title: Telecare for diabetes, CHF or COPD: effect on quality of life, hospital use and costs. A randomised controlled trial and qualitative evaluation.
abstract: OBJECTIVE
  To assess the effect of telecare on health related quality of life, self-care, hospital use, costs and the experiences of patients, informal carers and health care professionals.
  
  
  METHODS
  Patients were randomly assigned either to usual care or to additionally entering their data into a commercially-available electronic device that uploaded data once a day to a nurse-led monitoring station. Patients had congestive heart failure (Site A), chronic obstructive pulmonary disease (Site B), or any long-term condition, mostly diabetes (Site C). Site C contributed only intervention patients - they considered a usual care option to be unethical. The study took place in New Zealand between September 2010 and February 2012, and lasted 3 to 6 months for each patient. The primary outcome was health-related quality of life (SF36). Data on experiences were collected by individual and group interviews and by questionnaire.
  
  
  RESULTS
  There were 171 patients (98 intervention, 73 control). Quality of life, self-efficacy and disease-specific measures did not change significantly, while anxiety and depression both decreased significantly with the intervention. Hospital admissions, days in hospital, emergency department visits, outpatient visits and costs did not differ significantly between the groups. Patients at all sites were universally positive. Many felt safer and more cared-for, and said that they and their family had learned more about managing their condition. Staff could all see potential benefits of telecare, and, after some initial technical problems, many staff felt that telecare enabled them to effectively monitor more patients.
  
  
  CONCLUSIONS
  Strongly positive patient and staff experiences and attitudes complement and contrast with small or non-significant quantitative changes. Telecare led to patients and families taking a more active role in self-management. It is likely that subgroups of patients benefitted in ways that were not measured or visible within the quantitative data, especially feelings of safety and being cared-for.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry ACTRN12610000269033.
authors.affiliation: Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand.
authors.forename: Timothy W
authors.initials: TW
authors.lastname: Kenealy
authors.affiliation: Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand, in partnership with Waikato District Health Board, Waikato, New Zealand.
authors.forename: Matthew J G
authors.initials: MJ
authors.lastname: Parsons
authors.affiliation: Department of Accounting and Finance, The University of Auckland Business School, The University of Auckland, Auckland, New Zealand.
authors.forename: A Paul B
authors.initials: AP
authors.lastname: Rouse
authors.affiliation: Department of Medicine, University of Auckland and Greenlane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Robert N
authors.initials: RN
authors.lastname: Doughty
authors.affiliation: School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
authors.forename: Nicolette F
authors.initials: NF
authors.lastname: Sheridan
authors.affiliation: Ngati Porou Hauora Charitable Trust, Te Puia Springs, Tairawhiti/East Coast, New Zealand.
authors.forename: Jennifer K Harré
authors.initials: JK
authors.lastname: Hindmarsh
authors.affiliation: School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Masson
authors.affiliation: Department of Medicine, University of Auckland, Auckland, New Zealand.
authors.forename: Harry H
authors.initials: HH
authors.lastname: Rea
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D003920:Diabetes Mellitus / Q000469:parasitology / Q000628:therapy*; D005260:Female; D006333:Heart Failure / Q000469:parasitology / Q000628:therapy*; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D017060:Patient Satisfaction; D029424:Pulmonary Disease, Chronic Obstructive / Q000469:parasitology / Q000628:therapy*; D011788:Quality of Life; D012648:Self Care / Q000379:methods* / Q000523:psychology; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000191:economics / Q000379:methods*