title: Randomized trial of a daily electronic home monitoring system in patients with advanced heart failure: the Weight Monitoring in Heart Failure (WHARF) trial. Telemedical care reduces hypoglycemias and improves glycemic control in children and adolescents with type 1 diabetes. Using the vista 350 telephone to communicate the results of home monitoring of diabetes mellitus to a central database and to provide feedback The "telepress" system for self-measurement and monitoring of blood pressure (the "SHAHAL" experience in Israel). Noninvasive home telemonitoring for patients with heart failure at high risk of recurrent admission and death: the Trans-European Network-Home-Care Management System (TEN-HMS) study. Home monitoring of foot skin temperatures to prevent ulceration. Outcomes of chronic heart failure. An observational study of veterans with diabetes receiving weekly or daily home telehealth monitoring. A controlled pilot study in the use of telemedicine in the community on the management of heart failure--a report of the first three months. Using Telecommunication Technology to Manage Children with Diabetes: The Computer-Linked Outpatient Clinic (CLOC) Study Telephone Modem Access Improves Diabetes Control in Those with Insulin-Requiring Diabetes Improvement in diabetes control with a monitoring system based on a hand-held, touch-screen electronic diary Telecardiology for patients with chronic heart failure: the 'SHL' experience in Israel. Home monitoring for lung transplant candidates. Telematic Transmission of Computerized Blood Glucose Profiles for IDDM Patients Internet-based monitoring of asthma: a long-term, randomized clinical study of 300 asthmatic subjects. Do automated calls with nurse follow-up improve self-care and glycemic control among vulnerable patients with diabetes? A telecommunications system for monitoring and counseling patients with hypertension. Impact on medication adherence and blood pressure control. Home blood pressure monitoring for pregnant patients with hypertension. Tele-monitoring of Home Blood Pressure in Treated Hypertensive Patients Compliance and effectiveness of 1 year's home telemonitoring. The report of a pilot study of patients with chronic heart failure Effects of home telemonitoring and community-based monitoring on blood pressure control in urban African Americans: a pilot study. Are there time and cost savings by using telemanagement for patients on intensified insulin therapy?: A randomised, controlled trial Improving asthma control through telemedicine: a study of short-message service. Internet-based home monitoring of pulmonary function after lung transplantation. An Internet-based store-and-forward video home telehealth system for improving asthma outcomes in children. Systematic Reviews: Synthesis of Best Evidence for Clinical Decisions Home Monitoring Service Improves Mean Arterial Pressure in Patients with Essential Hypertension Modem transmission of glucose values reduces the costs and need for clinic visits. Improved care of patients with diabetes through telecommunications.
abstract: BACKGROUND Heart failure treatment guidelines emphasize daily weight monitoring for patients with heart failure , but data to support this practice are lacking . Using a technology-based heart failure monitoring system , we determined whether daily reporting of weight and symptoms in patients with advanced heart failure would reduce rehospitalization and mortality rates despite aggressive guideline -driven heart failure care . METHODS This was a r and omized , controlled trial . Patients hospitalized with New York Heart Association class III or IV heart failure , with a left ventricular ejection fraction < or = 35 % were r and omized to receive heart failure program care or heart failure program care plus the AlereNet system ( Alere Medical , Reno , Nev ) and followed-up for 6 months . The primary end point was 6-month hospital readmission rate . Secondary end points included mortality , heart failure hospitalization readmission rate , emergency room visitation rate , and quality of life . RESULTS Two hundred eighty patients from 16 heart failure centers across the United States were r and omized : 138 received the  AlereNet system and 142 received st and ard care .  Mean age was 59 + /- 15 years and 68 % were male . The population had very advanced heart failure , New York Heart Association class III ( 75 % ) or IV ( 25 % ) , as evidence d by serum norepinepherine levels , 6-minute walk distance and outcomes .  No differences in hospitalization rates were observed . There was a 56.2 % reduction in mortality ( P < .003 ) for patients r and omized to the AlereNet group . CONCLUSIONS This is the largest multicenter , r and omized trial of a technology-based daily weight and symptom-monitoring system for patients with advanced heart failure . Despite no difference in the primary end point of rehospitalization rates , mortality was significantly reduced for patients r and omized to the AlereNet system without an increase in utilization , despite specialized and aggressive heart failure care in both groups Education programs for intensive insulin therapy were found to be valuable in improving glycemic control , but , due to low prevalence of type 1 diabetes in children and adolescents , access to those programs varies considerably in rural areas . We report on a telemedical care program that overcomes geographical isolation of patients on intensive insulin therapy . Sixty-one children and adolescents under the age of 26 participated in a telemedical care program . They stored daily information on blood glucose , injected insulin , meals and exercise  in a glucosemeter with electronic memory and transferred the data via modem go a remote diabetes center outside of the region . By individual telephone consultations from home , they review ed the data with a diabetologist at the diabetes center and adjusted their intensive insulin therapy in order to achieve predefined treatment goals . Patients were trained for 19 ( 6 - 48 ) weeks in the program and measured blood glucose 4.9 ( 1.7 - 4.9 ) times daily . Compared to the run-in-period , mean blood glucose had decreased ( 167 to 158 mg/dL , p < 0.01 ) , st and ard deviation of blood glucose had decreased ( 81 to 70 mg/dL , p < 0.001 ) , and frequency of hypoglycemia had decreased ( 5.2 to 3.3 in 4 weeks , p = 0.01 ) at the end of the program . The proportion of blood glucose values within the target range ( 80 - 180 mg/dL ) had increased ( 47 - 55 % , p < 0.001 ) . HbAlc was reduced by 0.4 % ( -3.8 to + 2.2 % , p < 0.05 ) . Telemedical care for intensive insulin therapy is safe , can improve glycemic control , and reduce the number of hypoglycemias in children and adolescents with type 1 diabetes PURPOSE Self-monitoring of blood glucose has become routine practice in the management of diabetes mellitus . When all the data is complete , however , the amount of information to be taken into account when making therapeutic decisions becomes overwhelming not only for the patient but for the healthcare provider . Computers excel at processing large amounts of information quickly and impassively , which makes them potentially helpful for collating and communicating the data in a manner that facilitates decision-making by patient and healthcare provider . This should in turn improve control and help prevent acute and chronic complications . METHOD Using the Vista 350 telephone , we have developed a system that enables patients with diabetes to record home monitoring data to a central data base and receive feedback summaries . A small trial was conducted to determine if the Vista 350 telephone is an acceptable and feasible method to communicate the results of home monitoring of diabetes mellitus to a central data base and receive feedback summaries . A total of 35 volunteers with insulin-requiring diabetes mellitus in the London area were r and omly allocated to either use the Vista 350 phone for 6 months , or to a control group that continued to use traditional methods for recording home monitoring data . RESULTS 33 of the 35 patients enrolled completed the trial . All 16 patients who began using the phone continued to do so for 6 months confirming the feasibility of the system . Question naires completed at 3 and 6 months confirmed the Vista 350 telephone system to be acceptable to the subjects . The results will enable some minor modifications to be made to the telephone system before a larger definitive trial , design ed to determine the effect on diabetes control , is conducted later this year No " white coat " effect contaminated the validity of measurements in 30 participants in a " Telepress " program , in which subscribers to a telecardiologic facility transtelephonically transmit their self-measured blood pressure values OBJECTIVES We sought to identify whether home telemonitoring ( HTM ) improves outcomes compared with nurse telephone support ( NTS ) and usual care ( UC ) for patients with heart failure who are at high risk of hospitalization or death . BACKGROUND Heart failure is associated with a high rate of hospitalization and poor prognosis . Telemonitoring could help implement and maintain effective therapy and detect worsening heart failure and its cause promptly to prevent medical crises . METHODS Patients with a recent admission for heart failure and left ventricular ejection fraction ( LVEF ) < 40 % were assigned r and omly to HTM , NTS , or UC in a 2:2:1 ratio . HTM consisted of twice-daily patient self-measurement of weight , blood pressure , heart rate , and rhythm with automated devices linked to a cardiology center . The NTS consisted of specialist nurses who were available to patients by telephone . Primary care physicians delivered UC . The primary end point was days dead or hospitalized with NTS versus HTM at 240 days . RESULTS Of 426 patients r and omly assigned , 48 % were aged > 70 years , mean LVEF was 25 % ( SD , 8) and median plasma N-terminal pro-brain natriuretic peptide was 3,070 pg/ml ( interquartile range 1,285 to 6,749 pg/ml ) . During 240 days of follow-up , 19.5 % , 15.9 % , and 12.7 % of days were lost as the result of death or hospitalization for UC , NTS , and HTM , respectively ( no significant difference ) . The number of admissions and mortality were similar among patients r and omly assigned to NTS or HTM , but the mean duration of admissions was reduced by 6 days ( 95 % confidence interval 1 to 11 ) with HTM . Patients r and omly assigned to receive UC had higher one-year mortality ( 45 % ) than patients assigned to receive NTS ( 27 % ) or HTM ( 29 % ) ( p = 0.032 ) . CONCLUSIONS Further investigation and refinement of the application of HTM are warranted because it may be a valuable role for the management of selected patients with heart failure OBJECTIVE To evaluate the effectiveness of at-home infrared temperature monitoring as a preventative tool in individuals at high risk for diabetes-related lower-extremity ulceration and amputation . RESEARCH DESIGN AND METHODS Eighty-five patients who fit diabetic foot risk category 2 or 3 ( neuropathy and foot deformity or previous history of ulceration or partial foot amputation ) were r and omized into a st and ard therapy group ( n = 41 ) or an enhanced therapy group ( n = 44 ) . St and ard therapy consisted of therapeutic footwear , diabetic foot education , and regular foot evaluation by a podiatrist . Enhanced therapy included the addition of a h and held infrared skin thermometer to measure temperatures on the sole of the foot in the morning and evening . Elevated temperatures ( > 4 degrees F compared with the opposite foot ) were considered to be " at risk " of ulceration due to inflammation at the site of measurement . When foot temperatures were elevated , subjects were instructed to reduce their activity and contact the study nurse . Study subjects were followed for 6 months . RESULTS The enhanced therapy group had significantly fewer diabetic foot complications ( enhanced therapy group 2 % vs. st and ard therapy group 20 % , P = 0.01 , odds ratio 10.3 , 95 % CI 1.2 - 85.3 ) . There were seven ulcers and two Charcot fractures among st and ard therapy patients and one ulcer in the enhanced therapy group . CONCLUSIONS These results suggest that at-home patient self-monitoring with daily foot temperatures may be an effective adjunctive tool to prevent foot complications in individuals at high risk for lower-extremity ulceration and amputation BACKGROUND Outcomes related to chronic heart failure ( HF ) remain relatively poor , despite advances in pharmacological therapy and medical and nursing care . Experts agree that outpatient care may be among the factors that affect HF outcomes . We hypothesized that the method by which outpatient care is delivered may affect outcomes in this patient population . METHODS A prospect i ve , r and omized design was used to compare HF outcomes from 216 patients r and omized to 1 of 2 home health care delivery methods for 3 months after discharge . Care was delivered by the home nurse visit ( HNV ) or the nurse telemanagement ( NTM ) method . In the latter , patients used transtelephonic home monitoring devices to measure their weight , blood pressure , heart rate , and oxygen saturation . These data were transmitted daily to a secure Internet site . An advanced- practice nurse worked collaboratively with a cardiologist and subsequently treated patients via the telephone . Both delivery methods used the same HF-specific clinical guidelines to direct care . Outcomes include HF readmissions and length of stay , anxiety , depression , self-efficacy , and quality of life . Data were primarily tested using a 2-group analysis of variance ( ANOVA ) . We used a repeated- measures ANOVA to conduct preintervention-postintervention analyses . RESULTS After 3 months , patients in the  NTM group ( n = 108 ; mean + /- SD age , 62.9 + /- 13.2 years ; 83 % African American ; 64 % female ) had fewer HF readmissions ( 13 vs 24 ; P</=.001 ) with shorter lengths of stay ( 49.5 vs 105.0 days ; P</=.001 ) compared with the HNV group ( n = 108 ; mean + /- SD age , 63.2 + /- 12.6 years ; 89 % African American ; 62 % female ) . Hospitalization charges at 3 months were less in the NTM group compared with the HNV group ( $ 65 023 vs $ 177 365 ; P</=.02 ) . At 6 and 12 months , cumulative readmission charges in the NTM group were also less ( $ 223 638 vs $ 500 343 [ P<.03 ] and $ 541 378 vs $ 677 710 [ P</=.16 ] , respectively ) compared with the HNV group . Quality of life was significantly improved for both groups when we compared postintervention and preintervention scores . CONCLUSION The adaptation of state-of-the-art computerized technology to closely monitor patients with HF with advanced- practice nurse care under the guidance of a cardiologist significantly improves HF management while reducing the cost of care We assessed the utilization of health-care services and clinical outcomes in veterans with diabetes who were enrolled in two care coordination/home telehealth programmes .  One group of patients was monitored weekly  ( n = 197 ) , with more intensive evaluations , while the other was monitored daily ( n = 100 ) , but less intensively . Although patients in the two groups were fairly similar in demographic terms and in their clinical characteristics at baseline , they had different service utilization patterns during the 12-month pre-enrollment period . Over the 12-month study period , the proportion of one or more hospital admissions and number of bed days of care decreased in the daily monitoring group , and increased in the weekly monitoring group , more or less doubling in the former and being halved in the latter . Unscheduled primary care clinic visits were lower in the daily monitored group than in the weekly monitored group . The differences between the two groups were significant ( P < 0.01 ) . There were no significant differences between the groups in the clinical outcomes . Future research should employ r and omized controlled trial design s to determine if intensities of home monitoring lead to differences in service utilization and health outcomes This is a controlled pilot study of twenty patients to see if heart failure management can be optimised in the community using telemedicine . The study seeks to examine the feasibility , acceptability and reliability of using telemedicine in this context . Heart failure is a common condition . It is an important cause of mortality and morbidity and has large cost implication s for the NHS . Most patients are managed in the UK in General Practice based on clinical assessment by the practitioner . Twenty patients with a mean age of 75.1 years and mean New York Heart Association grade of 1.75 were r and omised in to two equal groups ( telemonitoring and control ) and observed for a period of three months . All twenty patients had a Cardiologist assessment and quality of life  measurement at the beginning and end of the study . Patients in the telemedicine group had their blood pressure , pulse and weight data collected daily and undertook a weekly video conference with the nurse . Control patients had their blood pressure , weight and pulse measured at six weekly intervals . The study has been extended for a further six months beyond its initial three-month observation period to see if the initial short term benefit in the telemedicine group is maintained The purpose of this study was to evaluate the effrcacy of using a telecommunication system to assist in the outpatient management of pediatric patients with insulin- dependent diabetes .  Metabolic control , patients ' psychosocial status , family functioning , perceived quality of life , patterns of parental/child responsibility for daily diabetes maintenance , and nursing time-on-task were evaluated . One hundred six pediatric patients ( mean age= 13.3 years ) were r and omly assigned to an experimental or control outpatient clinic for 1 year . Experimental subjects transmitted self-monitoring blood glucose data by modem to the hospital every 2 weeks . Transmitted data were review ed by nurse practitioners who telephoned subjects to discuss regimen adjustments . Control subjects received st and ard care with regimen adjustments made by physicians . There were no significant between-group differences for metabolic control , rates of hospitalization or emergency-room visits , psychological status , general family functioning , quality of life , or parent-child responsibility . A significant decrease was noted in nursing time-on-task for experimental subjects OBJECTIVE To assess whether modem access improves diabetes control in IDDM patients . RESEARCH DESIGN AND METHODS Forty-two patients participated in the study and were followed for 12 wk . The patients were r and omly divided into two groups at baseline , a modem group and a control group . There were no significant differences between HbA1c , r and om blood glucose , and weight between the groups at the beginning of the study . Patients were asked to perform five blood glucose determinations/day ( before breakfast , before lunch , afternoon [ 1500 ] , before dinner , and at bedtime ) twice/week . The modem group transferred their data over the phone once/week . The control group would bring in their results on their regular visits every 6 wk . Patients in the modem group were counseled every week over the telephone after transferring results to adjust insulin and food intake if necessary . RESULTS In the modem group , HbA1c improved from 0.106 to 0.092 ( 13.20 % ) . The control group improved from 0.112 to 0.102 ( 8.9 % ) . There was no significant change in weight , r and om blood glucose , or insulin . CONCLUSIONS The use of telephone modem-based patient-monitoring systems in diabetes clinical research seems to stimulate the patient to keep closer control of blood glucose levels . It might be especially useful in rural setting s , for which this study was design ed We conducted a six-month prospect i ve interventional crossover study examining a computerized diabetes monitoring system ( DMS ) that conveyed dietary information . The objectives were to compare glycaemic control between intervention and control periods , and to assess patients ' acceptance of the DMS . Nineteen patients were r and omized into two groups , each using the DMS for three months and serving as the control group for another three months . The patients recorded information about their meal portions and blood glucose readings in a h and -held electronic diary . After transmitting the data to the DMS through a telephone modem , the patients received immediate feedback about the carbohydrate , protein and fat content of the meal , as well as the calorie content . A significant improvement in glycaemic control was achieved during intervention compared with control periods ( mean HbA1C reduction of 0.825 % ) . The DMS was also highly acceptable : 95 % patients found it easy to operate while 63 % found it useful . The DMS was thus a feasible model of telemedicine in diabetes care and a larger study is warranted to examine its cost-effectiveness BACKGROUND Patients with chronic heart failure characteristically have multiple hospital admissions for symptom control , deleteriously affecting their quality of life and imposing a burden on national healthcare costs . We assessed the effect of a novel transtelephonic monitoring and follow-up program on the admission rate and length of hospital stay as well as changes in their subjectively rated quality of life of patients with chronic heart failure . METHODS This prospect i ve 1-year study was conducted on compliant subscribers to ' SHL ' , a telecardiological service with > 60,000 subscribers , who were admitted > or = 2 times during the previous year for recurrent pulmonary edema or deterioration in heart failure . Their heart rate , blood pressure and body weight measurements were now automatically transmitted daily to ' SHL"s data bank and added to stored and up date d medical records . A question naire survey acquired information on their quality of life . RESULTS The study cohort included 118 patients , mean age 75 years ( range 49 - 89 years ) , 65 % males , a II-IV class functional capacity and a 25 % ( range 10 - 39 % ) mean ejection fraction . There was a 66 % reduction in the total hospitalization days ( from 1623 in the year preceding study entry to 558 during the study period , p<0.0001 ) . Although only 38/118 patients were hospitalized , most participants reported a significant subjective improvement in their quality of life . CONCLUSIONS Data are provided to demonstrate that a transtelephonic system allowing primary care at the patient 's home can significantly reduce hospitalization rate and length of stay and significantly enhance the quality of life of patients with chronic heart failure Home monitoring by lung transplant recipients has been effective for early detection of clinical problems . This study used an electronic diary for home monitoring by lung transplant c and i date s to improve communication between c and i date s and the transplant team . C and i date s were r and omized into control ( 52 subjects following st and ard telephone reporting procedures ) and intervention ( 67 subjects using an electronic diary to record and transmit a range of health-related measures ) groups . Outcome measures were monitoring adherence and level of communication ( for monitor acceptability and utilization ) , hospital length of stay after transplantation and survival at 4 months ( for clinical effectiveness ) . Subjects used the diary without difficulty and with good adherence . Subjects and coordinator contacts were similar between groups ; intervention group subjects were positive regarding contact based on diary use . There were no significant differences in clinical outcomes between groups . Changing diary questions might improve the effectiveness of electronic monitoring for lung transplant c and i date Objective To improve the analysis of  self-monitoring of blood glucose ( SMBG ) and its communication between patients and physicians by a telematic transmission of computerized SMBG and to study the consequences of its use on glucose control of insulin-dependent diabetic ( IDDM ) patients . Research Design and Methods A prospect i ve r and omized crossover trial with two 3-mo periods , one with SMBG recorded on traditional booklets ( booklet period ) and another with computerized SMBG transmitted to a central data base through a telematic network ( telematic period ) , comprised the study . During the latter phase , patients could receive computerized SMBG analysis on individual terminals connected to the telephone network ( Minitel system ) . Blood glucose recordings and HbA1c were measured at inclusion and end of each period . Eleven pairs of IDDM patients on intensified insulin therapy  were r and omized within each pair to start with the telematic period ( group A ) or the booklet period ( group B ) . Results Telematic transmissions were successful ( < 1 % failure rate ) . Although initial HbA1c was low ( 6.7 % ) , it declined during the telematic period ( Δ = -0.41 % ) compared with the booklet period ( Δ = + 0.37 % , P = 0.05 ) . The percentage of low ( < 3.3 mM ) blood glucose values correlated with HbA1c changes during the telematic period ( r = 0.714 , P= 0.0014 ) but not the booklet period . The patients favored the telematic tool to analyze SMBG . Conclusions Telematic transmission of SMBG is feasible . It can improve SMBG analysis and perhaps glucose control , therefore offering a new way of communication between diabetic patients and their physicians BACKGROUND Experience from other fields of internal medicine shows that Internet-based technology can be used to monitor various diseases . The new technology h and les complex calculation programs easily , and it is a unique way of communicating . These advantages might be used in optimizing the treatment for asthmatic subjects because undertreatment is a common problem found in European asthmatic subjects . OBJECTIVE We sought to investigate the outcome of monitoring and treatment using a physician-managed online interactive asthma monitoring tool and to assess whether the outcome differs from that of monitoring and treatment in an outpatient respiratory clinic or in primary care . METHODS Three hundred asthmatic subjects were r and omized to 3 parallel groups in a 6-month prospect i ve study : ( 1 ) Internet-based monitoring ( n = 100 ) ; ( 2 ) specialist monitoring ( n = 100 ) ; and ( 3 ) general practitioner ( GP ) monitoring ( n = 100 ) . All the patients were examined on entry into the study and after 6 months of treatment . RESULTS The treatment and monitoring with the Internet-based management tool lead to significantly better improvement in the Internet group than in the other 2 groups regarding asthma symptoms ( Internet vs specialist : odds ratio of 2.64 , P = .002 ; Internet vs GP : odds ratio of 3.26 ; P < .001 ) , quality of life ( Internet vs specialist : odds ratio of 2.21 , P = .03 ; Internet vs GP : odds ratio of 2.10 , P = .04 ) , lung function ( Internet vs specialist : odds ratio of 3.26 , P = .002 ; Internet vs GP : odds ratio of 4.86 , P < .001 ) , and airway responsiveness ( Internet vs GP : odds ratio of 3.06 , P = .02 ) . CONCLUSION When physicians and patients used an interactive Internet-based asthma monitoring tool , better asthma control was achieved PURPOSE We sought to evaluate the effect of automated telephone assessment and self-care education calls with nurse follow-up on the management of diabetes . SUBJECTS AND METHODS We enrolled 280 English- or Spanish-speaking adults with diabetes who were using hypoglycemic medications and who were treated in a county health care system . Patients were r and omly assigned to usual care or to receive an intervention that consisted of usual care plus bi-weekly automated assessment and self-care education calls with telephone follow-up by a nurse educator . Outcomes measured at 12 months included survey-reported self-care , perceived glycemic control , and symptoms , as well as glycosylated hemoglobin ( Hb A1c ) and serum glucose levels . RESULTS We collected follow-up data for 89 % of enrollees ( 248 patients ) . Compared with usual care patients , intervention patients reported more frequent glucose monitoring , foot inspection , and weight monitoring , and fewer problems with medication adherence ( all P -0.03 ) . Follow-up Hb A , , levels were 0.3 % lower in the intervention group ( P = 0.1 ) , and about twice as many intervention patients had Hb A1c levels within the normal range ( P = 0.04 ) . Serum glucose levels were 41 mg/dL lower among intervention patients than usual care patients ( P = 0.002 ) . Intervention patients also reported better glycemic control ( P = 0.005 ) and fewer diabetic symptoms ( P < 0.0001 ) , including fewer symptoms of hyperglycemia and hypoglycemia . CONCLUSIONS Automated calls with telephone nurse follow-up may be an effective strategy for improving self-care behavior and glycemic control , and for decreasing symptoms among vulnerable patients with diabetes This study was conducted to evaluate the effect of automated telephone patient monitoring and counseling on patient adherence to antihypertensive medications and on blood pressure control . A r and omized controlled trial was conducted in 29 greater Boston communities . The study subjects were 267 patients recruited from community sites who were > or= 60 years of age , on antihypertensive medication , with a systolic blood pressure ( SBP ) of > or= 160 mm Hg and /or a diastolic blood pressure ( DBP ) of > or= 90 mm Hg . The study compared subjects who received usual medical care  with those who used a computer-controlled telephone system in addition to their usual medical care during a period of 6 months . Weekly , subjects in the telephone group reported self-measured blood pressures , knowledge and adherence to antihypertensive medication regimens , and medication side-effects . This information was sent to their physicians regularly . The main study outcome measures were change in antihypertensive medication adherence , SBP and DBP during 6 months , satisfaction of patient users , perceived utility for physicians , and cost-effectiveness .  The mean age of the study population was 76.0 years ; 77 % were women ; 11 % were black .  Mean antihypertensive medication adherence improved 17.7 % for telephone system users and 11.7 % for controls ( P = .03 ) . Mean DBP decreased 5.2 mm Hg in users compared to 0.8 mm Hg in controls ( P = .02 ) . Among nonadherent subjects , mean DBP decreased 6.0 mm Hg for telephone users , but increased 2.8 mm Hg for controls ( P = .01 ) . For telephone system users , mean DBP decreased more if their medication adherence improved ( P = .03 ) . The majority of telephone system users were satisfied with the system . Most physicians integrated it into their practice s. The system was cost-effective , especially for nonadherent patient users . Therefore , weekly use of an automated telephone system improved medication adherence and blood pressure control in hypertension patients . This system can be used to monitor patients with hypertension or with other chronic diseases , and is likely to improve health outcomes and reduce health services utilization and costs OBJECTIVE To determine whether automated measurement of blood pressure and pulse in a home setting can be easily accomplished by pregnant women with chronic hypertension . STUDY DESIGN In this prospect i ve investigation , seven women with chronic hypertension complicating pregnancy recorded their blood pressure at home twice a day . These data were offloaded once daily into a computer at a remote site , and a computerized printout of these data was received by the physician . RESULTS The patients participated in the study for 12.2 + /- 5.8 weeks ( range 4 to 18 weeks ) and were between 23 and 42 weeks ' gestation .  Average mean arterial pressure in the home was 102 + /- 10 mm Hg , and average pulse was 81 + /- 11 beats per minute . In the clinic , the values were 112 + /- 13 mm Hg and 90 + /- 30 beats per minute ( p < 0.05 ) . Each patient was easily taught how to use the machine . CONCLUSIONS The home blood pressure monitoring device was easy to use and correlated well with values recorded by health professionals for this limited number of subjects . It was particularly helpful to patients ( n = 5 ) who lived long distances ( more than 60 miles ) from the clinic and to women who needed adjustments of antihypertensive medication Aim : To compare the accuracy of clinic blood pressure ( CBP ) and telemedical home blood pressure ( HBP ) measurement in the assessment of antihypertensive effect . Methods : 362 patients on antihypertensive medication  performed  HBP measurement  ( 5 days , duplicate measurements , four times daily ) and ambulatory blood pressure ( ABP ) monitoring in r and om order . Main outcome measure was the agreement of CBP and HBP with daytime ABP . Results : CBP was much higher than ABP and average HBP ( p < 0.001 ) . There was a progressive decline in HBP over the course of the study , achieving the level of daytime ABP on the last 2 monitoring days . The correlation between CBP and ABP was weak ( systolic : r = 0.343 , diastolic r = 0.430 ) , whereas strong correlations existed between HBP and ABP ( systolic r = 0.804 , diastolic r = 0.776 ) . A progressive improvement in the strength of the correlation between average HBP of single days and ABP was obtained over the 5 monitoring days . The  HBP readings taken in the afternoon showed a stronger correlation with ABP than the values measured in the morning , at noon and in the evening . Averaging more HBP readings taken on succeeding days result ed in a progressive improvement in the agreement with ABP with a further benefit when readings of day 1 were included . Conclusions : The accuracy of telemedical HBP measurement is substantially better than that of CBP . The results suggest , that HBP should be measured for 5 days , and afternoon measurements should be preferred in assessing control of hypertension Patients with a diagnosis of heart failure , registered at the study practice , were recruited into the study . First , they had a cardiologist 's assessment . They were then r and omised into telemonitored patients who measured pulse , BP , weight and video consulted , and controls BACKGROUND African Americans have a higher prevalence and greater severity of hypertension than do other minorities and whites . This fact is particularly problematic when one realizes that the rate of control and treatment of hypertension in the US population is getting worse rather than better . Alternative strategies to promote blood pressure control need to be tested . OBJECTIVES The purpose of this pilot study was to test the following hypothesis : Persons who participate in nurse-managed home telemonitoring ( HT ) plus usual care or who participate in nurse-managed community-based monitoring ( CBM ) plus usual care will have greater improvement in blood pressure from baseline to 3 months ' follow-up than will persons who receive usual care only . METHODS This study used a r and omized controlled design ; participants were r and omly assigned to 1 of 3 groups that were stratified by use or nonuse of antihypertension medication . One-way analysis of variance ( ANOVA ) and analysis of covariance ( ANCOVA ) controlling for age and body weight were used to determine changes in blood pressure from baseline to 3 months . The sample contained 26 African Americans with a mean age of 59 years . RESULTS Both the HT group and the CBM group had clinical ly and statistically significant ( P < .05 ) drops in systolic blood pressure ( SBP ) and diastolic blood pressure ( DBP ) at 3 months ' follow-up , with participants in the HT group demonstrating the greatest improvement ( HT : baseline SBP 148.8 + /- 13.8 , DBP 90.2 + /- 5.79 ; 3 months ' follow-up SBP 124.1 + /- 13.82 , DBP 75.58 + /- 11.4 ; CBM : baseline SBP 155.25 + /- 17.014 , DBP 89.42 + /- 10.95 ; 3 months ' follow-up SBP 142.3 + /- 12.1 , DBP 78.25 + /- 6.86 ) . There was little change in SBP or DBP at 3 months ' follow-up in the usual care only group . CONCLUSION These are important pilot results , which if replicated in a larger sample will significantly improve care for urban African Americans with hypertension BACKGROUND Patients with insulin dependent diabetes require frequent advice if their metabolic control is not optimal . This study focuses on the fiscal and administrative aspects of telemanagement , which was used to establish a supervised autonomy of patients on intensified insulin therapy . METHODS A prospect i ve , r and omised trial with 43 patients on intensified insulin therapy  was conducted . Travelling distance to the diabetes centre was 50 min one way ; all patients had undergone a diabetes education course with lessons in dose adaptation . Patients were r and omly assigned to telecare ( n=27 ) or conventional care ( n=16 ) . They used BG-meters with a storage capacity of 120 values ( Precision QID Abbott/Medisense ) and transmitted their data over a combined modem/interface via telephone line to the diabetes centre . Data were displayed and stored by a customised software ( Precision Link Plus , Abbott/Medisense ) . Advice for proper dose adjustment was given by telephone . RESULTS Average time needed for instruction in the telemedical system was 15 min . Data were transmitted every 1 - 3 weeks and a teleconsultation was performed by phone every 2 - 4 weeks , depending on the extent of specific problems . On average , personal visits in the control group were performed once a month . Physician 's time expenditure for telemanagement , compared to conventional advice was moderately higher ( 50 vs. 42 min per month ) . A substantial amount of time on the patients side could be saved through replacing personal communications by telephone contacts and data transmission reduction ( 96 vs. 163 min/month including data transmission time ) . Setting up an optimal telemanagement scenario , a cost analysis was carried out yielding savings of approximately 650 euro per year per patient . HbA(1c ) dropped significantly from 8.2 to 7.0 % after 8 months of observation , but there was no significant difference between the intervention and control groups . Major technical problems with the telematic system did not occur during the study . CONCLUSIONS Telemanagement of insulin-requiring diabetic patients is a cost and time saving procedure for the patients and results in metabolic control comparable to conventional outpatient management Home peak expiratory flow ( PEF ) measurement is recommended by asthma guidelines . In a 16-week r and omized controlled study on 16 subjects with asthma ( 24.6 6.5 years old , asthma duration small ze , Cyrillic 6 months ) , we examined Global System for Mobile Communications ( GSM ) mobile telephone short-message service ( SMS ) as a novel means of telemedicine in PEF monitoring . All subjects received asthma education , self-management plan , and st and ard treatment . All measured PEF three times daily and kept a symptom diary . In the study group , therapy was adjusted weekly by an asthma specialist according to PEF values received daily from the patients . There was no significant difference between the groups in absolute PEF , but PEF variability was significantly smaller in the study group ( 16.12 + /- 6.93 % vs. 27.24 + /- 10.01 % , p = 0.049 ) . forced expiratory flow in 1 second ( FEV1 ; % predicted ) in the study group was slightly but significantly increased ( 81.25 + /- 17.31 vs. 77.63 + /- 14.80 , p = 0.014 ) and in the control group , unchanged ( 78.25 + /- 21.09 vs. 78.88 + /- 22.02 , p = 0.497 ) . Mean FEV1 was similar in the two groups both before and after the study . Controls had significantly higher scores for cough ( 1.85 + /- 0.43 vs. 1.42 + /- 0.28 , p < 0.05 ) and night symptoms ( 1.22 + /- 0.23 vs. 0.85 + /- 0.32 , p < 0.05 ) . There was no significant difference between the groups in daily consumption of inhaled medicine , forced vital capacity , or compliance . Per patient , per week , the additional cost of follow-up by SMS was Euros 1.67 ( equivalent to approximately $ 1.30 per 1 Euro ) , and SMS transmission required 11.5 minutes . Although a study group of 40 patients is needed for the follow-up study to achieve the power of 80 % within the 95 % confidence interval , we conclude that SMS is a convenient , reliable , affordable , and secure means of telemedicine that may improve asthma control when added to a written action plan and st and ard follow-up Home monitoring of spirometry has been advocated in lung transplant recipients for the early detection of acute infection and rejection of the allograft . We have developed a user-friendly , Internet-based telemonitoring system providing direct transmission of home spirometry to the hospital . In this prospect i ve study , we assessed patient adherence with the monitoring , agreement between home and hospital spirometry  , intrasubject coefficient of variation ( CV ) for FEV(1 ) and FEF(25 - 75 ) , and sensitivity of these variables for the detection of acute complications .  Twenty-two bilateral-lung and heart-lung transplant recipients were followed for a median of 473 d ( range , 60 - 822 ) , during which 13,833 measurements were obtained . Patient compliance was 55 % for two measurements a day and 84 % for one measurement a day . Agreement between home and hospital spirometry was within 4 % for FEV(1 ) and 6 % for FEF(25 - 75 ) . Mean CV was 3.2 % for FEV(1 ) and 7.5 % for FEF(25 - 75 ) . Using transbronchial lung biopsy and /or bronchoalveolar lavage as gold st and ards , the sensitivity of home spirometry was 63 % , and 23 % of true positives were detected by changes in FEF(25 - 75 ) alone . We conclude that home monitoring of pulmonary function in lung transplant recipients via the Internet is feasible and provides very reproducible data ; yet it has only a mild sensitivity for the detection of acute allograft dysfunction The adherence and disease-control outcomes associated with the use of an Internet-based store- and -forward video home telehealth system to manage asthma in children were studied . Pediatric patients with persistent asthma were provided with home computers and Internet access and monitored biweekly over the Internet .  All patients were seen in the pediatric clinic at 0 , 2 , 6 , 12 , and 24 weeks . Half of the patients received  asthma education in person and half via an interactive Web site .  Adherence measures were assessed by therapeutic and diagnostic monitoring . Therapeutic monitoring included digital videos of patients using their controller medication inhaler . Diagnostic monitoring included an asthma symptom diary and a video of peak flow meter use . Videos were su bmi tted electronically twice a week by using in-home telemonitoring with store- and -forward technology . Feedback was provided electronically to each patient . Disease control was assessed by examining quality of life , utilization of services , rescue-therapy use , symptom control , satisfaction with home telemonitoring , and retention of asthma knowledge . Patients were r and omly assigned to an asthma education group ( Internet versus office ) , and the data were analyzed by comparing results for study days 0 - 90 and 91 - 180 . Ten children participated . A total of 321 videos of inhaler use and 309 videos of peak flow meter use were su bmi tted . Inhaler technique scores improved significantly in the second study period . Su bmi ssion of diagnostic monitoring videos and asthma diary entries decreased significantly . Peak flow values as a percentage of personal best values increased significantly . Overall , there was no change in quality of life reported by patients . However , the caregivers in the virtual-education group reported an increase in the patients ' quality -of-life survey scores . Emergency department visits and hospital admissions for asthma were avoided . Rescue therapy was infrequent . A high rate of satisfaction with home telemonitoring was reported . Internet-based , store- and -forward video assessment of children 's use of asthma medications and monitoring tools in their homes appeared effective and well accepted At the end of a long week in the office , you sink back into your chair , reflecting on some of the more memorable patients you cared for and counseled . Through gentle history taking , you discovered that urinary incontinence is the underlying cause of an elderly patient 's increasing social isolation . During a careful physical examination , you detected bruising on the torso of a woman with chronic headaches and began to explore the longst and ing abusive relationship between the woman and her alcoholic partner . You discontinued procainamide therapy in a 72-year-old man who had asymptomatic premature ventricular contractions after myocardial infa rct ion . To prevent bleeding from esophageal varices , you started -blocker therapy in a woman with long-st and ing cryptogenic cirrhosis and portal hypertension . In couples ' therapy , discussing the future quality of life of a middle-aged gay man with human immunodeficiency virus infection , you journeyed through emotionally intense dialogue about advance directives . You presented the risk factors for major and minor bleeding to a 39-year-old woman who was considering warfarin therapy because of recently diagnosed atrial fibrillation and valvular heart disease . You listened to , made diagnoses for , treated , advised , and comforted many patients . Yet there were some hiccoughs in your practice along the way . You stumbled while debating the pros and cons of breast cancer screening with a healthy 48-year-old woman who has been staying current with information on the Internet . You question ed the merits of a personalized walking program suggested to you by a motivated 66-year-old man with severe claudication . Explaining that you wanted to review the best current evidence on these issues , you resolved to address your uncertainties before these patients made their next office visits , in a week 's time . Sighing deeply , you acknowledge that you have little time to read . You subscribe to three journals , which you browse months after they arrive-either when your journal stack becomes precariously high or when your guilt is sufficiently motivational . You sometimes find the conclusions of individual articles conflicting or confusing . You know that some of the decisions and suggestions you made this week , specifically your decisions about stopping procainamide therapy and starting -blocker therapy and your advice about bleeding risks from anticoagulant therapy , were based on the best current research evidence [ 1 - 3 ] . On the other h and , your patients ' inquiries about breast cancer screening and exercise treatment for claudication highlight your need for a concise , current , rigorous synthesis of the best available evidence on each of these topics : in brief , a systematic review [ 4 , 5 ] . Incorporating Research Evidence into Clinical Decision Making The foregoing scenario is familiar to practitioners . In a typical week , we encounter patients with diverse problems ; exercise numerous clinical , interpersonal , and technical skills ; and make many decisions . The factors that affect these decisions and their outcomes are complex . For instance , each patient has unique sociodemographic characteristics , cultural circumstances , and personal preferences . Each physician has unique knowledge , experiences , and values . Moreover , practitioners and their patients make decisions within the context of a rapidly changing health care system that influences the availability , accessibility , and cost of diagnostic tests and therapies [ 6 ] . Timely , useful evidence from the biomedical literature should be an integral component of clinical decision making . If one treatment has been shown to be better than another , we need to know , so that we can recommend the treatment to the appropriate patients . The worldwide effort to develop new tests and treatments , and to determine their usefulness , has never been stronger , and our patients and their families expect us to be fonts of the knowledge that results from this effort [ 7 ] . Unfortunately , it is easy for current best research evidence to pass us by [ 8 ] . We may lack the time , motivation , and basic skills needed to find , critically appraise , and synthesize information , all of which we must do if we are to integrate the results of original studies into our practice . Fortunately , several potent methods are emerging that can greatly enhance our ability to interpret and apply research evidence ; foremost among them is the systematic review . This article begins a series in Annals that will examine systematic review s in detail and explore their many applications . Systematic review s represent the best chance that most practitioners will have to underst and and accurately apply the key signals arising from the robust and increasingly productive search for solutions to medical problems . A properly conducted systematic review faithfully summarizes the evidence from all relevant studies on the topic of interest , and it does so concisely and transparently . What Is a Systematic Review ? Systematic review s are scientific investigations in themselves , with pre-planned methods and an assembly of original studies as their subjects . They synthesize the results of multiple primary investigations by using strategies that limit bias and r and om error [ 9 , 10 ] . These strategies include a comprehensive search of all potentially relevant articles and the use of explicit , reproducible criteria in the selection of articles for review . Primary research design s and study characteristics are appraised , data are synthesized , and results are interpreted . When the results of primary studies are summarized but not statistically combined , the review may be called a qualitative systematic review . A quantitative systematic review , or meta- analysis , is a systematic review that uses statistical methods to combine the results of two or more studies . The term overview is sometimes used to denote a systematic review , whether quantitative or qualitative . Summaries of research that lack explicit descriptions of systematic methods are often called narrative review s. Review articles are one type of integrative publication ; practice guidelines , economic evaluations , and clinical decision analyses are others . These other types of integrative articles often incorporate the results of systematic review s. For example , practice guidelines are systematic ally developed statements intended to assist practitioners and patients with decisions about appropriate health care for specific clinical circumstances [ 11 ] . Evidence -based practice guidelines are based on systematic review s of the literature , appropriately adapted to local circumstances and values . Economic evaluations compare both the costs and the consequences of different courses of action ; the knowledge of consequences that are considered in these evaluations is often generated by systematic review s of primary studies . Decision analyses quantify both the likelihood and the valuation of the expected outcomes associated with competing alternatives . Differences between Systematic and Narrative Review s All review s , narrative and systematic alike , are retrospective , observational research studies and are therefore subject to systematic and r and om error . Accordingly , the quality of a review - and thus its worth-depends on the extent to which scientific review methods have been used to minimize error and bias . This is the key feature that distinguishes traditional narrative review s from systematic review s ( Table 1 ) . If a review is prepared according to the steps outlined in the right column of Table 1 , it is more likely to be systematic and to provide unbiased conclusions . If review methods approximate those found in the middle column of Table 1 , the article is more likely to be a narrative review , and the conclusions are less likely to be based on an unbiased summary of all relevant evidence . Table 1 . Differences between Narrative Review s and Systematic Review s Systematic review s are generated to answer specific , often narrow , clinical questions in depth . These questions can be formulated explicitly according to four variables : a specific population and setting ( such as elderly out patients ) , the condition of interest ( for example , hypertension ) , an exposure to a test or treatment ( such as pharmacologic management ) , and one or more specific outcomes ( such as cardiovascular and cerebrovascular events and mortality ) [ 12 ] . Thus , an example of a well-formulated , clinical ly relevant question is , Does pharmacologic treatment of hypertension in the elderly prevent strokes and myocardial infa rct ions or delay death ? If the question that is driving the review is not clear from the title , abstract , or introduction , or if no methods section is included , the paper is more likely to be a narrative review than a systematic review [ 13 ] . Most narrative review articles deal with a broad range of issues related to a given topic rather than addressing a particular issue in depth [ 9 ] . For example , a narrative review on diabetes ( such as that which might be found in a textbook chapter ) might include sections on the physiology and pathophysiology of carbohydrate , lipid , and protein metabolism ; the epidemiology of and prognosis associated with diabetes ; diagnostic and screening approaches ; and preventive , therapeutic , rehabilitative , and palliative interventions . Thus , narrative review s may be most useful for obtaining a broad perspective on a topic ; they are less often useful in furnishing quantitative answers to specific clinical questions . Narrative review s are appropriate for describing the history or development of a problem and its management . Narrative review s may better describe cutting-edge developments if research is scant or preliminary or if studies are very limited by flawed design or execution [ 13 ] . They may be particularly useful for discussing data in light of underlying theory and context . Narrative review s can draw analogies and can conceptually integrate two independent fields of research , such as Although the use of telecommunication systems in medicine has been increasing , few trials have assessed the efficacy of such technology for improving blood pressure in patients with essential hypertension ( 1 , 2 ) . Friedman and colleagues ( 1 ) found that when hypertensive patients used a telephone-linked computer system to report blood pressure , diastolic blood pressure decreased significantly . Bondmass and colleagues ( 2 ) also found a significant decrease in both diastolic and systolic blood pressure , although their trial lacked controls . In these studies and in other trials of home monitoring , self-report of blood pressure was the basic mechanism for transmission of information to physicians ( 1 - 8 ) . This may have consequences for patient care , since it has recently been shown that patients often erroneously report blood pressure , especially patients whose blood pressure is uncontrolled ( 9 ) . Johnson and colleagues ( 9 ) found that in approximately 20 % of instances , self-report of blood pressure differed from the electronic reading by more than 10 mm Hg . Another limitation of previous trials is accurate assessment of the outcome . In some studies , the outcome was determined by one or two blood pressure readings taken during an office visit or by a technician in the home setting ( 1 , 4 - 7 ) . Only one study of 31 patients used  automatic ambulatory blood pressure monitoring ( ABPM )  to assess usual blood pressure at baseline and exit ( 3 ) . Twenty-fourhour ABPM recordings yield a more reliable assessment of usual blood pressure levels during the course of daily activities ( 10 ) . To improve on the previous studies , we design ed a r and omized , controlled trial that used 24-hour ABPM measurements at baseline and at exit to determine change in blood pressure more accurately . The intervention was a service provided to physicians that used electronic transmission of results and did not rely on  self-report of blood pressure . Methods Study Protocol From May 1999 to April 2000 , five internists from the Department of Medicine at the State University of New York Upstate Medical University in Syracuse recruited patients from internal medicine outpatient practice s affiliated with the general medicine division . Out patients seen by these physicians were covered by private insurance plans or Medicare . Eligible patients were adults who had previously received a diagnosis of essential hypertension and were under evaluation for a change in antihypertensive therapy because of 1 ) elevated blood pressure [ systolic pressure 140 or diastolic pressure 90 mm Hg ] despite current antihypertensive therapy , 2 ) undesirable side effects of current antihypertensive medication , or 3 ) office systolic pressure of at least 180 mm Hg or diastolic pressure of at least 110 mm Hg with no current use of antihypertensive medication . For patients with diabetes mellitus , heart disease , stroke , nephropathy , peripheral arterial disease , or hypertensive retinopathy , an office systolic pressure of at least 130 mm Hg or an office diastolic pressure of at least 85 mm Hg was a criterion for eligibility . Patients who were younger than 18 years of age , were pregnant , had secondary hypertension , or did not have the mental or physical capacity to monitor blood pressure at home were excluded . All patients were informed of the study procedures , the risks and benefits of participation , confidentiality , rights , and personnel to contact for additional information . The institutional review board at Upstate Medical University approved the trial , and all patients gave written consent before participation . Patients received printed educational material s on nonpharmacologic approaches to blood pressure  control from the National Heart , Lung , and Blood Institute ( 11 ) . These approaches included reducing weight , increasing physical activity , and changing diet if necessary . At baseline , height and weight were recorded at the clinic for all patients . Body mass index was calculated as kg/m2 . Printed information on the treatment of hypertension from the Sixth Report of the Joint National Committee on Prevention , Detection , Evaluation , and Treatment of High Blood Pressure ( National High Blood Pressure Education Program ) ( 12 ) was available at each clinical site as a reference for physicians and clinical staff . Study Group Assignment We conducted a r and omized trial with concurrent controls . The two study groups were home service and usual care .  To ensure an equal number of patients in both study groups , we used a blocking procedure with r and om permuted blocks of varying size to reduce predictability . R and omization was stratified by the number of prescription medications patients were taking ( 0 to 2 or 3 ) at study entry , which served as a general indicator of morbidity . Sequentially numbered , sealed , opaque envelopes were used for assignment . The r and omization procedure was concealed to physicians and clinical research staff , but physicians , investigators , and patients were aware of group assignment when r and omization was complete . In addition , adherence to the protocol was monitored independently of the clinicians . A priori sample size was calculated to detect a mean ( SD ) difference in blood pressure of 3 5 mm Hg between the two study groups . This yielded 60 patients per group with 90 % power ( = 0.05 [ two-tailed ] ) . Intervention The intervention was a telecommunication service consisting of three components : automatic blood pressure recording at home , central processing , and electronic reports provided weekly to the primary physician and patient . We used a home blood pressure monitoring device that transmitted data over analog telephone lines ( Model 52500 , Welch Allyn , Inc. , Skaneateles Falls , New York ) and was vali date d according to the st and ards of the American National St and ard Institute , Inc. , and the Association for the Advancement of Medical Instrumentation ( 13 ) . The oscillometric device ( 16.26 cm 10.92 cm 6.6 cm ) had a digital display for blood pressure and pulse and used automatic pressurization and exhaust for cuff inflation and deflation . Patients were instructed to take their blood pressure three times in the morning before eating or drinking and three times in the evening before going to bed . After each reading , the device automatically dialed the Service and Support Center at Welch Allyn and transmitted the data . Patients were asked to conduct this routine at least three days each week for a minimum of 8 weeks and could take additional readings if they desired . A computer program was developed to display the results in a report form , which was then faxed to each patient 's physician . The report form contained information on the mean systolic pressure , mean diastolic pressure , and heart rate ( overall , morning , and evening ) . It also graphed the pressure by date and displayed individual readings in tabular form . Both physicians and patients received a report form each week , as well as a summary report form at the end of the trial . When physicians received report forms that indicated elevated pressure , they adjusted antihypertensive medications through a telephone call , an office visit , or both . At the time of the trial , the service cost $ 24.95 per month . Patients assigned to usual care were treated for hypertension according to the guidelines of the Joint National Committee on Prevention , Detection , and Treatment of High Blood Pressure ( 12 ) . Question naire Information Information about patients ' medical histories , past diagnoses of disease , and use of medications was obtained from question naires . The Baecke question naire of habitual physical activity was used to assess usual activity levels ( 14 ) . Subscales included a work index , a sports index , and a nonsports leisure index , as well as a total physical activity score . Dietary intake was estimated by using the Block screening question naire , which consists of two subscales : intake of highly saturated fatty foods and intake of fruit , vegetables , and high-fiber grains ( 15 ) . Questions about smoking and stress were taken from the previously vali date d Health Habits and History Question naire ( 16 ) . The study question naire was collected at the time of the second 24-hour ambulatory readings . Outcome Measures The primary end point was the change in mean arterial pressure during the trial ( baseline to exit ) for home service compared with usual care . A clinical research nurse ( the study manager ) fitted participants with a 24-hour ABPM device at baseline and at exit . The nurse gave the patients detailed instructions for using the device . The ABPM device automatically recorded blood pressure every half-hour from 7:00 a.m. to 11:00 p.m. and every hour from 11:00 p.m. to 7:00 a.m. Information from baseline and exit ABPM readings was given to physicians only after the patient exited the trial . All blood pressure measurements indicated in this report refer to these 24-hour readings . Means and SDs were recorded for systolic pressure , diastolic pressure , arterial pressure , and heart rate by using 24-hour ABPM . Mean arterial pressure was measured as ( diastolic pressure + 1/3 [ systolic pressure diastolic pressure ] ) . The ABPM device also recorded the percentage of readings above the desired target levels ( 140 mm Hg systolic or 90 mm Hg diastolic for patients without target organ damage ; 130 mm Hg systolic or 85 mm Hg diastolic for patients with target organ damage ) . Patients were scheduled to remain in the trial for a minimum of 8 weeks . During the sixth and seventh weeks , appointments were made to schedule second 24-hour ABPM sessions . For both the home service and usual care groups , the median time from baseline to exit was 11 weeks . The final patient receiving usual care exited at 20 weeks , and the final patient receiving home service exited at 28 weeks . Statistical Analysis All information was entered into an Excel data base ( Microsoft Corp. , Redmond , Washington ) and was manually rechecked for errors . Statistical analyses were conducted by using STATISTICA software ( OBJECTIVE To determine whether modem technology allows for effective management of type 1 diabetes when used in lieu of a clinic visit . RESEARCH DESIGN AND METHODS A total of 70 adolescent patients with diabetes were prospect ively r and omized to either a control group or a modem group . Control group patients continued the st and ard of care of quarterly clinic visits , and modem group patients were instructed to transmit blood glucose data every 2 weeks for 6 months instead of a usual quarterly clinic visit . Health care providers analyzed the data received by modem and contacted patients to discuss diabetes treatment changes . GHbA(1c ) levels were determined at 0 and 6 months , and the number of high and low blood glucose levels and adverse events were tracked . Clinic visit costs , patient expenses , and health care provider times were tracked for cost analysis for both groups . RESULTS A total of 63 patients ( 33 control , 30 modem ) completed the 6-month study . The GHbA(1c ) values significantly decreased in both groups , with no statistically significant difference between groups ( P = 0.96 ) . The occurrence of mild-to-moderate hypoglycemic events were similar in the two groups , and there were no severe hypoglycemic events . The average cost of care for a clinic visit was $ 305.00 , whereas the cost for 6 months of modem transmission was $ 163.00 . CONCLUSIONS This study shows that electronic transmission of blood glucose levels and other diabetes data every 2 weeks-in lieu of a clinic visit- results in a similar level of glucose control and incidence of acute diabetes complications when compared with current st and ard care This project tested the importance of enhanced information transfer of home monitoring results to health care providers . The study tested whether computer-assisted communication of medical information between the chronic care patient and the physician can result in health care benefit . The information tools were constructed/adapted as a test of this hypothesis for diabetes mellitus . Patients connected a glucometer to an intelligent modem weekly for six to nine months . Graphical and mathematical tools extracted and emphasized the information content of the home monitoring data arriving at the central site . Data smoothing , trend analysis , and calculation of quality control statistics were incorporated into a graphical time series oriented report that was used by the health care provider during an outpatient visit . The integrated home monitoring system was tested on 20 patients with diabetes in a double cross-over design over a 15-month period . A significant improvement in serum glucose control as measured by glycated hemoglobin was shown in the study group , but not in the control group
target: RESULTS The magnitude and significance of the telemonitoring effects on patients ' conditions ( e.g. , early detection of symptoms , decrease in blood pressure , adequate medication , reduced mortality ) still remain inconclusive for all four chronic illnesses .
  However , the results of this study suggest that regardless of their nationality , socioeconomic status , or age , patients comply with telemonitoring programs and the use of technologies .
  Importantly , the telemonitoring effects on clinical effectiveness outcomes ( e.g. , decrease in the emergency visits , hospital admissions , average hospital length of stay ) are more consistent in pulmonary and cardiac studies than diabetes and hypertension .
  Home telemonitoring of chronic diseases seems to be a promising patient management approach that produces accurate and reliable data , empowers patients , influences their attitudes and behaviors , and potentially improves their medical conditions .
background: OBJECTIVE Home telemonitoring represents a patient management approach combining various information technologies for monitoring patients at distance .
  This study presents a systematic review of the nature and magnitude of outcomes associated with telemonitoring of four types of chronic illnesses : pulmonary conditions , diabetes , hypertension , and cardiovascular diseases .