Elsevier

Heart & Lung

Volume 32, Issue 4, July–August 2003, Pages 226-233
Heart & Lung

Issues in cardiovascular nursing
Pilot study of a Web-based compliance monitoring device for patients with congestive heart failure

https://doi.org/10.1016/S0147-9563(03)00026-8Get rights and content

Abstract

BACKGROUND: Web-based home care monitoring systems can assess medication compliance, health status, quality of life, and physiologic parameters. They may help overcome some of the limitations associated with current congestive heart failure management models.

OBJECTIVES: This pilot study compared the effects of a self-care and medication compliance device, linked to a Web-based monitoring system, to the effects of usual care alone on compliance with recommended self-care behaviors; medication taking; quality of life; distance walked during a 6-minute walk test; and New York Heart Association Functional Class. We also assessed patient experiences living with the compliance device.

METHODS: We enrolled 18 patients with Functional Class II-III congestive heart failure in an urban VA Medical Center. The patients were randomized into 2 groups. Group A received usual care plus the compliance device. Group B (controls) received usual care only. Data were collected using the compliance device, the Heart Failure Self-Care Behavior Scale, pill counts, 6-minute walk test, and the Minnesota Living with Heart Failure Questionnaire at baseline and at 3 months follow-up.

RESULTS: At baseline and at 3 months, there were no differences between the compliance device group and the usual care group in self-care behaviors, pill counts, 6-minute walk-test distance, or Functional Class. However, quality of life improved significantly from baseline to 3-month follow-up (ANOVA, P = .006). This difference was due to an improvement in quality of life for the monitor group (P = .002) but not the usual care only group (P = .113). Patients in the compliance device group had a 94% medication compliance rate, 81% compliance with daily blood pressure monitoring, and 85% compliance with daily weight monitoring as compared to 51% for blood pressure monitoring and 79% for weight monitoring in the usual care group (P = NS).

CONCLUSION: These are promising pilot results that, if replicated in a larger sample, may significantly improve care and outcomes for patients with heart failure.

Section snippets

Conceptual framework

Figure 1 describes the conceptual basis of the study. We employed self-care theory17, 18 to plan the study and assess compliance with recommended self-care behaviors. The study’s hypothesis was based on the assumption that if the intervention strengthened self-care behaviors clinical outcomes would improve.

Review of literature

There are few reports that describe Web-based methods for improving the care of patients with CHF although there are reports of telehealth methods that may be computer-based or web-enhanced. Bennett et al19 reported promising results in one patient who used a WebTV system. Another study20 found physical assessments could be performed via a two-way telemedicine audio-visual system. De Lusignan et al21 showed that at 1-year follow-up, patients randomized to a video consulting system using

Design

Potentially eligible patients were identified on arrival for scheduled CHF clinic visits by screening charts. Eligible patients were given a detailed explanation of the study and written informed consent was obtained. Following baseline data collection and using a random numbers table, patients were randomized either to usual care or to the Web-based intervention plus usual care. The Wayne State University Human Investigation Committee approved the study protocol.

At baseline all patients

Patient characteristics

There were 17 men (94%) and 1 woman (6%), aged 50 to 87 years (M = 68, SD = 11 years). Table I describes their clinical characteristics and perceived health. Eleven patients (65%) were black and 6 were white (35%). The mean educational level was 13 years (range, 8–19 years). Two patients (13%) reported annual income levels <$10,000, 8 patients (53%) reported incomes between $10,000–$19,000, 4 patients (27%) reported incomes between $20,000–$29,999, and 1 participant (6%) reported annual income

Discussion

This was a pilot study that showed promising results. Participants in the monitor group had a 94% medication-taking compliance rate. This is particularly important, as noncompliance with medications is one of the major factors directly implicated in readmissions of CHF patients.30 The monitor patients also had an 81% compliance rate with daily blood pressure monitoring and an 85% compliance rate with daily weight monitoring as compared 51% for blood pressure monitoring and 79% for weight

Acknowledgements

This study was supported in part by a Center for Health Research Summer Research Initiative, Wayne State University. The investigators would also like to thank the staff in the CHF clinic at the John D. Dingell VA Medical Center for their help.

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