Result card

  • ORG7: What are the processes ensuring access to care of structured telephone support (STS) for adult patients with chronic heart failure for patients/participants?

What are the processes ensuring access to care of structured telephone support (STS) for adult patients with chronic heart failure for patients/participants?

Authors: Valentina Prevolnik Rupel, Taja Čokl, Eleftheria Karampli

Internal reviewers: Ulla Saalasti - Koskinen, Elle Kisk, Ricardo Ramos

To answer the questions in the assessment elements we mainly used the basic literature search provided for the whole project. Additionally, two more systematic searches were used: one performed by ORG and ECO domains (described in methodology of ECO domain) and one perfomed by EFF, SAF and ECO domains (described in SAF domain).A qualitative handsearch (google; keywords: structured telephone support, heart failure, telemedicine) was done adding further information for this question. The results are provided in descriptive way.

In general, RM including STS provides greater access to care in geographical terms. In most of the studies the problems with accessability to phone line were not reported. Careful planning of STS is necessary among specific population that might have issues in moving around and having lower access to phone lines. Also, the number of telephone contacts per week should not be too high, not even in the first week as this may affect adherence. The problems might arise on the side of physicians as patients might relocate to more developed health care centres with remote monitoring programs posing financial risk for smaller providers.

Speaking in terms of financial accessability, no specific problems were mentioned on the side of the patient, although we must take into account that the literature is mostly reporting studies and less real time and location STS programs that would be reimbursed regularly by health care system. On the side of the provider, the current reimbursement structures basically do not support STS and hence act as a disincentive to providers wanting to offer RM including STS to patients sustaining HF. Innovative reimbursement schemes such as coverage with evidence in development are suggested in the literature.

Programmes involving RM of patients, including TM and STS, offer the potential of improved access to specialist care for a larger number of patients across a larger geographical area compared to usual care {290}. RM may be of particular benefit to patients who have difficulty accessing specialised care because of geography, transport or infirmity {1280}.

All CHF patients for which STS is provided need access to phone line. In the TIM-HF study it was assured that patients had access to telephone {1150}. Inability to access the patient by telephone is an exclusion criterion in a study {30}. In a study {30} that took place in South Texas, where patients came from urban, suburban and rural settings (general real-world setting), there was no mentioning of access restriction due to phone line accessability. In Riegel’s study of Hispanic patients {230}, the authors point out that nurses had difficulty reaching patients at various times during the follow-up period because they were moving among different households or travelling back to Mexico.

In a study {1} for all subjects assigned to the telephone groups, all intervention contacts were conducted using their personal telephone in their home. One reason for the fewer-than-expected contacts is that the study nurses sometimes found it difficult to schedule and complete the planned three contacts in the first week postdischarge. In the same study, some planned videophone contacts were  replaced using telephone contacts due to technical issues, such as inability to connect by videophone or transitory problems with video resolution. Although a broadband Internet connection could minimize the problem of slow transmission rates, use of a computer adds a level of complexity that would deter many older patients from participating in this type of intervention. Furthermore, the monthly fee for the broadband services is an expense that some patients could not afford {1}. Based on the results of the subanalysis in a Tele-HF trial {270} it does not seem that interactive voice response technology is an appropriate strategy for comparison of clinical studies of remote monitoring for HF.

For designers and manufacturers, home health monitoring systems occupy a unique niche. As a result, as insurance reimbursement for home telemonitoring evolves, these devices are more cost-sensitive than most other medical devices {12}. The current reimbursement structure is a disincentive to providers wanting to offer DM services to HF patients. Today, physicians reimbursement remains a major concern with a lack of appropriate reimbursement in place in most countries worldwide and as a result limiting an increased use of evidence-based RM {120}. Today’s cost containment pressure requires increased reimbursement effort with the burden of proof shifting to medical communities and manufacturers. Innovative reimbursement schemes such as coverage with evidence in development might be a viable option to overcome the current discrimination of RM reimbursement. Based on today’s evidence in place, the utilization of RM should not be further limited by discriminative reimbursement policies but should be left to the decision making of doctors and patients to optimize individual patient care {120}. Although many providers and healthcare systems would like to offer DM services to patients with HF, current reimbursement can create a disincentive to provide DM interventions {1500}. The lack of reimbursment has been identified as a significant reason for the limited use of DM by providers.  On the other hand, the cost of providing DM services such as additional clinical visits, patient education materials, or additional personnel time has not been well documented. {1500}.

Rupel V et al. Result Card ORG7 In: Rupel V et al. Organisational aspects In: Jefferson T, Cerbo M, Vicari N [eds.]. Structured telephone support (STS) for adult patients with chronic heart failure [Core HTA], Agenas - Agenzia nazionale per i servizi sanitari regionali ; 2015. [cited 5 July 2022]. Available from: