Use of Telehealth as a New Model for Following Intermittent Claudication and Promoting Patient Expertise

• Published in: Telemedicine journal and e-health Vol. 24; no. 10; p. 773
• Main Authors: Davins Riu, Meritxell, Borràs Pérez, Xavier, Artigas Raventós, Vicenç, Palomera Fanegas, Elisabet, Serra Prat, Mateu, Alós Villacrosa, Jesus
• Format: Journal Article
• Language: English
• Published: United States 01.10.2018
• Subjects: empowerment; expert patient; peripheral arterial disease; CONTECI; self-management; telehealth
• ISSN: 1556-3669
• DOI: 10.1089/tmj.2017.0226

A change in healthcare systems is needed, due to the increased prevalence of chronic diseases. Patient empowerment improves results in terms of patient quality of life (QoL) and satisfaction. We have developed a telehealth program Control Telehealth Claudication Intermittent (CONTECI) for patients with peripheral arterial disease (PAD), aimed at enhancing patient satisfaction and QoL, while improving health system efficiency. We conducted a randomized clinical trial of patients with PAD, at the intermittent claudication stage. Study subjects were randomized into either (1) an intervention arm (IA), which utilized our CONTECI program for promoting patient self-management, or (2) a control arm (CA), utilizing the familiar system of in-person patient visits. All patients were followed up at 1 year. The trial included 150 patients, 75 in each arm. Complications were diagnosed more quickly in the IA (7.85 days standard deviation (SD) 9.95 vs. 53.89 days SD 41.56; p = 0.016) compared with the CA. Rest pain decreased (1.4% vs. 8.4%; p = 0.05) in the IA group, as did the number of scheduled visits-decreased by 95.95%-and the number of emergency visits (p = 0.017). QoL scores in IA patients improved from baseline (67.87 vs. 72.25; p = 0.047), as did patient satisfaction (67.36 vs. 76.78; p = 0.03). Telemedicine can improve health results and aid communication and visit scheduling. Our e-Health programs are financially viable. Self-management using the CONTECI telehealth program is feasible for patients with PAD. The program promotes patient expertise, encourages proactivity, increases QoL and satisfaction with disease control, and improves health resource use, with no evidence of clinical inferiority to conventional practices.