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Veronica Kirk

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  • EP03 - Application / Implementation / Benefits and Realization (ID 14)

    • Event: e-Health 2019 Virtual Meeting
    • Type: ePoster Session
    • Track: Clinical Delivery
    • Presentations: 1
    • Coordinates: 5/27/2019, 03:30 PM - 04:30 PM, Pod 9
    • EP03.05 - Use of Telemonitoring to Facilitate Heart Failure Medication Titration (ID 513)

      Veronica Kirk, Institute of Health Policy, Management and Evaluation; Toronto/CA

      • Abstract
      • Slides

      Heart failure (HF) is a common diagnosis with high prevalence, reduced life expectancy and a significant clinical and economic burden. The Heart and Stroke Foundation estimates that nearly 700,000 Canadians are living with heart failure, about 50,000 new cases are diagnosed every year, and heart failure costs the Canadian health-care system $2.8 billion annually. Large-scale randomized controlled trials have demonstrated that combination drug therapy, optimized to maximal tolerated doses, improves clinical outcomes in HF patients. However, evidence suggests that in clinical practice many patients never achieve target doses. Barriers to medication titration include provider and patient-related factors, as well as limited time and support facilities to enable regular monitoring. Telemonitoring is a potential component in the management of HF that can provide reliable and real-time physiological data for clinical decision support, alerting, and patient self-management. The primary objective of this study is to evaluate the efficacy and safety of the implementation of telemonitoring to facilitate HF medication titration. The secondary objective is to obtain a deeper understanding of the experience of clinicians and HF patients taking part in the remote titration program.

      The study will be conducted at the Peter Munk Cardiac Centre (PMCC), University Health Network, in Toronto. It will be based on a mixed methods effectiveness-implementation hybrid design and incorporate process evaluations alongside assessment of clinical outcomes. The effectiveness research component will be assessed via a 2-arm randomized controlled trial (RCT), which will enroll 42 patients in total. The RCT will compare a predefined remote titration management strategy, which will utilize data from a smartphone-based telemonitoring system, with a standard titration management strategy consisting of regular in-office visits, and assess the efficacy and safety of the telemonitoring system in facilitating titration. The implementation research component will consist of a qualitative study based on semi-structured interviews with a purposive sample of clinicians and patients, and assess the factors that can positively impact the implementation and effectiveness of the intervention.

      Data collection has begun and will be completed in the spring of 2019. The results of this study will be presented at the conference.

      Successful use of telemonitoring for the purpose of medication titration has the potential to alter the existing approach to titration and provide evidence for the development of a care delivery model that combines clinic visits with virtual follow-ups. This model could decrease the number of visits that patients make to the clinic, increase the proportion of patients who achieve optimal doses and impact the median time to dose optimization. Our study will be the first to provide evidence on the potential of telemonitoring to optimize the medication titration process, and thereby reduce healthcare resource utilization, the burden on the patient, and the cost of the process from the patient?s perspective.

      140 Character Summary:
      Use of telemonitoring to facilitate heart failure medication titration in order to reduce the amount of clinic visits made by patients.

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