Issues in cardiovascular nursingPilot study of a Web-based compliance monitoring device for patients with congestive 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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