Today CADTH published new recommendations that offer advice to pan-Canadian health systems on how to implement remote monitoring programs for patients with chronic cardiac conditions. These recommendations emphasize patient, caregiver, and provider considerations, data and privacy, digital equity, and evaluation.
Remote patient monitoring programs are a form of virtual care that allows patients to be examined at a distance instead of in a hospital or clinic setting. Patients are consulted via telephone calls and/or video conferencing, and the patient’s health data can be exchanged by stand-alone devices or other digital platforms. The focus of these recommendations is on the use of remote monitoring programs for patients with heart failure, atrial fibrillation, or hypertension, or for those who are participating in cardiac rehabilitation. Monitoring conducted via implantable cardiac devices was outside the scope of this work.
Millions of Canadians live with chronic cardiac conditions, but remote monitoring programs for these patients vary greatly across the country. The needs of jurisdictional health systems to successfully implement these programs also vary significantly and depend on the operational infrastructure and technology platforms they may have adopted.
The CADTH Health Technology Expert Review Panel (HTERP) developed these forward-looking recommendations to offer guidance on the design and implementation of remote monitoring programs. The recommendations address key program characteristics, including:
Expanding virtual care in Canada has been a top priority of federal, provincial, and territorial governments since the start of the pandemic, and remote patient monitoring tools have been identified as one of their five shared priority areas for investment.
“The pandemic has been a turning point for remote monitoring programs but the uptake across Canada remains fragmented and inconsistent,” says Lesley Dunfield, Vice-President of Medical Devices and Clinical Interventions at CADTH. “CADTH’s recommendations come at a pivotal time for our health systems. Decision-makers are looking for evidence-informed guidance on how to both sustain and advance the use of remote monitoring to improve patient outcomes and make health care services more accessible to patients.”
The Evidence on Remote Monitoring Programs for Cardiac Conditions
The expert recommendations were informed by two CADTH reports published earlier this year, including an Environmental Scan and a Health Technology Assessment (HTA).
This report describes remote monitoring programs for patients with chronic cardiac conditions that are offered in 5 jurisdictions across Canada. The shared goals of these programs include providing greater patient autonomy and engagement, improving quality of life, and reducing hospital visits and admissions. Common barriers to program implementation include funding and resourcing limitations, and common implementation facilitators include patient engagement and greater uptake of remote care in the wake of the pandemic.
This comprehensive HTA delves into the intertwined technical, organizational, and human factors that can enable the optimal use of remote monitoring programs, and it offers three distinct analyses of the evidence: a realist review, a patient perspectives and experiences review, and an ethical analysis.
The report concludes that to be most effective, remote monitoring programs must use platforms that are easy to use, incorporate individualized data feedback, and integrate smoothly with the homes and routines of patients and caregivers. The HTA also found that both patients and health care providers view remote monitoring programs as complementary to overall care as opposed to an alternative to existing health care professionals and services. And importantly, without careful pathway design and management of expectations, these programs may increase net costs and clinical workload during early set-up and operational phases.
Draft versions of the project protocol, evidence reports, and recommendations were publicly posted for stakeholder feedback before finalization. CADTH would like to thank our external reviewers for their contributions, as well as the patients and caregivers who generously shared their experiences with these technologies and helped us refine the protocol and interpret our overall findings.
CADTH is an independent, not-for-profit agency funded by Canadian federal, provincial, and territorial governments to provide credible, impartial advice and evidence-based information about the effectiveness of drugs and other health technologies to Canadian health care decision-makers.
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