Effect of remote patient monitoring and resource utilisation in primary and specialist healthcare services: a systematic review
Systematic review
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The purpose of this systematic review was to investigate effects of remote patient monitoring for adults with non-communicable chronic diseases regarding use of resources in primary and specialist healthcare services.
Key message
Welfare technology, including remote patient monitoring, is an important element in evolving healthcare services. The purpose of this systematic review was to investigate effects of remote patient monitoring for adults with non-communicable chronic diseases regarding use of resources in primary and specialist healthcare services. Remote patient monitoring in this review entails predetermined health-related measurements which the patient digitally transfers to healthcare services (e.g., with applications, tablet, and telephone).
Our main findings show that:
- Remote patient monitoring probably makes little or no difference in hospital admissions and days, visits to outpatient clinics and emergency rooms, and the use of general practitioners, compared to usual care after 12 months.
- Remote patient monitoring may not reduce hours spent on healthcare at home compared to usual care after 12 months.
- The effect of remote patient monitoring on general practitioner appointments is very uncertain compared to paper-based diary cards after 12 months.
The results are based on individual studies and the evidence is too limited to be certain whether remote patient monitoring has any effect on resource utilisation in specialist and primary healthcare services compared to usual care.
Summary
Introduction
Treatment of non-communicable chronic diseases constitutes a large proportion of patient treatment in the healthcare service and people with chronic diseases are today the largest user group of health services. The follow-up of people with chronic diseases is resource-intensive and requires a large degree of interdisciplinary and comprehensive follow-up over time. This entails increased requirements for both capacity and competence in health- and care services.
With a larger proportion of people with chronic diseases, the demand for innovative strategies to meet the population's need for good future-oriented health services increases (1). Welfare technology, in the form of technological solutions for follow-up at home, is highlighted as an important element in the development of the healthcare sector (2;3). The use of welfare technology cannot replace human contact, but it can be a tool for people with health challenges to gain a greater degree of independence and self-management through active involvement in their own health. The use of welfare technology can also contribute to increased sense of safety for both patients and relatives. It is likely that welfare technology can free up resources in healthcare services, which can be utilised with increased focus on quality. Furthermore, it is expected that welfare technology can prevent or postpone institutional admissions. However, there is a need for summarized research on the effect of remote patient monitoring on resource use in primary and specialist healthcare services.
Objective
The purpose of this systematic review is to investigate the effects of remote patient monitoring for people with non-communicable chronic diseases on resource utilisation in the primary and specialist healthcare service.
Method
We systematically searched for literature published between January 2017 and April 2022. We assessed titles and abstracts against the inclusion criteria and then compared and agreed on which studies were relevant. References that were considered relevant were obtained in full text and we made a final assessment of which studies should be included. In line with the project plan, randomised trials from the Nordic countries and the United Kingdom were prioritized for inclusion. We assessed the risk of systematic biases in the included studies. We then extracted predetermined data from the studies and performed analyses where possible. When we lacked sufficient data to conduct statistical analyses, we described the results narratively. We described the results from each study separately, as it was not possible to pool the results in meta-analyses. We assessed confidence in the estimates using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach.
Results
We included three studies with five publications that were published between 2017 to 2022. The randomised trials were conducted in Norway and Denmark. The studies had a total of 1841 participants and the sample sizes varied from 78 to 1225 participants. The participants were persons with chronic obstructive pulmonary disease (COPD), diabetes, heart failure, cancer, mental health problems and comorbidity. The interventions in all the studies were varieties of remote patient monitoring where health personnel were notified in the event of worsening of symptoms and contacted the patients if necessary. In two of the studies, the intervention was compared with usual care. In one study, the comparison was daily entries on diary cards. Due to different interventions and patient groups, we could not compile the results from the studies in meta-analysis. One study did not provide data to calculate effect estimates and we could not assess our confidence in the results from this study. The most important results and our confidence in the results are presented in the table below.
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Remote patient monitoring compared to standard care for adults with non-communicable chronic diseases |
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Patient or population: adults with non-communicable chronic diseases; Intervention: Remote patient monitoring; Comparison: standard care |
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Outcomes |
Anticipated absolute effects* (95% CI) |
№ of participants |
Certainty of the evidence |
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Risk with remote patient monitoring compared to standard care |
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Remote patient monitoring with a tablet for persons with COPD |
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Hospital length of stay (days) after 12 months |
MD 0.09 higher |
1225 |
⨁⨁⨁◯ |
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Contacts with GP |
MD 0.8 higher |
1225 |
⨁⨁⨁◯ |
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Outpatient/emergency department visits after 12 months |
MD 0.13 higher |
1225 |
⨁⨁⨁◯ |
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Help and care at home after 12 months |
MD 523.23 higher |
1225 |
⨁⨁◯◯ |
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Number of hospital admissions after 12 months |
MD 0.05 higher |
1225 |
⨁⨁⨁◯ |
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Mobile diary app for persons with borderline personality disorder |
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General practice contacts after 12 months |
MD 2.02 higher |
78 |
⨁◯◯◯ |
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*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). a. Rated down one level for imprecision due to only one study b. Rated down one level for imprecision due to wide confidence intervals c. Rated down one level for risk of bias due to better adherence to treatment in the intervention group than in the control group d. Rated down one level for imprecision due to few participants |
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Discussion
We included three Nordic studies which assessed effects of remote patient monitoring on resource use in healthcare services. The transferability of these results was considered to be high, and the studies were assessed to have a low to moderate risk of systematic biases. The main findings in this review show that remote patient monitoring probably makes little or no difference on hospital admissions, hospital stays, visits to outpatient clinics and emergency rooms and the use of general practitioners compared to usual care after 12 months. The findings also suggests that remote patient monitoring possibly gives little or no difference in hours spent on home health services compared with usual care after 12 months. The effect of remote patient monitoring on the use of a general practitioner compared with the use of paper-based diary cards after 12 months is very uncertain. This is in line with results from previous reviews that show that there is limited evidence about the effect of remote patient monitoring on the use of health services.
Remote patient monitoring is a relatively new field, which is reflected in the number of studies included in this systematic review. The results must therefore be seen in connection with research on other outcomes such as quality of life, health competence, users' experiences, and preferences, as well as clinical experience. It is conceivable that one reason why we did not find any pronounced effects on remote patient monitoring, is that the follow-up time was too short. There are also other factors that may affect the use of resources, such as variations in digital competence among patients and different practices. It can be difficult to reduce services that a user has already been granted, and remote patient monitoring can thus become a supplement to, rather than a replacement for, regular follow-up and this can result in increased instead of reduced resource use.
There is a great need for more randomised trials of high methodological quality and with a long enough follow-up time that measure the effect of remote patient monitoring compared with usual care, on resource use in healthcare services (both primary and specialist) for patients with non-communicable chronic diseases.
Conclusion
The results from this review indicate that there is little or no difference in use of healthcare resources with remote patient monitoring compared with usual care after 12 months. However, the results are based on individual studies and the evidence is too limited to conclude with certainty.
