Research Into Factors Determining Participation in 2 Interventions Modifying the Care Pathways of Patients With Heart Failure: PRADO and Telemedicine
- Conditions
- Heart Failure
- Registration Number
- NCT05417490
- Lead Sponsor
- University Hospital, Montpellier
- Brief Summary
Patients with heart failure (HF), after hospitalization, present a marked fragility. Interventions improving the coordination of care actors at the time of discharge from hospitalization have been tested and have shown, in preliminary studies, a reduction in rehospitalizations for heart failure and all-cause mortality.
Among these promising devices, two have recently been deployed nationwide.
* The return home program for IC patients (PRADO IC), set up by the Health Insurance, aims to facilitate the return and stay at home after hospitalization. It offers assistance with the initiation of outpatient medical follow-up, nursing follow-up for 2 to 6 months depending on the severity of the patient, and a follow-up log facilitating the exchange of information.
* At the same time, as part of the ETAPES (Telemedicine experiments for the improvement of healthcare pathways) program of the Health Insurance, the deployment of telemedicine for remote monitoring of heart failure pursues a comparable objective of reducing rehospitalizations.
These two systems are widely deployed on a national scale, and are intended to be universal.
Our hypothesis is that adherence to care transition and telemedicine programs, and therefore their effectiveness, may depend on their association, as well as socio-demographic, cultural, and geographical factors.
- Detailed Description
Patients with heart failure (HF), after hospitalization, present a marked fragility: in France, in the first year, 29% die and 45% are rehospitalized for HF. Interventions improving the coordination of care actors at the time of discharge from hospitalization have been tested and have shown in preliminary studies a reduction in rehospitalizations for HF (relative risk (RR) from 0.51 to 0.74) and all-cause mortality (RR 0.75 to 0.87).
Among these promising devices, two have recently been deployed nationwide.
* The return home program for IC patients (PRADO IC), set up by the Health Insurance, aims to facilitate the return and stay at home after hospitalization. It offers assistance with the initiation of outpatient medical follow-up, nursing follow-up for 2 to 6 months depending on the severity of the patient, and a follow-up log facilitating the exchange of information. It is based on the assumption that these actions will improve the coordination of care between the hospital and the city, and between home nurses and doctors. In addition, nurses reinforce therapeutic patient education (TPE), whether or not it is initiated in a setting dedicated to TPE.
* At the same time, as part of the ETAPES program of the Health Insurance, the deployment of telemedicine for remote monitoring of heart failure pursues a comparable objective of reducing rehospitalizations. It is based on the hypothesis that the early signs of cardiac decompensation can be diagnosed by telemonitoring and trigger earlier and therefore less aggressive management for similar effectiveness.
These two systems are widely deployed on a national scale, and are intended to be universal.
However, three points can call into question the effectiveness of this deployment: their evaluation is often difficult, the extrapolability of randomized studies to health systems and different populations is low, and the complementarity of two independently constructed programs has never been been studied so far.
1. The preliminary data concerning the PRADO were epidemiological, historical, comparative before-elsewhere, on the SNIIRAM (National health insurance inter-scheme information system) databases, without optimal consideration of clinical and cultural confounding factors.
2. The acceptability of these programs by all health professionals (and therefore how they choose to deploy such and such a system for a given patient) and patients in the French context is not known.
3. The PRADO system and telemedicine solutions, acting differently, could be synergistic and therefore multiply the benefits obtained. However, in practice, some patients experience these programs as intrusive, and it is possible that their adherence is in fact all the worse when two programs are implemented. Similarly, from the prescriber's point of view, the way in which the various possible combinations are chosen is unknown.
The answer to these three questions is necessary to guide the most effective deployment of these programs nationwide.
Our hypothesis is that adherence to care transition and telemedicine programs, and therefore their effectiveness, may depend on their association, as well as socio-demographic, cultural, and geographical factors.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 700
- Adult patient
- Patient hospitalized at the time of inclusion for cardiac decompensation, or cause of admission for which heart failure plays a decisive or aggravating role (co-infection, etc.) recognized by the clinician.
- Patient agreeing to take part in this research (absence of non-objection)
- Refusal to participate
- Pregnant or breastfeeding women, patients unable to give protected adult consent, vulnerable people (art.L.1121-6, L.1121-7, L.1211-8, L.1211-9)
- Subject deprived of liberty by judicial or administrative decision
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method Percentage of patients participating in heart failure programs at 6 months At 6 months Participation corresponds to:
* for the PRADO group: visits to the attending physician and home nurses, and appointments made with the cardiologist
* for the remote monitoring group: completion of at least 80% of the weighings
* for the group without intervention: completion of the visit at 6 monthsPercentage of patients participating in heart failure programs at 1 month At 1 month Participation corresponds to:
* for the PRADO group: visits to the attending physician and home nurses, and appointments made with the cardiologist
* for the remote monitoring group: completion of at least 80% of the weighings
- Secondary Outcome Measures
Name Time Method Percentage effectiveness of pathology programs at 6 months between inclusion and 6 months Evaluate the effectiveness at 1 month of the PRADO and telemedicine programs, as well as their interaction, on deaths due to heart failure
percentage of medical appointments made between inclusion and 6 months according to the continuity of care index, corresponding to the percentage of appointments made by patients with a doctor
Number of non-participation of patients through study completion, an average of 6 months Describe the causes of non-participation secondary (after initial acceptance)
Percentage effectiveness of pathology programs at 1 month between inclusion and 1 month Evaluate the effectiveness at 1 month of the PRADO and telemedicine programs, as well as their interaction, on deaths due to heart failure
Average number of treatment days taken per patient per month between inclusion and 6 months Coefficient of variation of the daily dose of loop diuretics, calculated as the average dose between two deliveries
percentage of effectiveness on the course of care at 6 months between inclusion and 6 months Time between the first consultation with the cardiologist and discharge from hospital
percentage of days with at least one nursing contact between inclusion and 6 months number of days with at least one nursing contact
Number of emergency medical contacts between inclusion and 6 months are considered as emergency contacts: consultations with emergency increase, or increase for Night, Weekend or Public Holiday; consultations in emergencies; hospitalizations with emergency entry mode
percentage of efficiency on the cost of the care pathway at 6 months between inclusion and 6 months Cost of care pathways: made up of production costs over 6 months after initial hospitalization, and includes all direct costs, whether medical or non-medical.
percentage of physicians offering heart failure programs between inclusion and 6 months Beliefs of physicians on the facilitating elements and on the obstacles of these programs
Trial Locations
- Locations (1)
University Hospital, Montpellier
🇫🇷Montpellier, France
University Hospital, Montpellier🇫🇷Montpellier, FranceFrançois ROUBILLE, PUPHContactf-roubille@chu-montpellier.fr