title: Predictors and outcomes of early adherence to the use of a home telehealth device by older veterans with heart failure.
abstract: OBJECTIVE
  The present study examined home telehealth (HT) adherence, and its potential predictors and outcomes, in older Veterans with heart failure (HF) using the Health Buddy (Bosch Healthcare, Palo Alto, CA) device.
  
  
  METHODS
  This was a retrospective study using secondary data from the Department of Veterans Affairs (VA) databases, describing adherence rates and patterns in the first 90 days after enrollment in 248 older Veterans with HF enrolled in the VA HT Programs using the Health Buddy at five medical centers in Southern California and Nevada, between June 1, 2006 and June 1, 2008. Adherence to the use of Health Buddy was defined as the number of days the patient completed an HT session over different time frames during the study period.
  
  
  RESULTS
  Significant differences occurred between average adherence across all three 30-day time frame increments, with adherence decreasing over time. Despite the use of standardized VA HT protocols and equipment, the department in which the HT program was embedded was a consistent significant predictor of patient adherence in all time frames, with odds ratios of 2.2-4.0 for the department with the consistent best adherence versus that with the worse adherence (confidence intervals varying with the time frame, p<0.03). Increased co-morbidity burden was associated with decreased adherence only in the first 30 days after enrollment. In this short-term study, no relationship was found between adherence to the use of the Health Buddy and outcomes.
  
  
  CONCLUSIONS
  Program and patient characteristics warrant further study as potential predictors of HT device adherence. Additional research is also needed to further examine the relationships between HT device adherence and various outcomes.
authors.affiliation: VA Greater Los Angeles Healthcare System Geriatric Research, Education & Clinical Center, Los Angeles, California 90073, USA. Jenice.Guzman@va.gov
authors.forename: Jenice Ria S
authors.initials: JR
authors.lastname: Guzman-Clark
authors.forename: Gwen
authors.initials: G
authors.lastname: van Servellen
authors.forename: Betty
authors.initials: B
authors.lastname: Chang
authors.forename: Janet
authors.initials: J
authors.lastname: Mentes
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Hahn
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006304:Health Status; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D008603:Mental Health; D010349:Patient Compliance / Q000706:statistics & numerical data*; D017060:Patient Satisfaction; D012189:Retrospective Studies; D017216:Telemedicine / Q000458:organization & administration* / Q000706:statistics & numerical data*; D013997:Time Factors; D014481:United States; D014728:Veterans