268122 Home telehealth monitoring in high-risk dialysis patients: Adherence and behavior change

Wednesday, October 31, 2012 : 9:30 AM - 9:50 AM

Puihan Chao, PhD , The H.O.P.E. Project, Honolulu, HI
Dayna Minatodani, PHD , H.O.P.E. Project, Honolulu, HI
Nicholas Gibson, MA , Department of Sociology, University of Hawaii at Manoa, Honolulu, HI
     
Objective: Emerging evidence supports the feasibility and cost-effectiveness of using remote technology to promote health management. The results of a randomized controlled study published in 2011 suggested that home telehealth monitoring with remote nurse clinician (RNC) support improved health outcomes and reduced cost of care in high-risk dialysis patients. This present study aimed to identify the specific therapeutic components of nurse clinician support and patient self-monitoring and to evaluate perceived barriers and facilitators in using home telehealth monitoring.

Methods: Content analysis was used to analyze transcribed audiotaped data of semi-structured interviews. Additionally, a survey was designed and administered to quantify patient's perceived satisfaction and utility of nurse support and self-monitoring. The sample consisted of 33 ethnically diverse, underserved, high-risk dialysis patients in Hawaii. Their mean age was 60 years (13 females; 20 males).

Results: Therapeutic components and facilitators that promoted adherence and health behavioral change included: Efficient RNC feedback, provision of informational, instrumental, and emotional support by RNC, emphasis of promotion of patients' accountability and skills for disease self-management, and patients' high level of perceived utility of RT home health monitoring. In addition, patients reported high levels of satisfaction with telehealth monitoring despite facing challenges in mastering the technology, conflicts with daily schedule, and significant declines in health status. Preliminary results also suggest that nurse support and patient empowerment in self-management could reduce caregivers burden.

Conclusions: The results support the feasibility and cost-effectiveness of telehealth technology with nurse clinician support to promote chronic disease self-management in high-risk dialysis patients.

Learning Areas:
Chronic disease management and prevention
Communication and informatics
Conduct evaluation related to programs, research, and other areas of practice
Diversity and culture

Learning Objectives:
1) Identify three facilitators and three barriers to use of home telehealth monitoring. 2) Evaluate the role of nurse clinician support (or other health care professional) in adherence to and satisfaction of home health self-monitoring. 3) Discuss implications of home telehealth monitoring for chronic disease management.

Keywords: Telehealth, Disease Management

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a 20-year type 1 diabetic and sociology Ph.D. student and Instructor at the University of Hawai'i at Mānoa. I have 5 years of management experience at summer camps primarily serving the type 1 diabetic youth population, and over a year of clinical research oversight at the University of California Irvine Medical Center. Current research: homelessness; the intersection of technology and self-care; the impact of knowledge and technology on patient self-concept, health care communication.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 5061.0: Telehealth: Innovative Technology and the Competition