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First telehealth pilot improves patients’ quality of life

New Zealand’s first telehealth pilot improves patients’ quality of life

Telehealth monitoring for people with chronic conditions shows the technology can improve patients’ quality of life and may have a positive impact on life expectancy.

The results from the first New Zealand pilot of telehealth technology have just been released by health innovator Healthcare of New Zealand.

William Hall, who has chronic pulmonary disease and was one of the people who trialled the technology says, “Since I’ve been on telehealth my health has improved dramatically. I got the monitor 12 months ago and if I didn’t have it, I wouldn’t be here today.”

During the 12 month pilot, which was run in partnership with Midlands Health Network and the Lakes District Health Board, telehealth monitors were set up in the homes of ten of the twenty Turangi/Taupo patients involved in the trial. These patients had either chronic heart failure or chronic obstructive pulmonary disease.

Telehealth monitors enable patients to take their own vital health measurements, for example lung capacity, blood sugars and blood pressure. These measurements are assessed remotely by nurses so medical teams can detect any changes before they become serious and the patient requires hospitalisation.

The results of the pilot suggest that those patients who were remotely monitored through the telehealth technology had improved life expectancy and reduced hospital admissions. Of the original ten participants of the non-telehealth group, four died during the pilot, compared to one person in telehealth monitored group Patients who used telehealth also noted improved confidence and an ability to manage their conditions.

“I understand my condition more and I know what my body is doing. As a result, I’ve changed my food, sleep more instead of exerting myself, and take regular breaks,” says Mr Hall.

The telehealth monitored patients also showed significant improvements in their depression levels - a key quality of life measure.

National integrated care manager for Healthcare of New Zealand, Anton Venter, said
the pilot’s trends were reinforced by large international studies that prove telehealth has a positive impact on reducing hospital admissions, converting emergency department attendances to planned admissions, and even reducing mortality when compared to other forms of care.

“This pilot has proven that the remote monitoring technology can be successfully applied in a New Zealand community to aid in chronic condition management. The local results are really exciting and provide huge potential to change the way these complex conditions are managed both by the medical professionals and the patients themselves,” says Mr Venter.

Chronic conditions are the leading cause of hospitalisations in New Zealand. National Health Committee reported that they account for 80% of all preventable deaths and are estimated to consume a major proportion of our health care funds.

The growing need to provide innovative solutions to support chronic care management in the community is also recognised by chief executive officer of Midlands Health Network, John Macaskill-Smith

“The telehealth pilot has enabled us to start to develop an understanding of how technology might contribute to the more effective care of our patients with chronic conditions.”

Chief executive of Lakes DHB, Cathy Cooney says, “Lakes DHB has been proud to be a partner during the pilot of the telehealth technology in the Turangi and Taupo communities. The findings show that telehealth provides a useful tool for health professionals to incorporate into the overall plan of care they establish with individual patients with chronic conditions.”

Cathy Cooney added that the telehealth monitoring also helps patients have improved understanding of their condition and it supports their self management.

The pilot’s outcomes were assessed by Sapere, an independent research company who also determined the evaluation framework.



Overview of the pilot progamme
The Turangi/Taupo pilot, which began ran for 12 month from September 2009 to September 2010, had formal Ethics Committee approval. It was a randomised controlled trial (RCT) with an intervention arm and matching control group (10 patients in each group). The pilot’s aim was to test the telehealth technology in the New Zealand context and while this small sample size was unlikely to produce statistically significant results, trends toward positive outcomes may be observed.

Selection criteria were: Lake Taupo PHO patients discharged from Taupo hospital in the previous 12 months with primary diagnosis of chronic heart failure (CHF) or chronic obstructive pulmonary disease (COPD). The ten patients in the intervention group received telehealth monitoring combined with the PHO’s chronic care management programme, HealthRight; while the ten patients in the control group only received the HealthRight programme.

Patients in the intervention group, nurses and health practitioners received intensive training on using the telehealth monitor. The monitors have been installed in the intervention patient’s homes and tested by a professional. A free phone number and support structure was put in place to assist patients should they have any problems once the machine was operating.

During the pilot, nurses checked the intervention patient’s telemonitored data on a predetermined basis and followed-up with clients if their results were not received when expected.

Baseline data collection testing which took place at the beginning of the study was compared with final data. Analysis of the pilot was done in two phases after the first six months and at the end of the 12 month pilot.

International research summary
Studies of international pilots and programmes reviewed by Sapere (formerlyLECG) found that telehealth monitoring, if implemented well, has shown to enable practices to support a higher caseload, while maintaining the health of the managed population at existing levels. It is very likely to replace emergency department admissions with planned admissions; and can reduce the total number of hospital bed-days, re-admissions; and deaths compared to management by a hospital based, or even a primary care, nursing service. The studies also show a high level of patient satisfaction with the technology.

Healthcare of New Zealand
Healthcare of New Zealand provides a broad range of home and community-based services where age, disability, illness or accidents make such support necessary. We provide support to more than 17,000 people living in their own homes, specialist community homes or with family/whānau, making us the one of the largest providers of health and disability support services in New Zealand. Freedom Health Technologies, a division of Healthcare of New Zealand, provides telecare, telehealth and medication management solutions.

Midland Health Network
Midlands Health Network is a not-for-profit health management organisation that supports the delivery of primary and community health care to nearly half a million people enrolled with over one hundred general practices in Gisborne, Taranaki, Taupo-Turangi, and the Waikato.

Lakes District Health Board
The Lakes DHB serves an area that includes the Rotorua and Taupo districts, and is situated in the middle of the North Island. The DHB serves a population of close to 104,000 and stretches from Mourea in the north to Mangakino in the west down to south of Turangi and to Kaingaroa Village in the east. These boundaries take in the major population centres of Rotorua, Taupo, Turangi and Mangakino. Two main iwi groups (Te Arawa and Ngati Tuwharetoa) are located within the Lakes District Health Board area.

Sapere Research Group
Formely known as LECG, Sapere, was employed by Healthcare of New Zealand to develop an evaluation framework to provide an independent assessment of the telehealth pilot.

Sapere are a global expert services firm with highly credentialed experts and professional staff with specialist knowledge in regulation, economics, financial and statistical theories and analysis. The company’s experts provide independent testimony, original authoritative studies and strategic advice to both public and private sector clients including legislative, judicial, regulatory, policy and business decision makers.

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