The Effects of Telenursing on Readmission of Patients with Chronic Heart Failure: A Literature Review

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Abstract

Nurses have the role of educators. Nurses in this role help clients learn about their condition and health care procedures that clients must take to restore or maintain their health. Telenursing is one of the communication methods used to educate the client, especially in heart failure. They were often admitted repeatedly to the hospital due to a lack of knowledge and poor adherence to the regiment. And rarely discussed what methods that have the most efficient to implement in telenursing. This study tried to describe the effective implementation of telenursing programs in readmission among patients with heart failure. Database conducted from Science Direct, ProQuest, Scopus, EBSCO, BMJ, Research Gate, Clinical Key, Taylor & Francis, PubMed, Wiley Online Library, and SAGE Journal, published in 2014 – 2019 matched with specific keywords. Good telephone communication skills of nurses can be improved to meet patients’ needs. Thus, in combination with systematic comprehensive monitoring can be used to build a professional relationship between patients and nurses, and it could be easy to implement. Telenursing methods are still being developed to get a better way of communication after the client’s hospitalization to decrease readmission. Telenursing requires an integrated system to support through telemonitoring so that clients will get continuous monitoring to maintain their health.

Keywords: telenursing, nurse telephone follow-up, heart failure, readmission

Introduction

Noncommunicable diseases (NCDs), such as heart disease, stroke, cancer, chronic respiratory diseases, and diabetes, are the leading cause of mortality in the world. The burden is growing – the number of people, families, and communities afflicted is increasing (WHO, 2016). Prevalence of heart failure will increase 46% from 2012 to 2030, resulting in >8 million people ≥18 years of age with heart failure. Additionally, the total percentage of the population with heart failure is predicted to increase from 2.42% in 2012 to 2.97% in 2030. Because most forms of heart failure tend to present in older age, and the population is aging, lifetime risk for heart failure the community is high. The prevalence estimates for heart failure across Asia range from 1.26% to 6.7% (Benjamin et al., 2019).

Previous research results showed that heart failure patients’ nonadherence to self-care behaviors is still a major challenge, which leads to exacerbation of symptoms, complications, repeated visits to specialists, and unwanted readmission (Jaarsma, et.al., 2003). Therefore, heart failure has the highest rate of readmission. The readmission rate due to HF, 30 to 60 days after discharge, has been reported to be 30% (Ahmadi, et.al., 2014).

Reductions in readmission rates among patients with heart failure have been demonstrated with both homebased programs and telephone monitoring. The effects of multidisciplinary home-based interventions in the population with heart failure have also been shown to be sustained for periods of at least 18 months, resulting in both reduced hospital-based costs and mortality (Stewart, Marley, & Horowitz, 1999). Structured telephone support included regular telephone contacts between patients and health care providers, with discussions about patient-reported symptoms and physiological data, including reminders about the importance of adherence to treatment recommendations and proper self-management. This support was provided by trained nurses or using interactive voice interviews with validated standard questionnairs (Chaudhry et al., 2010).

Telenursing has been applied since the early 1990s, where nurses’ roles are relied upon in facilitating the transition period after hospital discharge. Although not explicitly mentioned as telenursing, the role of the nurse becomes the main telephone program and even telemedicine. The ACCF/AHA guidelines in 2013 recommend early postdischarge follow-up, because it may help minimize gaps in understanding of changes to the care plan or knowledge of test results and has been associated with a lower risk of subsequent rehospitalization (Yancy, et.al., 2013). A follow-up visit within 7 to 14 days and/or a telephone follow-up within 3 days of hospital discharge are reasonable goals of care (Ponikowski et al., 2016). In adults discharged to home after hospitalization for heart failure, outpatient follow-up with a cardiology or general medicine provider within 7 days was associated with a lower chance of 30-day readmission (Lee, et.al., 2016)

Many studies have shown the benefits of telenursing. Specific types of telephone support have been developed and tested, such as telephone case management for patients with heart failure (Riegel, 2002). It can improving knowledge about signs and symptoms of disease progression, treatment plan, and actions to engage in to manage symptoms has been reported to minimize exacerbation and frequent hospitalization. Based on this, author was interested in finding out more about how to apply effective methods implement in telenursing to prevent the readmission of patients with chronic heart failure.

Objective

The aim of this literature review was to describe the effective implementation of telenursing in readmission among patients with heart failure.

Methods

This literature review used PRISMA as process of article selection, as shown on figure 1.1. The author collected articles from several studies both qualitative and quantitative, to describe the effective implementation of telenursing in readmission among patients with heart failure. The author collected articles related to the purpose of this study, through several stages of searching process using the keywords “telenursing”, “nurse telephone follow-up”, “heart failure”, and “readmission”. Database and article’s search engine published in English were used, it consists of 11 database sources: Science Direct, ProQuest, Scopus, EBSCO, BMJ, Research Gate, Clinical Key, Taylor & Francis, PubMed, Wiley Online Library, SAGE Journal, published in 2014 – 2019. The results of this literature review are explained in the type of methods were used from the implementation of their use in each study.

Results

In the last two decades, there has been considerable focus on post-discharge telephone calls to address preventable readmissions (Harrison, Auerbach, Quinn, Kynoch, & Mourad, 2014). From retrospective study in USA in 2014, patients who received a call and completed the intervention were significantly less likely to be readmitted compared to those who did not 155 patients (5.8%) vs 123 patients (8.6 %), with p 65 years of age.

Weekly NP phone management and access to NP consultative services around the clock allowed home care staff to continue to monitor and treat CHF patients in their home environment and prevented unnecessary emergency room visits and hospital readmissions.

Daily interactions with professional healthcare staff (RNs, physical therapists, and/or occupational therapists) improved patient monitoring and early detection of patient decompensation.

Spinsante (2014) Systematic overview Italy

To provides evidence for a simple, but effective, paradigm upon which a telehealth system may be built, and highlights how such a model may successfully apply to Heart Failure management, to improve patients’ quality of life after discharge, increase independence, and reduce readmissions and costs for the public health institutions

A quite significant amount (almost 20%) of all hospital admissions are actually readmissions, and a majority of these could be avoided through more effective management of health care after discharge.

Factors that contribute to excessive hospital readmissions include service fragmentation and poor communication among and between health care settings and care providers and poorly delivered and/or understood discharge instructions and follow-up. By improving coordination across the continuum of care and promoting seamless transitions from the hospital to home, skilled nursing care, or home health care, avoidable readmission rates can be decreased.

Harrison et al., (2014) Retrospective observational study the USA

To determine the specific effects of receiving a post-discharge telephone call on all-cause 30-day readmission, and to describe the post-discharge issues addressed by the calls.

The effectiveness of post-discharge phone call programs may be more related to whether patients are able to answer a phone call than to the care delivered by the phone call. Programs would benefit from improving their ability to perform phone outreach while simultaneously improving on the care delivered during the calls.

Black et al., (2014) Multi-center, Randomized Controlled Trial USA

To evaluate the effectiveness of this remote care transition intervention in reducing all-cause 180-day hospital readmissions for older adults hospitalized with heart failure.

Better Effectiveness After Transition-Heart Failure (BEAT-HF) is poised to serve as an important research resource to understand how best to use telehealth approaches to improve key healthcare processes and outcomes, including care transitions and hospital readmissions, and to set the stage for future comparative effectiveness research on chronic disease management for heart failure.

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