Acceptance of Consumer Health Information Technology. J Am Med Inform Assoc. 2009;16:550–60.

    Article  PubMed  Google Scholar 

  30. Czaja SJ, Charness N, Fisk AD, et al. Factors predicting the use of technology: Findings from the center for research and education on aging and technology enhancement (create). Psychol Aging. 2006;21:333–52.

    Article  PubMed  Google Scholar 

  31. Evangelista LS, Strömberg A, Westlake C, et al. Developing a web-based education and counseling program for heart failure patients. Prog Cardiovasc Nurs. 2006;21:196–201.

    Article  PubMed  Google Scholar 

  32. Kressig RW, Echt KV. Exercise prescribing: computer application in older adults. Gerontologist. 2002;42:273–7.

    Article  PubMed  Google Scholar 

  33. Venkatesh V. Determinants of perceived ease of use: Integrating control, intrinsic motivation, and emotion into the technology acceptance model. Inf Syst Res. 2000;11:342–65.

    Article  Google Scholar 

  34. Ellis RD, Allaire JC. Modeling computer interest in older adults: The role of age, education, computer knowledge, and computer anxiety. Hum Factors. 1999;41:345–55.

    Article  PubMed  CAS  Google Scholar 

  35. Earnest MA, Ross SE, Wittevrongel L, et al. Use of a patient-accessible electronic medical record in a practice for congestive heart failure: patient and physician experiences. J Am Med Inform Assoc. 2004;11:410–7.

    Article  PubMed  Google Scholar 

  36. Yeh YT, Chiu YT, Liu CT, et al. Development and evaluation of an integrated patient-oriented education management system for diabetes. Stud Health Technol Inform. 2006;122:172–5.

    PubMed  Google Scholar 

  37. Zimmerman L, Barnason S, Nieveen J, et al. Symptom management intervention in elderly coronary artery bypass graft patients. Outcomes Manag. 2004;8:5–12.

    PubMed  Google Scholar 

  38. Ralston JD, Revere D, Robins LS, et al. Patients' experience with a diabetes support programme based on an interactive electronic medical record: qualitative study. BMJ. 2004;328(7449):1159.

    Article  PubMed  Google Scholar 

  39. Van den Brink JL, Moorman PW, de Boer MF, et al. Involving the patient: a prospective study on use, appreciation and effectiveness of an information system in head and neck cancer care. Int J Med Inform. 2005;74:839–49.

    Article  PubMed  Google Scholar 

  40. Feil EG, Glasgow RE, Boles S, et al. Who participates in Internet-based self-management programs? A study among novice computer users in a primary care setting. Diabetes Educ. 2000;26:806–11.

    Article  PubMed  CAS  Google Scholar 

  41. Strömberg A. The crucial role of patient education in heart failure. Eur J Heart Fail. 2005;7:363–9.

    Article  PubMed  Google Scholar 

  42. Lober WB, Zierler B, Herbaugh A, et al. Barriers to the use of a personal health record by an elderly population. Annual Symposium Proceedings/AMIA Symposium. 2006;514–518.

  43. Gilroy FD, Desai HB. Computer anxiety: Sex, race, and age. Int J Man Mach Stud. 1986;25:711–9.

    Article  Google Scholar 

  44. Igbaria M, Chakrabarti A. Computer anxiety and attitudes towards microcomputer use. Behav Inform Technol. 1990;9:229–41.

    Article  Google Scholar 

  45. Cruz-Correia R, Fonseca J, Lima L, et al. Web-based or paper-based self-management tools for asthma patients' opinions and quality of data in a randomized crossover study. Stud Health Technol Inform. 2007;127:178–89.

    PubMed  Google Scholar 

  46. Chae YM, Park HJ, Cho JG, et al. The reliability and acceptability of telemedicine for patients with schizophrenia in Korea. J Telemed Telecare. 2000;6:83–90.

    Article  PubMed  CAS  Google Scholar 

  47. Mekhjian H, Turner JW, Gailiun M, et al. Patient satisfaction with telemedicine in a prison environment. J Telemed Telecare. 1999;5:55–61.

    Article  PubMed  CAS  Google Scholar 

  48. Stanney KM, Smith MJ, Carayon P, et al. Human computer interaction. In: Salvendy G, editor. Handbook of Industrial Engineering: Technology and Operations Management. 3rd ed. New York: John Wiley and Sons; 2001. p. 1192–236.

    Chapter  Google Scholar 

  49. Oudshoorn N. How places matter: telecare technologies and the changing spatial dimensions of healthcare. Soc Stud Sci. 2012;42(1):121–42.

    Article  PubMed  Google Scholar 

  50. De Vries AE, Van der Wal MH, Nieuwenhuis MMW, et al. Health Professionals' Expectations Versus Experiences of Internet-Based Telemonitoring: Survey Among Heart Failure Clinics. J Med Internet Res. 2013;15(1):e4.

    Article  PubMed  Google Scholar 

  51. Lemay G, Azad N, Struthers C. Utilization of home telemonitoring in patients 75 years of age and over with complex heart failure. J telemed Telecare. 2013; doi:10.1177/1357633X12473917

  52. •• Elwyn G, Hardisty AR, Peirce, May C, Evans R, Robinson DK, et al. Detecting deterioration in patients with chronic disease using telemonitoring: navigating the ‘trough of disillusionment’. J Eval Clin Prac. 2012;(18) 896–903. This paper gives a critical overview of the (non)readiness of the implementation of telemonitoring into daily care.

  53. Hardisty AR, Peirceb SC, Preecea A, et al. Bridging two translation gaps: A new informatics research agenda for telemonitoring of chronic disease. Int J Med Inform. 2011;80:734–44.

    Article  PubMed  Google Scholar 

  54. Joseph V, West RM, Shickle D, Keen J, et al. Key challenges in the development and implementation of telehealth projects. J Telemed Telecare. 2011;17:71–7.

    Article  PubMed  Google Scholar 

  55. Chang JY, Chen LK, Chang CC. Perspectives and expectations for telemedicine opportunities from families of nursing home residents and caregivers in nursing homes. Int J Med Inform. 2009;78:494–502.

    Article  PubMed  Google Scholar 

  56. • Barrett DI. The role of telemonitoring in caring for older people with long-term conditions. Telehealth. 2012;24:21-25. This manuscript extensively reflects on the possibilities of telemonitoring in daily care.

  57. Burghouts A. Improving patient Improving patient information for telemonitoring in chronic heart failure. 2nd International Congress on Telehealth and Telecare. 2012;Vol 12.

  58. Tanriverdi H, Iacono CS. Diffusion of telemedicine: a knowledge barrier perspective. Telemed J. 1999;5:223–44.

    Article  PubMed  CAS  Google Scholar 

  59. OECD/Statistical Office of the European Communities, Luxembourg (2005),Oslo Manual: Guidelines for Collecting and Interpreting Innovation Data, 3rd Edition, The Measurement of Scientific and Technological Activities, OECD Publishing. doi: 10.1787/9789264013100-en

  60. Berwick D. The science of improvement. JAMA. 2008;299:1182–3.

    Article  PubMed  CAS  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Josiane J.J. Boyne declares that she has no conflict of interest.

Hubertus J.M. Vrijhoef declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Department of Health Services Research, Maastricht University Medical Center, Duboisdomein 30, 6229 GT, Maastricht, The Netherlands

    Josiane J. J. Boyne

  2. Saw Swee Hock School of Public Health, National University of Singapore, 16 Medical Drive, Block MD3, Singapore, 117596, Singapore

    Hubertus J. M. Vrijhoef

  3. Scientific Center for Care and Welfare, Tilburg University, Warandelaan 2, 5000 LE, Tilburg, The Netherlands

    Hubertus J. M. Vrijhoef

Authors
  1. Josiane J. J. Boyne
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hubertus J. M. Vrijhoef
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Josiane J. J. Boyne.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Boyne, J.J.J., Vrijhoef, H.J.M. Implementing Telemonitoring in Heart Failure Care: Barriers from the Perspectives of Patients, Healthcare Professionals and Healthcare Organizations. Curr Heart Fail Rep 10, 254–261 (2013). https://doi.org/10.1007/s11897-013-0140-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11897-013-0140-1

Keywords

Search

Navigation