Home Telehealth Technologies for Heart Failure: An Examination of Adherence Among Veterans.
Jenice Guzman-Clark, Maria Yefimova, Melissa M Farmer and 4 others
PMID 32597998WHAT IT FOUND
Veterans with heart failure used home telehealth on 53% of days they could have used it at 1 month and 69% after 1 year.
Older age and no depression were linked to better use; Black race and depression were linked to lower use.
Key findings
01Average adherence to home telehealth was 53% at 1 month and 69% after 1 year, while the number of patients using the technology fell from 3,449 to 2,291.
02Not having depression and older age were associated with higher average adherence, while Black race was associated with lower average adherence at all time points.
03Not using the VA patient portal was associated with lower adherence at 1 and 3 months, and using a web browser or interactive voice response instead of an in-home messaging device with a hub was associated with 2.5% lower average adherence at 1 year.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study included only Veterans with heart failure who enrolled in a VA home telehealth program between January 1 and June 30, 2014, so it may not apply to other patients or settings. It used administrative data, so it could not measure patient-provider communication, ease of equipment use, perceived benefits, health literacy, training, or self-efficacy. Electronic health record data can contain information bias and misclassification. Later adherence averages excluded patients who stopped using the technology after the first month, so the rise from 53% to 69% may reflect only continuing users. The study was observational, so associations do not show that any factor caused better or worse adherence. Missing ejection fractions were imputed, and missing weekly adherence data were not imputed, although the number of weekly reports was included in the models.
The easy way to misread this
Do not read the rise from 53% to 69% as evidence that the telehealth program improved adherence over time. Later averages excluded patients who stopped using the technology after the first month, so they describe only those who continued.