The telephone and the Internet are increasingly used to teach patients to manage a chronic condition. Wakefield and coworkers evaluated the efficacy of two telehealth applications, delivered by telephone and videophone, for improving outcomes of patients following hospital discharge for an acute exacerbation of heart failure. The outcomes measured were patient self-efficacy, satisfaction with care, and knowledge of and compliance with prescribed medications. At hospital discharge, patients were randomly assigned to control (usual care), telephone, or videophone groups. Study nurses contacted the intervention patients each week for 90 days after discharge. A total of 148 patients were enrolled: 49 were randomized to usual care, 52 to the videophone intervention, and 47 to the telephone intervention. At 90 days, 126 patients (85%) had completed follow-up; at 180 days, 109 patients (74%) had completed follow-up. There were no significant differences between the groups in medication compliance, self-efficacy, or satisfaction with care. The intervention group patients were more likely to have had their medications adjusted during the 90-day intervention period. Knowledge scores improved in the intervention group patients, although these scores were lower at enrollment compared to the control group. It is possible that routine monitoring of symptoms by the study nurses led to medication adjustments and accounted for the intervention patients' significantly delayed time to readmission relative to the control patients.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: The conclusions by the authors are likely valid: routine monitoring of all patients led to the lack of difference on some outcome measures.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: The study was too short to expect significant differences to emerge with respect to self-efficacy. That would occur only if patients performed whatever self-management skills they knew over a period of time and across settings. It would be interesting to compare self-management training with telephone monitoring to usual care with telephone monitoring. Differences, particularly in self-efficacy, would likely emerge if the study were conducted for 12 or more months.

BJ Wakefield et al. Outcomes of a home telehealth intervention for patients with heart failure. Journal of Telemedicine & Telecare, 2009;15:46-50.