Home telehealth (HT) programs are increasingly used to improve chronic disease management. Patient adherence to the use of HT devices impacts both care efficiency and effectiveness. However, the factors that impact adherence to HT, as well as associations between adherence and health services outcomes, remain to be fully explored.
This study in Veterans with heart failure enrolled in the VA HT Program: (1) described patient adherence to the use of HT devices in the first year; (2) examined the relationship between patient adherence to the use of HT devices and health services use at 12 months; and (3) identified patient characteristics that influence adherence to the use of HT devices at 1, 3, 6, and 12 months after enrollment.
This retrospective cohort study used existing VA data from the national VA HT Database and the VA Corporate Data Warehouse, and included all Veterans with heart failure who enrolled in the VA HT Program between 1/1/14 and 6/30/14. The Andersen Behavioral Model guided the study. Patient adherence was weekly reports of daily HT device use adjusted if the patient was in the hospital during the week. Health services use indicators included number of emergency room (ER) visits, cardiology clinic visits, and hospital admissions. Patient variables that may influence adherence to the use of HT devices included predisposing, enabling, and need factors. Available health care system factors (i.e., urban/rural setting, facility size, etc.) were obtained as control variables.
Descriptive statistics were used to summarize sample characteristics and percent average adherence over various time frames. Zero-Inflated Negative Binomial is used to examine relationships between adherence and health service use. To determine patient characteristics that influenced adherence, General Estimating Equation was used with facility as covariate. In addition, Cox Proportional Hazards model was used to determine factors associated with time to drop-off from HT program.
The sample (n=3,449) was mainly white, older, male Veterans who were married. Percent average adherence increased when patients were grouped based on their continued use (i.e., 53% at 1 month, 63% at 3 months, 67% at 6 months, and 69% at 1 year). No relationship was found between average adherence and number of ER visits, cardiology clinic visits, or hospital admissions after 1 year. Number of weekly adherence reports submitted, having no depression, and being older were all associated with higher percent average adherence in all time frames studied. Compared to White Veterans, Black and other minority Veterans had lower adherence at all time frames studied. In addition, age, race, Care Assessment Need (CAN) score, prior year's hospital readmission rate, non-institutional care (NIC) designation, use of My HealtheVet, use of in-home messaging device (as opposed to a web browser or interactive voice response), and percent average adherence were all predictors of time to drop-off from the HT program.
Further research is needed to determine outcomes associated with Veteran adherence to the use of HT devices. This study identified potential opportunities to improve care of Veterans enrolled in the VA Home Telehealth Program. This included provision of support for Veterans who enroll in HT with depression or from a minority group to improve their adherence to the use of HT devices over time, and those who enroll with high CAN score, NIC designation, and prior hospital re-admission (which are common selection criteria for enrollment) to prevent program drop-off.
- Guzman-Clark J, Wakefield BJ, Farmer MM, Yefimova M, Viernes B, Lee ML, Hahn TJ. Adherence to the Use of Home Telehealth Technologies and Emergency Room Visits in Veterans with Heart Failure. Telemedicine journal and e-health : the official journal of the American Telemedicine Association. 2020 Dec 3.
- Guzman-Clark J, Farmer MM, Wakefield BJ, Viernes B, Yefimova M, Lee ML, Hahn TJ. Why patients stop using their home telehealth technologies over time: Predictors of discontinuation in Veterans with heart failure. Nursing Outlook. 2020 Dec 2.
- Guzman-Clark J, Yefimova M, Farmer MM, Wakefield BJ, Viernes B, Lee ML, Hahn TJ. Home Telehealth Technologies for Heart Failure: An Examination of Adherence Among Veterans. Journal of gerontological nursing. 2020 Jul 1; 46(7):26-34.