Heart failure (HF) is a condition associated with a high rate of hospitalizations. Improved organization of HF care, with HF Units or Programmes, have a major impact on hospitalizations. On the other hand, interest in telehealth as a way of providing care is gradually increasing within healthcare systems around the world due to the availability of technology and to the wider availability of patient-friendly equipment. The hypothesis that telehealth can be used on top of HF specific management was the basis of the CARME (Catalan Remote Management Evaluation) study with Philips’ telehealth system, Motiva.
CARME (Catalan Remote Management Evaluation) Study Summary
The main objective of CARME was to evaluate the effectiveness of a Remote Patient Management program (RPM) in Heart Failure (HF) patients already managed in a specific multidisciplinary HF Unit, assessing the impact of such a program on the number of hospitalizations and days-in-hospital.
The study also evaluated the changes in patient behaviour obtained after the program and its impact on the perception of their Quality of Life (QoL).
Finally, researchers evaluated the feasibility, acceptance rate, confidence and satisfaction of the RPM program in patients included in the study.
A total of 97 Heart Failure patients were monitored during a 12 month period with Philips Motiva, a telehealth solution that uses TV and a broad band Internet connection. Patients were randomized in 2 groups: one using the Motiva system as a disease management tool that provides educative videos, messages, charts, questionnaires, and the other group using the Motiva system together with telemonitoring of blood pressure, pulse rate and weight. Hospitalizations were compared during similar periods of time (one full year) before and after the inclusion in the RPM.
A total number of 92 patients (71% men; mean age 66.3; 51 in group A and 41 in group B) were studied. Most patients were in moderate to severe disease stages -NYHA class II (81.5%) or III (18.5%).
The study was conducted at the Heart Failure Unit, Department of Cardiology, of the Hospital Germans Trias i Pujol in Badalona (Barcelona province, Spain) in 2008-2009.
- Hospital admissions
The RPM program using Motiva significantly reduced the number of admissions due to HF and other CV disorders and also the number of total days of hospitalization. Patients in group B, that added telemonitoring to disease management tools had a higher reduction in “all cause” hospital admissions.
The number of cardiovascular (CV) hospitalizations falls significantly from 54 to 20, that represents a 62.9 % reduction in total CV admissions, a 67.8% reduction in HF hospitalizations and a 57.6% reduction in other CV admissions. A significant reduction of almost 74% in total days-in-hospital was observed from 646 days (HF 259; other CV 387) to 168 days (HF 69 in-hospital and 33 home-hospitalization; other CV 66).
For patients in group A, with only disease telemanagement tools, all cause admissions raised about 30%, but admissions due to HF were reduced by 80%. On the contrary, patients in group B with both management tools and telemonitoring tools experienced a significant reduction in both all cause hospital admissions (63%) and in HF admissions (75%). The percentage of patients in group A with hospital admissions was 38% (of total patients enrolled) while in Group B the percentage with hospital admissions was 23,5%.
- Patients behaviours’ change and quality of life
Although the number of patients who discontinued RPM was far from negligible, positive changes in several aspects of patients’ behaviour were observed with the use of RPM, together with the improvement in the perception of their QoL.
Positive changes in patients’ behaviour were mostly observed, such as being able tro enjoy hobbies and pastime or modifying nutrition habits although no effect on nutritional and exercise data recording was obtained. The perception of Quality of Life significantly improved during the 12 month period.
Data from Carme Study reveal that patients included showed a continuous improvement in their perception of Quality of Life over the 12 month observation period (based on EuroQoL and Minessota questionnaires), with statistically significant changes. At the beginning of the study more than half of the patients (55,88%) said that their quality of life was medium or low. After six months, this number decreased to 29,41%, and at the end of the study to 22,06%. Furthermore, the percentage of patients that considered their quality of life medium-high rose from 43,61% at the beginning of the study to 77,94% after one year, and almost one third (27,94%) considered it as almost excellent.
The improvement in Quality of Life was significantly higher in Group B vs. Group A at 6 months, staying stable until the completion of the 12 month period of the study.
- Acceptance of Motiva among patients
Patients who finished the study showed confidence considering the RPM system with Philips Motiva and a high degree of satisfaction with the tools used.
The satisfaction about the tools used was quite high. Almost all patients felt confident with the information they got and affirmed to enjoy using the system. The percentage of patients rating their satisfaction to the information provided in Motiva high or very high (points 8 to 10 in a ten point scale) was higher in the Group B than in Group A. A higher percentage of patients in Group B said they wanted to keep Motiva after the study completion: 27 out of 34 wanted to keep it, while in Group A 50% patients wanted to keep it and 50% didn’t (17 vs.17).
About Philips Motiva
Philips’ Motiva is an interactive healthcare system that connects patients with chronic conditions, e.g. (Chronic) Heart Failure, Diabetes Mellitus, and Chronic Obstructive Pulmonary Disease (COPD), to their healthcare providers via their home television and a broadband internet connection.
Motiva automates disease management activities, and engages patients with personalized daily interactions and education delivered through the home television. The system enables healthcare providers to motivate behaviour change through user-friendly technology, helping them meet goals for improved patient compliance, telehealth programme efficiency, and lower healthcare costs.
In addition to automated monitoring of their vital signs, patients are supported by:
- Educational videos on topics relevant to their individual healthcare needs.
- Feedback on the measurements of their vital signs to help patients track their progress toward their personal goals.
- Motivational messages from caregivers to help encourage healthy lifestyle choices in diet and exercise.
- Health-related surveys that evaluate patients’ comprehension, motivation, and self-efficacy levels to provide subjective information about their current health status to the remote caregiver.
Home Healthcare at Philips
A core part of Philips’ healthcare strategy is to take a leadership position in the high-growth sector of home healthcare. Empowered consumers make smarter healthcare decisions and Philips provides products and services that improve the quality of life for aging adults, people with chronic illnesses and their caregivers, by enabling independent living at home. Philips’ heritage in understanding how consumers think is combined with our deep clinical knowledge, putting the company in a unique position to help address the modern day challenges of healthcare systems in groundbreaking ways.
Philips Home Healthcare, which continued to grow at double-digit percentage growth rates in the first quarter of 2009, provides innovative solutions for the home that connect patients to their healthcare providers and support independent living for seniors and the chronically ill.
The Philips Home Healthcare Solutions include Sleep and Home Respiratory diagnosis and treatment, solutions for Independent Living and Remote Monitoring devices.