A Successful Multifaceted Trial to Improve Hypertension Control in Primary Care: Why Did it Work? Blood pressure control during telemonitoring of home blood pressure. A randomized controlled trial during 6 months Feasibility of blood pressure telemonitoring in patients with poor blood pressure control Economic evaluation of home blood pressure telemonitoring: A randomized controlled trial Effect of home blood pressure telemonitoring and pharmacist management on blood pressure control: a cluster randomized clinical trial. Effect of Home Blood Pressure Telemonitoring With Self-Care Support on Uncontrolled Systolic Hypertension in Diabetics Telemonitoring and self-management in the control of hypertension (TASMINH2): a randomised controlled trial Impact of telemonitoring home care patients with heart failure or chronic lung disease from primary care on healthcare resource use (the TELBIL study randomised controlled trial) Experiences of patients and professionals participating in the HITS home blood pressure telemonitoring trial: a qualitative study Comparative effectiveness of home blood pressure telemonitoring (HBPTM) plus nurse case management versus HBPTM alone among Black and Hispanic stroke survivors: study protocol for a randomized controlled trial A comparison of in-person home care, home care with telephone contact and home care with telemonitoring for disease management Assessment of a primary care-based telemonitoring intervention for home care patients with heart failure and chronic lung disease. The TELBIL study Telemonitoring based service redesign for the management of uncontrolled hypertension: multicentre randomised controlled trial The effect of a randomized trial of home telemonitoring on medical costs, 30-day readmissions, mortality, and health-related quality of life in a cohort of community-dwelling heart failure patients. Active Care Management Supported by Home Telemonitoring in Veterans With Type 2 Diabetes Linking clinic and home: a randomized, controlled clinical effectiveness trial of real-time, wireless blood pressure monitoring for older patients with kidney disease and hypertension Physical activity for the prevention and treatment of major chronic disease: an overview of systematic reviews Economic evaluation of telephone self-management interventions for blood pressure control. Telemonitoring and Protocolized Case Management for Hypertensive Community-Dwelling Seniors With Diabetes: Protocol of the TECHNOMED Randomized Controlled Trial A remote monitoring and telephone nurse coaching intervention to reduce readmissions among patients with heart failure: study protocol for the Better Effectiveness After Transition - Heart Failure (BEAT-HF) randomized controlled trial The impact of group leaders' behaviour on parents acquisition of key parenting skills during parent training. A coordinated PCP-Cardiologist Telemedicine Model (PCTM) in China’s community hypertension care: study protocol for a randomized controlled trial Supported Telemonitoring and Glycemic Control in People with Type 2 Diabetes: The Telescot Diabetes Pragmatic Multicenter Randomized Controlled Trial Mixed methods feasibility study for a trial of blood pressure telemonitoring for people who have had stroke/transient ischaemic attack (TIA) Hypertension Intervention Nurse Telemedicine Study (HINTS): testing a multifactorial tailored behavioral/educational and a medication management intervention for blood pressure control. The rationale and design of reduction of uncontrolled hypertension by Remote Monitoring and Telemedicine (REMOTE) study Mobile telemonitoring for achieving tighter targets of blood pressure control in patients with complicated diabetes: a pilot study. The effectiveness of nurse-led telemonitoring of asthma: results of a randomized controlled trial. Home blood pressure management and improved blood pressure control: results from a randomized controlled trial. Key Steps in Conducting Systematic Reviews for Underpinning Clinical Practice Guidelines: Methodology of the European Association of Urology. Use of Home Telemonitoring to Support Multidisciplinary Care of Heart Failure Patients in Finland: Randomized Controlled Trial Community-based care for the management of type 2 diabetes: an evidence-based analysis. Telemonitoring-based service redesign for the management of uncontrolled hypertension (HITS): cost and cost-effectiveness analysis of a randomised controlled trial A randomized trial of home telemonitoring in a typical elderly heart failure population in North West London: results of the Home-HF study. Home blood pressure telemonitoring improves hypertension control in general practice. The TeleBPCare study First outline and baseline data of a randomized, controlled multicenter trial to evaluate the health economic impact of home telemonitoring in chronic heart failure – CardioBBEAT 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. Telephone counseling and home telemonitoring: the Weigh by Day Trial. Effects and costs of home-based training with telemonitoring guidance in low to moderate risk patients entering cardiac rehabilitation: The FIT@Home study Effects of home telemonitoring and community-based monitoring on blood pressure control in urban African Americans: a pilot study. Home Health Care With Telemonitoring Improves Health Status for Older Adults With Heart Failure A novel telemonitoring device for improving diabetes control: protocol and results from a randomized clinical trial. Designing for action: adapting and implementing a community-based newborn care package to affect national change in Uganda Home telemonitoring and quality of life in stable, optimised chronic obstructive pulmonary disease Home-based blood pressure interventions for blacks.
ABSTRACT Background It is important to underst and which components of successful multifaceted interventions are responsible for study outcomes , since some components may be more important contributors to the intervention effect than others . Objective We conducted a mediation analysis to determine which of seven factors had the greatest effect on change in systolic blood pressure ( BP ) after 6 months in a trial to improve hypertension control . Design The study was a preplanned secondary analysis of a cluster-r and omized clinical trial . Eight clinics in an integrated health system were r and omized to provide usual care to their patients ( n = 222 ) , and eight were r and omized to provide a telemonitoring intervention ( n = 228 ) . Participants Four hundred three of 450 trial participants completing the 6-month follow-up visit were included . Interventions Intervention group participants received home BP telemonitors and transmitted measurements to pharmacists , who adjusted medications and provided advice to improve adherence to medications and lifestyle modification via telephone visits . Main measures Path analytic models estimated indirect effects of the seven potential mediators of intervention effect ( defined as the difference between the intervention and usual care groups in change in systolic BP from baseline to 6 months ) . The potential mediators were change in home BP monitor use , number of BP medication classes , adherence to BP medications , physical activity , salt intake , alcohol use , and weight . Key Results The difference in change in systolic BP was 11.3 mmHg . The multivariable mediation model explained 47 % ( 5.3 mmHg ) of the intervention effect . Nearly all of this was mediated by two factors : an increase in medication treatment intensity ( 24 % ) and increased home BP monitor use ( 19 % ) . The other five factors were not significant mediators , although medication adherence and salt intake improved more in the intervention group than in the usual care group . Conclusions Most of the explained intervention effect was attributable to the combination of self-monitoring and medication intensification . High adherence at baseline and the relatively low intensity of re sources directed toward lifestyle change may explain why these factors did not contribute to the improvement in BP Aim . To compare the effectiveness of antihypertensive treatment based on telemonitoring of home blood pressure ( BP ) and conventional monitoring of office BP . Methods . Hypertensive patients ( n = 236 ) participated in a r and omized , controlled study . In the intervention group , antihypertensive treatment was based on home BP monitoring . BP readings were registered by a PDA and automatically transmitted to a server , by which the patient and doctor could communicate . In the control group , patients received usual care with office visits to adjust antihypertensive treatment as needed . Primary outcome was difference in systolic daytime ambulatory BP monitoring ( ABPM ) change between baseline and 6 months . Results . In both groups , systolic daytime ABPM decreased significantly from baseline to follow‐up . The decrease in systolic daytime ABPM was −11.9 mmHg in the intervention group and −9.6 mmHg in the control group ( mean difference −2.3 [ 95 % CI −6.1 to −1.5 ] , p = 0.225 ) . The likelihood of daytime ABPM normalization was similar in the two groups [ 32/113 ( 28 % ) vs 46/123 ( 37 % ) , p = 0.139 ] . Conclusion . Antihypertensive treatment based on telemonitoring of home BP was as effective as usual monitoring of office BP with regards to reduction of BP . Trial registration : Clinical Trials.gov identifier : NCT00282334 We examined the feasibility of using home blood pressure ( BP ) telemonitoring devices for managing patients with poor BP control .  We enrolled 591 subjects with a diagnosis of hypertension . Patients were r and omized to usual care ( n = 147 ) or to the intervention arm ( n = 441 ) . Those in the intervention arm were issued with a home BP telemonitoring device . The device transmitted BP readings automatically via the home telephone line . Technical alerts were generated if patients did not transmit their BP readings according to the protocol . During the first six months , 693 technical alerts were generated by 267 patients . About half of these patients ( 112 ) generated more than two technical alerts . Resolution of the alerts showed that 61 % were caused by patient non-adherence . Patients who generated > 2 technical alerts were younger ( 61 vs. 64 years ; P = 0.001 ) and were more likely to be non-Caucasian  ( 64 % vs. 47 % , P = 0.002 ) than those generating 2 or fewer alerts . Despite the potential for improving health care using home BP telemonitoring , certain patients will require more support to use the equipment successfully Abstract Aims . The purpose of the present study was to compare the costs of  home blood pressure ( BP ) telemonitoring ( HBPM )  with the costs of conventional office BP monitoring . In a r and omized controlled trial , 105 hypertensive patients performed HBPM and 118 patients received usual care with conventional office BP monitoring  during 6 months . Costs were quantified from the healthcare perspective . Non-parametric simulations were performed to quantify the uncertainty around the mean estimates and cost-effectiveness acceptability curves were made . Major findings . Systolic and diastolic daytime and night-time ambulatory BP ( ABP ) were reduced in both groups . The uncertainty around the incremental cost effectiveness ratio point estimates was considerable for both systolic and diastolic ABP . For systolic ABP , the difference in cost effectiveness ratio between the two groups was 256 Danish kroner (DKK)/mmHg [ 95 % uncertainty interval , UI −860 to 4544 ] . For diastolic ABP , the difference in cost effectiveness ratio between the two groups was 655 DKK/mmHg [ 95 % UI −674 to 69315 ] . Medication and consultation costs were lowest in the intervention group , but were offset by the cost of the telemonitoring equipment . Conclusions . Cost-effectiveness analysis showed that telemonitoring of home BP was more costly compared with usual monitoring of office BP . The cost-effectiveness result is surrounded with considerable uncertainty . Trial registration : Clinical Trials.gov identifier : NCT282334 IMPORTANCE Only about half of patients with high blood pressure ( BP ) in the United States have their BP controlled . Practical , robust , and sustainable models are needed to improve BP control in patients with uncontrolled hypertension . OBJECTIVES To determine whether an intervention combining home BP telemonitoring with pharmacist case management improves BP control compared with usual care and to determine whether BP control is maintained after the intervention is stopped . DESIGN , SETTING , AND PATIENTS A cluster r and omized clinical trial of 450 adults with uncontrolled BP recruited from 14,692 patients with electronic medical records across 16 primary care clinics in an integrated health system in Minneapolis-St Paul , Minnesota , with 12 months of intervention and 6 months of postintervention follow-up . INTERVENTIONS Eight clinics were r and omized to provide usual care to patients ( n = 222 ) and 8 clinics were r and omized to provide a telemonitoring intervention ( n = 228 ) . Intervention patients received home BP telemonitors and transmitted BP data to pharmacists who adjusted antihypertensive therapy accordingly . MAIN OUTCOMES AND MEASURES Control of systolic BP to less than 140 mm Hg and diastolic BP to less than 90 mm Hg ( < 130/80 mm Hg in patients with diabetes or chronic kidney disease ) at 6 and 12 months . Secondary outcomes were change in BP , patient satisfaction , and BP control at 18 months ( 6 months after intervention stopped ) . RESULTS At baseline , enrollees were 45 % women , 82 % white , mean ( SD ) age was 61.1 ( 12.0 ) years , and mean systolic BP was 148 mm Hg and diastolic BP was 85 mm Hg .  Blood pressure was controlled at both 6 and 12 months in 57.2 % ( 95 % CI , 44.8 % to 68.7 % ) of patients in the telemonitoring intervention group vs 30.0 % ( 95 % CI , 23.2 % to 37.8 % ) of patients in the usual care group ( P = .001 ) . At 18 months ( 6 months of postintervention follow-up ) , BP was controlled in 71.8 % ( 95 % CI , 65.0 % to 77.8 % ) of patients in the telemonitoring intervention group vs 57.1 % ( 95 % CI , 51.5 % to 62.6 % ) of patients in the usual care group ( P = .003 ) . Compared with the usual care group , systolic BP decreased more from baseline among patients in the telemonitoring intervention group at 6 months ( -10.7 mm Hg [ 95 % CI , -14.3 to -7.3 mm Hg ] ; P<.001 ) , at 12 months ( -9.7 mm Hg [ 95 % CI , -13.4 to -6.0 mm Hg ] ; P<.001 ) , and at 18 months ( -6.6 mm Hg [ 95 % CI , -10.7 to -2.5 mm Hg ] ; P = .004 ) . Compared with the usual care group , diastolic BP decreased more from baseline among patients in the telemonitoring intervention group at 6 months ( -6.0 mm Hg [ 95 % CI , -8.6 to -3.4 mm Hg ] ; P<.001 ) , at 12 months ( -5.1 mm Hg [ 95 % CI , -7.4 to -2.8 mm Hg ] ; P<.001 ) , and at 18 months ( -3.0 mm Hg [ 95 % CI , -6.3 to 0.3 mm Hg ] ; P = .07 ) . CONCLUSIONS AND RELEVANCE Home BP telemonitoring and pharmacist case management achieved better BP control compared with usual care during 12 months of intervention that persisted during 6 months of postintervention follow-up . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00781365 Lowering blood pressure reduces cardiovascular risk , yet hypertension is poorly controlled in diabetic patients . In a pilot study we demonstrated that a home blood pressure telemonitoring system , which provided self-care messages on the smartphone of hypertensive diabetic patients immediately after each reading , improved blood pressure control . Messages were based on care paths defined by running averages of transmitted readings . The present study tests the system 's effectiveness in a r and omized , controlled trial in diabetic patients with uncontrolled systolic hypertension . Of 244 subjects screened for eligibility , 110 ( 45 % ) were r and omly allocated to the intervention ( n=55 ) or control ( n=55 ) group , and 105 ( 95.5 % ) completed the 1-year outcome visit . In the intention-to-treat analysis , mean daytime ambulatory systolic blood pressure , the primary end point , decreased significantly only in the intervention group by 9.1±15.6 mmHg ( SD ; P<0.0001 ) , and the mean between-group difference was 7.1±2.3 mmHg ( SE ; P<0.005 ) . Furthermore , 51 % of intervention subjects achieved the guideline recommended target of < 130/80 mmHg compared with 31 % of control subjects ( P<0.05 ) . These improvements were obtained without the use of more or different antihypertensive medications or additional clinic visits to physicians . Providing self-care support did not affect anxiety but worsened depression on the Hospital Anxiety and Depression Scale ( baseline , 4.1±3.76 ; exit , 5.2±4.30 ; P=0.014 ) . This study demonstrated that home blood pressure telemonitoring combined with automated self-care support reduced the blood pressure of diabetic patients with uncontrolled systolic hypertension  and improved hypertension control . Home blood pressure monitoring alone had no effect on blood pressure . Promoting patient self-care may have negative psychological effects BACKGROUND Control of blood pressure is a key component of cardiovascular disease prevention , but is difficult to achieve and until recently has been the sole preserve of health professionals . This study assessed whether self-management by people with poorly controlled hypertension result ed in better blood pressure control compared with usual care . METHODS This r and omised controlled trial was undertaken in 24 general practice s in the UK . Patients aged 35 - 85 years were eligible for enrolment if they had blood pressure more than 140/90 mm Hg despite antihypertensive treatment and were willing to self-manage their hypertension . Participants were r and omly assigned in a 1:1 ratio to self-management , consisting of self-monitoring of blood pressure and self-titration of antihypertensive drugs , combined with telemonitoring of home blood pressure measurements or to usual care . R and omisation was done by use of a central web-based system and was stratified by general practice with minimisation for sex , baseline systolic blood pressure , and presence or absence of diabetes or chronic kidney disease . Neither participants nor investigators were masked to group assignment . The primary endpoint was change in mean systolic blood pressure between baseline and each follow-up point ( 6 months and 12 months ) . All r and omised patients who attended follow-up visits at 6 months and 12 months and had complete data for the primary outcome were included in the analysis , without imputation for missing data . This study is registered as an International St and ard R and omised Controlled Trial , number IS RCT N17585681 . FINDINGS 527 participants were r and omly assigned to self-management ( n=263 ) or control ( n=264 ) , of whom 480 ( 91 % ; self-management , n=234 ; control , n=246 ) were included in the primary analysis . Mean systolic blood pressure decreased by 12.9 mm Hg ( 95 % CI 10.4 - 15.5 ) from baseline to 6 months in the self-management group and by 9.2 mm Hg ( 6.7 - 11.8 ) in the control group ( difference between groups 3.7 mm Hg , 0.8 - 6.6 ; p=0.013 ) . From baseline to 12 months , systolic blood pressure decreased by 17.6 mm Hg ( 14.9 - 20.3 ) in the self-management group and by 12.2 mm Hg ( 9.5 - 14.9 ) in the control group ( difference between groups 5.4 mm Hg , 2.4 - 8.5 ; p=0.0004 ) . Frequency of most side-effects did not differ between groups , apart from leg swelling ( self-management , 74 patients [ 32 % ] ; control , 55 patients [ 22 % ] ; p=0.022 ) . INTERPRETATION Self-management of hypertension in combination with telemonitoring of  blood pressure measurements represents an important new addition to control of hypertension in primary care . FUNDING Department of Health Policy Research Programme , National Coordinating Centre for Research Capacity Development , and Midl and s Research Practice s Consortium Background There is growing evidence that home telemonitoring can be advantageous in societies with increasing prevalence of chronic diseases . The main objective of this study is to evaluate the effect of a primary care-based telemonitoring intervention on the number and length of hospital admissions . Methods A r and omised controlled trial was carried out across 20 health centres in Bilbao ( Basque Country , Spain ) to assess the impact of home telemonitoring on in-home chronic patients compared with st and ard care . The study lasted for one year . Fifty-eight in-home patients , diagnosed with heart failure ( HF ) and /or chronic lung disease ( CLD ) , aged 14 or above and with two or more hospital admissions in the previous year were recruited . The intervention consisted of daily patient self- measurements of respiratory-rate , heart-rate , blood pressure , oxygen saturation , weight , body temperature and the completion of a health status question naire using PDAs . Alerts were generated when pre-established thresholds were crossed . The control group ( CG ) received usual care . The primary outcome measure was the number of hospital admissions that occurred at 12 months post-r and omisation . The impact of telemonitoring on the length of hospital stay , use of other healthcare re sources and mortality was also explored . Results The intervention group ( IG ) included 28 patients and the CG 30 . Patient baseline characteristics were similar in both groups . Of the 21 intervention patients followed-up for a year , 12 had some admissions ( 57.1 % ) , compared to 19 of 22 controls ( 86.4 % ) , being the difference statistically significant ( p = 0.033 , RR 0.66 ; 95%CI 0.44 to 0.99 ) . The mean hospital stay was overall 9 days ( SD 4.3 ) in the IG versus 10.7 ( SD 11.2 ) among controls , and for cause-specific admissions 9 ( SD 4.5 ) vs. 11.2 ( SD 11.8 ) days , both without statistical significance ( p = 0.891 and 0.927 , respectively ) . Four patients need to be telemonitored for a year to prevent one admission ( NNT ) . There were more telephone contacts in the IG than in the CG ( 22.6 -SD 16.1- vs. 8.6 -SD 7.2- , p = 0.001 ) , but fewer home nursing visits ( 15.3 -SD 11.6- vs. 25.4 -SD 26.3- , respectively ) , though the difference was not statistically significant ( p = 0.3603 ) . Conclusions This study shows that telemonitoring of in-home patients with HF and /or CLD notably increases the percentage of patients with no hospital admissions and indicates a trend to reduce total and cause-specific hospitalisations and hospital stay .  Home telemonitoring can constitute a beneficial alternative mode of healthcare provision for medically unstable elderly patients .Trial registration Current Controlled Trials IS RCT Objectives To explore the experiences of patients and professionals taking part in a r and omised controlled trial ( RCT ) of remote blood pressure ( BP ) telemonitoring supported by primary care . To identify factors facilitating or hindering the effectiveness of the intervention and those likely to influence its potential translation to routine practice . Design Qualitative study adopting a qualitative descriptive approach . Participants 25 patients , 11 nurses and 9 doctors who were participating in an RCT of BP telemonitoring .  A maximum variation sample of patients from within the trial based on age , sex and deprivation status of the practice was sought . Setting 6 primary care practice s in Scotl and . Method Data were collected via taped semistructured interviews . Initial thematic analysis was inductive . Multiple strategies were employed to ensure that the analysis was credible and trustworthy . Results Prior to the trial , both patients and professionals were reluctant to increase the medication based on single BP measurements taken in the surgery . BP measurements based on multiple electronic readings were perceived as more accurate as a basis for action . Patients using telemonitoring became more engaged in the clinical management of their condition . Professionals reported that telemonitoring challenged existing roles and work practice s and increased workload . Lack of integration of telemonitoring data with the electronic health record was perceived as a drawback . Conclusions BP telemonitoring in a usual care setting can provide a trusted basis for medication management and improved BP control . It increases patients ’ engagement in the management of their condition , but supporting telemetry and greater patient engagement can increase professional workloads and dem and changes in service organisation . Successful service design in practice would have to take account of how additional roles and responsibilities could be realigned with existing work and data management practice s. The embedded qualitative study was included in the protocol for the HITS trial registered with IS RCT N no. 72614272 Background Black and Hispanic stroke survivors experience higher rates of recurrent stroke than whites . This disparity is partly explained by disproportionately higher rates of uncontrolled hypertension in these population s. Home blood pressure telemonitoring ( HBPTM ) and nurse case management ( NCM ) have proven efficacy in addressing the multilevel barriers to blood pressure ( BP ) control and reducing BP . However , the effectiveness of these interventions has not been evaluated in stroke patients . This study is design ed to evaluate the comparative effectiveness , cost-effectiveness and sustainability of these two telehealth interventions in reducing BP and recurrent stroke among high-risk Black and Hispanic stroke survivors with uncontrolled hypertension . Methods / Design A total of 450 Black and Hispanic patients with recent nondisabling stroke and uncontrolled hypertension are r and omly assigned to one of two 12-month interventions : 1 ) HBPTM with wireless feedback to primary care providers or 2 ) HBPTM plus individualized , culturally-tailored , telephone-based NCM .  Patients are recruited from stroke centers and primary care practice s within the Health and Hospital Corporations ( HHC ) Network in New York City . Study visits occur at baseline , 6 , 12 and 24 months . The primary outcomes are within-patient change in systolic BP at 12 months , and the rate of stroke recurrence at 24 months . The secondary outcome is the comparative cost-effectiveness of the interventions at 12 and 24 months ; and exploratory outcomes include changes in stroke risk factors , health behaviors and treatment intensification . Recruitment for the stroke telemonitoring hypertension trial is currently ongoing . Discussion The combination of two established and effective interventions along with the utilization of health information technology supports the sustainability of the HBPTM + NCM intervention and feasibility of its widespread implementation . Results of this trial will provide strong empirical evidence to inform clinical guidelines for management of stroke in minority stroke survivors with uncontrolled hypertension . If effective among Black and Hispanic stroke survivors , these interventions have the potential to substantially mitigate racial and ethnic disparities in stroke recurrence . Trial registration Clinical Trials.gov NCT02011685 . Registered 10 December 2013 We compared the effects of evidence -based disease management guidelines delivered to patients with heart failure and diabetes using three different modalities : in-person visits alone ( Control ) , in-person visits and a telephone intervention ( Telephone ) , and in-person visits and telemonitoring ( Telemonitoring ) .  Patients were r and omized to the three groups . There were 112 patients in the Control group , 93 in the Telephone group and 98 in the Telemonitoring group . During the first 60 days , 10 % of the Control group were rehospitalized , 17 % of the Telephone group and 16 % of the Telemonitoring group . Having heart failure and receiving more in-person visits were significantly related to readmission and time to readmission . However , after adjusting for diagnosis and visits , the differences between the three groups were non-significant . There was a trend for increased risk of readmission for the Telephone group compared to Control alone ( P = 0.07 , risk ratio 2.2 , 95 % CI : 0.9 to 5.2 ) and for readmission sooner ( P = 0.02 , risk ratio 2.3 , 95 % CI : 1.2 to 4.6 ) . Patient rehospitalization and emergency department visit rates were lower than the national average , making it difficult to detect a difference between groups . Previous rehospitalization was a consistent predictor of those who were rehospitalized , suggesting that it may be a useful indicator for identifying patients likely to need additional attention Background Telemonitoring technology offers one of the most promising alternatives for the provision of health care services at the patient 's home . The primary aim of this study is to evaluate the impact of a primary care-based telemonitoring intervention on the frequency of hospital admissions . Methods / design A primary care-based r and omised controlled trial will be carried out to assess the impact of a telemonitoring intervention aim ed at home care patients with heart failure ( HF ) and /or chronic lung disease ( CLD ) . The results will be compared with those obtained with st and ard health care practice . The duration of the study will be of one year . Sixty patients will be recruited for the study . In-home patients , diagnosed with HF and /or CLD , aged 14 or above and with two or more hospital admissions in the previous year will be eligible . For the intervention group , telemonitoring will consist of daily patient self- measurements of respiratory-rate , heart-rate , blood pressure , oxygen saturation , weight and body temperature . Additionally , the patients will complete a qualitative symptom question naire daily using the telemonitoring system . Routine telephone contacts will be conducted every fortnight and additional telephone contacts will be carried out if the data received at the primary care centre are out of the established limits . The control group will receive usual care . The primary outcome measure is the number of hospital admissions due to any cause that occurred in a period of 12 months post-r and omisation . The secondary outcome measures are : duration of hospital stay , hospital admissions due to HF or CLD , mortality rate , use of health care re sources , quality of life , cost-effectiveness , compliance and patient and health care professional satisfaction with the new technology . Discussion The results of this study will shed some light on the effects of telemonitoring for the follow-up and management of chronic patients from a primary care setting . The study may contribute to enhance the underst and ing of alternative modes of health care provision for medically unstable elderly patients , who bear a high degree of physical and functional deterioration . Trial Registration IS RCT N : IS RCT Objective To determine if an intervention consisting of telemonitoring and supervision by usual primary care clinicians of home self measured blood pressure and optional patient decision support leads to clinical ly important reductions in daytime systolic and diastolic ambulatory blood pressure in patients with uncontrolled blood pressure . Design Multicentre r and omised controlled trial . Setting 20 primary care practice s in south east Scotl and . Participants 401 people aged 29 - 95 years with uncontrolled blood pressure ( mean daytime ambulatory measurement ≥135/85 mm Hg but ≤210/135 mm Hg ) . Intervention Self measurement and transmission of blood pressure readings to a secure website for review by the attending nurse or doctor and participant , with optional automated patient decision support by text or email for six months . Main outcome measures Blinded assessment of mean daytime systolic ambulatory blood pressure six months after r and omisation . Results 200 participants were r and omised to the intervention and 201 to usual care ; primary outcome data were available for 90 % of participants ( 182 and 177 , respectively ) . The mean difference in daytime systolic ambulatory blood pressure adjusted for baseline and minimisation factors between intervention and usual care was 4.3 mm Hg ( 95 % confidence interval 2.0 to 6.5 ; P=0.0002 ) and for daytime diastolic ambulatory blood pressure was 2.3 mm Hg ( 0.9 to 3.6 ; P=0.001 ) , with higher values in the usual care group . The intervention was associated with a mean increase of one general practitioner ( 95 % confidence interval 0.5 to 1.6 ; P=0.0002 ) and 0.6 ( 0.1 to 1.0 ; P=0.01 ) practice nurse consultations during the course of the study . Conclusions Supported self monitoring by telemonitoring is an effective method for achieving clinical ly important reductions in blood pressure in patients with uncontrolled hypertension in primary care setting s. However , it was associated with increase in use of National Health Service re sources . Further research is required to determine if the reduction in blood pressure is maintained in the longer term and if the intervention is cost effective . Trial registration Current Controlled Trials IS RCT N72614272 BACKGROUND Telemonitoring has been advocated as a way of decreasing costs and improving outcomes , but no study has looked at true Medicare payments and 30-day readmission rates in a r and omized group of well treated patients . OBJECTIVE The aim of this work was to analyze Medicare cl aims data to identify effects of home telemonitoring on medical costs , 30-day rehospitalization , mortality , and health-related quality of life . METHODS A total of 204 subjects were r and omized to usual-care and monitored groups and evaluated with the SF-36 and Minnesota Living With Heart Failure Question naire ( MLHF ) . Hospitalizations , Medicare payments , and mortality were also assessed . Monitored subjects transmitted weight , blood pressure , and heart rate , which were monitored by an experienced heart failure nurse practitioner . RESULTS Subjects were followed for 802 ± 430 days ; 75 subjects in the usual-care group ( 316 hospitalizations ) and 81 in the monitored group ( 327 hospitalizations ) were hospitalized at least once ( P = .51 ) . There were no differences in Medicare payments for inpatient or emergency department visits , and length of stay was not different between groups . There was no difference in 30-day readmissions ( P = .627 ) or mortality ( P = .575 ) . Scores for SF-36 and MLHF improved ( P < .001 ) over time , but there were no differences between groups . The percentage of patients readmitted within 30 days was lower with telemonitoring for the 1st year , but this did not persist . CONCLUSIONS Telemonitoring did not result in lower total costs , decreased hospitalizations , improved symptoms , or improved mortality . A decrease in 30-day readmission rates for the 1st year did not result in decreased total cost or better outcomes OBJECTIVE We compared the short-term efficacy of home telemonitoring coupled with active medication management by a nurse practitioner with a monthly care coordination telephone call on glycemic control in veterans with type 2 diabetes and entry A1C ≥7.5 % . RESEARCH DESIGN AND METHODS Veterans who received primary care at the VA Pittsburgh Healthcare System from June 2004 to December 2005 , who were taking oral hypoglycemic agents and /or insulin for ≥1 year , and who had A1C ≥7.5 % at enrollment were r and omly assigned to either active care management with home telemonitoring ( ACM+HT group , n = 73 ) or a monthly care coordination telephone call ( CC group , n = 77 ) . Both groups received monthly calls for diabetes education and self-management review . ACM+HT group participants transmitted blood glucose , blood pressure , and weight to a nurse practitioner using the Viterion 100 TeleHealth Monitor ; the nurse practitioner adjusted medications for glucose , blood pressure , and lipid control based on established American Diabetes Association targets . Measures were obtained at baseline , 3-month , and 6-month visits . RESULTS Baseline characteristics were similar in both groups , with mean A1C of 9.4 % ( CC group ) and 9.6 % ( ACM+HT group ) . Compared with the CC group , the ACM+HT group demonstrated significantly larger decreases in A1C at 3 months ( 1.7 vs. 0.7 % ) and 6 months ( 1.7 vs. 0.8 % ; P < 0.001 for each ) , with most improvement occurring by 3 months . CONCLUSIONS Compared with the CC group , the ACM+HT group demonstrated significantly greater reductions in A1C by 3 and 6 months . However , both interventions improved glycemic control in primary care patients with previously inadequate control Objective Older adults with chronic kidney disease have a high rate of uncontrolled hypertension . Home monitoring of  blood pressure ( BP ) is an integral part of management , but requires that patients bring records to clinic visits . Telemonitoring interventions , however , have not targeted older , less technologically-skilled population s. Methods Veterans with stage 3 or greater chronic kidney disease and uncontrolled hypertension were r and omized to a novel telemonitoring device pairing a Bluetooth-enabled BP cuff with an Internet-enabled hub , which wirelessly transmitted readings ( n=28 ) , or usual care ( n=15 ) . Home recordings were review ed weekly and telemonitoring participants were contacted if BP was above goal . The prespecified primary endpoints were improved data exchange and device acceptability . Secondary endpoint was BP change . Results Forty-three participants ( average age 68 years , 75 % white ) completed the 6-month study . Average start-of- study BP was 147/78 mmHg . Those in the intervention arm had a median of 29 ( IQR 22 , 53 ) transmitted BP readings per month , with 78 % continuing to use the device regularly , whereas only 20 % of those in the usual care group brought readings to in-person visits . The median number of telephone contacts triggered by the wireless monitoring was 2 ( IQR 1 , 4 ) per patient . Both groups had a significant improvement in systolic BP ( P<0.05 , for both changes ) ; systolic BP fell a median of 13 mmHg in monitored participants compared with 8.5 mmHg in usual care participants ( P for comparison 0.31 ) . Conclusion This low-cost wireless monitoring strategy led to greater sharing of data between patients and clinic and produced a trend toward improvements in BP control over usual care at 6 months Background The evidence that higher levels of physical activity and /or lower levels of physical inactivity are associated with beneficial health-related outcomes stems mainly from observational studies . Findings from these studies often differ from r and omised controlled trials and systematic review s currently demonstrate mixed results , due partly to heterogeneity in physical activity interventions , method ologies used and population s studied . As a result , translation into clinical practice has been difficult . It is therefore essential that an overview is carried out to compare and contrast systematic review s , and to identify those physical activity interventions that are the most effective in preventing and /or treating major chronic disease . This protocol has been registered on PROSPERO 2013 : CRD42013003523 . Methods We will carry out an overview of Cochrane systematic review s. We will search the Cochrane Data base of Systematic Review s for systematic review s of r and omised controlled trials that have a primary focus on disease-related outcomes . We will restrict review s to those in selected major chronic diseases . Two authors will independently screen search outputs , select studies , extract data and assess the quality of included review s using the assessment of multiple systematic review s tool ; all discrepancies will be resolved by discussing and reaching a consensus , or by arbitration with a third author . The data extraction form will summarise key information from each review , including details of the population ( s ) ( for example , disease condition ) , the context ( for example , prevention , treatment or management ) , the participants , the intervention(s ) , the comparison(s ) and the outcomes . The primary outcomes of interest are the prevention of chronic disease and /or improved outcomes , in the treatment or management of chronic disease . These outcomes will be summarised and presented for individual chronic diseases ( for example , any change in blood pressure in hypertension or glucose control in diabetes ) . Secondary outcomes of interest are to describe the structure and delivery of physical activity interventions  across chronic disease conditions and adverse events associated with physical activity . Discussion We anticipate that our results could inform research ers , guideline groups and policymakers of the most efficacious physical activity interventions in preventing and /or managing major chronic disease BACKGROUND Half of patients with hypertension have poor  blood pressure ( BP ) control . Recent models for treating hypertension have integrated disease monitoring and telephone-based interventions delivered in patients ' homes . This study evaluated the costs of the Hypertension Intervention Nurse Telemedicine Study ( HINTS ) , aim ed to improve BP control  in veterans . METHODS Eligible veterans were r and omized to either  usual care  or 1 of 3 telephone-based intervention groups using home BP telemonitoring : ( 1 ) behavioral management , ( 2 ) medication management , or ( 3 ) combined . Intervention costs were derived from information collected during the trial . Direct medical costs ( inpatient , outpatient , and outpatient pharmacy , including hypertension-specific pharmacy ) at 18 months by group were calculated using Veterans Affairs ( VA ) Decision Support System data . Bootstrapped CIs were computed to compare intervention and medical costs between intervention groups and usual care . RESULTS Patients receiving behavior or medication management showed significant gains in BP control at 12 months ; there were no differences in BP control at 18 months . In subgroup analysis , patients with poor baseline BP control receiving combined intervention significantly improved BP at 12 and 18 months . In overall and subgroup sample s , average intervention costs were similar in the 3 study arms , and at 18 months , there were no statistically significant differences in direct VA medical costs or total VA costs between treatment arms and usual care . CONCLUSIONS To optimize investment in telephone-based home interventions such as the HINTS , it is important to identify groups of patients who are most likely to benefit from more intensive home BP management Background Diabetes and hypertension are devastating , deadly , and costly conditions that are very common in seniors . Controlling hypertension in seniors with diabetes dramatically reduces hypertension-related complications . However , blood pressure ( BP ) must be lowered carefully because seniors are also susceptible to low BP and attendant harms . Achieving “ optimal BP control ” ( ie , avoiding both undertreatment and overtreatment ) is the ultimate therapeutic goal in such patients . Regular BP monitoring is required to achieve this goal . BP monitoring at home is cheap , convenient , widely used , and guideline endorsed . However , major barriers prevent proper use . These may be overcome through use of BP telemonitoring — the secure teletransmission of BP readings to a health portal , where BP data are summarized for provider and patient use , with or without protocol ized case management . Objective To examine the incremental effectiveness , safety , cost-effectiveness , usability , and acceptability of home BP telemonitoring , used with or without protocol ized case management , compared with “ enhanced usual care ” in community-dwelling seniors with diabetes and hypertension . Methods A 300-patient , 3-arm , pragmatic r and omized controlled trial with blinded outcome ascertainment will be performed in seniors with diabetes and hypertension living independently in seniors ’ residences in greater Edmonton . Consenting patients will be r and omized to usual care , home BP telemonitoring alone , or home BP telemonitoring plus protocol ized pharmacist case management . Usual care subjects will receive a home BP monitor but neither they nor their providers will have access to teletransmitted data . In both telemonitored arms , providers will receive telemonitored BP data summaries . In the case management arm , pharmacist case managers will be responsible for review ing teletransmitted data and initiating guideline -concordant and protocol ized changes in BP management . Results Outcomes will be ascertained at 6 and 12 months . Within- study -arm change scores will be calculated and compared between study arms . These include : ( 1 ) clinical outcomes : proportion of subjects with a mean 24-hour ambulatory systolic BP in the optimal range ( 110 - 129 mmHg in patients 65 - 79 years and 110 - 139 mmHg in those ≥80 years : primary outcome ) ; additional ambulatory and home BP outcomes ; A1c and lipid profile ; medications , cognition , health care use , cardiovascular events , and mortality . ( 2 ) Safety outcomes : number of serious episodes of hypotension , syncope , falls , and electrolyte disturbances ( requiring third party assistance or medical attention ) . ( 3 ) Humanistic outcomes : quality of life , satisfaction , and medication adherence . ( 4 ) Economic outcomes : incremental costs , incremental cost-utility , and cost per mmHg change in BP of telemonitoring ± case management compared with usual care ( health payor and societal perspectives ) . ( 5 ) Intervention usability and acceptability to patients and providers . Conclusion The potential benefits of telemonitoring remain largely unstudied and unproven in seniors . This trial will comprehensively assess the impact of home BP telemonitoring across a range of outcomes . Results will inform the value of implementing home-based telemonitoring within supportive living residences in Canada . Trial Registration Clinical trials.gov NCT02721667 ; https:// clinical trials.gov/ct2/show/NCT02721667 ( Archived by Webcite at http://www.webcitation.org/6i8tB20Mc Background Heart failure is a prevalent health problem associated with costly hospital readmissions . Transitional care programs have been shown to reduce readmissions but are costly to implement . Evidence regarding the effectiveness of telemonitoring in managing the care of this chronic condition is mixed . The objective of this r and omized controlled comparative effectiveness study is to evaluate the effectiveness of a care transition intervention that includes pre-discharge education about heart failure and post-discharge telephone nurse coaching combined with home telemonitoring of weight , blood pressure , heart rate , and symptoms in reducing all-cause 180-day hospital readmissions for older adults hospitalized with heart failure . Methods / Design A multi-center , r and omized controlled trial is being conducted at six academic health systems in California . A total of 1,500 patients aged 50 years and older will be enrolled during a hospitalization for treatment of heart failure . Patients in the intervention group will receive intensive patient education using the ‘ teach-back ’ method and receive instruction in using the telemonitoring equipment . Following hospital discharge , they will receive a series of nine scheduled health coaching telephone calls over 6 months from nurses located in a central ized call center . The nurses also will call patients and patients ’ physicians in response to alerts generated by the telemonitoring system , based on predetermined parameters . The primary outcome is readmission for any cause within 180 days . Secondary outcomes include 30-day readmission , mortality , hospital days , emergency department ( ED ) visits , hospital cost , and health-related quality of life . Discussion BEAT-HF is one of the largest r and omized controlled trials of telemonitoring in patients with heart failure , and the first explicitly to adapt the care transition approach and combine it with remote telemonitoring . The study population also includes patients with a wide range of demographic and socioeconomic characteristics . Once completed , the study will be a rich re source of information on how best to use remote technology in the care management of patients with chronic heart failure . Trial registration Clinical Trials.gov # NCT01360203 BACKGROUND Parent training ( PT ) is identified as the most effective intervention for the treatment of conduct disorder ( CD ) . Intervention observational outcomes are often reported as summarised composite scores , providing an overview of overall construct change . METHODS AND AIMS Parents of children aged 3 - 5 years identified ' at risk ' of developing CD were r and omly allocated to either PT intervention or waiting list control group . Parent and child behaviours were assessed before and after the intervention period . The current paper aims to establish which individual observed parenting categories change as a result of PT , and which specific observed leader categories predict these changes . RESULTS Controlling for baseline scores , ANCOVA demonstrated changes in parent praise and reflective behaviours as significant post-intervention . One-way ANOVAs demonstrated higher levels of leader praise and reflective behaviours result ed in greater change in parental praise and reflective behaviours respectively . Regression analyses indicated these leader behaviours predict positive change in parental praise and reflective behaviours for intervention families . CONCLUSIONS Composite observational scores provide an account of behaviour constructs , whereas individual behaviour categories provide an insight into the core components of these constructs . The results suggest praise and reflection as key leader behaviours that influence the mechanisms of change in parenting behaviours as a result of PT Background Hypertension is a major risk factor for cardiovascular disease , and its control rate has remained low worldwide . Studies have found that telemonitoring blood pressure ( BP ) helped control hypertension in r and omized controlled trials . However , little is known about its effect in a structured primary care model in which primary care physicians ( PCPs ) are partnering with cardiology specialists in electronic healthcare data sharing and medical interventions . This study aims to identify the effects of a coordinated PCP-cardiologist model that applies telemedicine tools to facilitate community hypertension control in China . Methods / design Patients with hypertension receiving care at four community healthcare centers that are academically affiliated to Shanghai Chest Hospital , Shanghai JiaoTong University are eligible if they have had uncontrolled BP in the previous 3 months and access to mobile Internet . Study subjects are r and omly assigned to three interventional groups : ( 1 ) usual care ; ( 2 ) home-based BP telemonitor with embedded Global System for Mobile Communications ( GSM ) module and unlimited data plan , an app to access personal healthcare record and receive personalized lifestyle coaching contents , and proficiency training of their use ; or ( 3 ) this plus coordinated PCP-cardiologist care in which PCPs and cardiologists share data via a secure CareLinker website to determine interventional approaches . The primary outcome is mean change in systolic blood pressure over a 12-month period . Secondary outcomes are changes of diastolic blood pressure , HbA1C , blood lipids , and medication adherence measured by the eight-item Morisky Medication Adherence Scale . Discussion This study will determine whether a coordinated PCP-Cardiologist Telemedicine Model that incorporates the latest telemedicine technologies will improve hypertension care . Success of the model would help streamline the present community healthcare processes and impact a greater number of patients with uncontrolled hypertension . Trial registration Clinical Trials.gov , NCT02919033 . Registered on 23 September 2016 Background Self-monitoring of blood glucose among people with type 2 diabetes not treated with insulin does not appear to be effective in improving glycemic control . We investigated whether health professional review of telemetrically transmitted self-monitored glucose results in improved glycemic control in people with poorly controlled type 2 diabetes . Methods and Findings We performed a r and omized , parallel , investigator-blind controlled trial with central ized r and omization in family practice s in four regions of the United Kingdom among 321 people with type 2 diabetes and glycated hemoglobin ( HbA1c ) > 58 mmol/mol . The supported telemonitoring intervention involved self-measurement and transmission to a secure website of twice-weekly morning and evening glucose for review by family practice clinicians who were not blinded to allocation group . The control group received usual care , with at least annual review and more frequent review s for  people with poor glycemic or blood pressure control .  HbA1c assessed at 9 mo was the primary outcome . Intention-to-treat analyses were performed . 160 people were r and omized to the intervention group and 161 to the usual care group between June 6 , 2011 , and July 19 , 2013 .  HbA1c data at follow-up were available for 146 people in the intervention group and 139 people in the control group . The mean ( SD ) HbA1c at follow-up was 63.0 ( 15.5 ) mmol/mol in the intervention group and 67.8 ( 14.7 ) mmol/mol in the usual care group . For primary analysis , adjusted mean HbA1c was 5.60 mmol/mol / 0.51 % lower ( 95 % CI 2.38 to 8.81 mmol/mol/ 95 % CI 0.22 % to 0.81 % , p = 0·0007 ) . For secondary analyses , adjusted mean ambulatory systolic blood pressure was 3.06 mmHg lower ( 95 % CI 0.56–5.56 mmHg , p = 0.017 ) and mean ambulatory diastolic blood pressure was 2.17 mmHg lower ( 95 % CI 0.62–3.72 , p = 0.006 ) among people in the intervention group when compared with usual care after adjustment for baseline differences and minimization strata . No significant differences were identified between groups in weight , treatment pattern , adherence to medication , or quality of life in secondary analyses . There were few adverse events and these were equally distributed between the intervention and control groups . In secondary analysis , there was a greater number of telephone calls between practice nurses and patients in the intervention compared with control group ( rate ratio 7.50 ( 95 % CI 4.45–12.65 , p < 0.0001 ) but no other significant differences between groups in use of health services were identified between groups . Key limitations include potential lack of representativeness of trial participants , inability to blind participants and health professionals , and uncertainty about the mechanism , the duration of the effect , and the optimal length of the intervention . Conclusions Supported telemonitoring result ed in clinical ly important improvements in control of glycaemia in patients with type 2 diabetes in family practice . Current Controlled Trials , registration number IS RCT N71674628 . Trial Registration Current Controlled Trials IS RCT N Background Good blood pressure ( BP ) control reduces the risk of recurrence of stroke/transient ischaemic attack ( TIA ) . Although there is strong evidence that BP telemonitoring helps achieve good control , none of the major trials have considered the effectiveness in stroke/TIA survivors . We therefore conducted a feasibility study for a trial of BP telemonitoring for stroke/TIA survivors with uncontrolled BP in primary care . Method Phase 1 was a pilot trial involving 55 patients stratified by stroke/TIA r and omised 3:1 to BP telemonitoring for 6 months or usual care . Phase 2 was a qualitative evaluation and comprised semi-structured interviews with 16 trial participants who received telemonitoring and 3 focus groups with 23 members of stroke support groups and 7 carers . Results Overall , 125 patients ( 60 stroke patients , 65 TIA patients ) were approached and 55 ( 44 % ) patients were r and omised including 27 stroke patients and 28 TIA patients . Fifty-two participants ( 95 % ) attended the 6-month follow-up appointment , but one declined the second daytime ambulatory blood pressure monitoring ( ABPM ) measurement result ing in a 93 % completion rate for ABPM − the proposed primary outcome measure for a full trial . Adherence to  telemonitoring  was good ; of the 40 participants who were  telemonitoring  , 38 continued to provide readings throughout the 6 months . There was a mean reduction of 10.1 mmHg in systolic ABPM in the telemonitoring group compared with 3.8 mmHg in the control group , which suggested the potential for a substantial effect from telemonitoring . Our qualitative analysis found that many stroke patients were concerned about their BP and telemonitoring increased their engagement , was easy , convenient and reassuring . Conclusions A full-scale trial is feasible , likely to recruit well and have good rates of compliance and follow-up . Trial Registration IS RCT N61528726 15/12/2011 BACKGROUND Only 31 % of Americans with hypertension have their blood pressure ( BP ) under effective control . We describe a study that tests 3 different interventions in a r and omized controlled trial using home BP telemedicine monitoring . METHODS A sample of hypertensive patients with poor BP control at baseline ( N = 600 ) are r and omized to 1 of 4 arms : ( 1 ) control group -- a group of hypertensive patients who receive usual care ; ( 2 ) nurse-administered tailored behavioral intervention ; ( 3 ) nurse-administered medication management according to a hypertension decision support system ; ( 4 ) combination of the 2 interventions . The interventions are triggered based on home BP values transmitted via telemonitoring devices over st and ard telephone lines . The tailored behavioral intervention involves promoting adherence with medication and health behaviors . Patients r and omized to the medication management or the combined arm have their hypertension regimen changed by the study team using a vali date d hypertension decision support system based on evidence -based hypertension treatment guidelines and individualized to patients ' comorbid illnesses . The primary outcome is BP control : < or = 140/90 mm Hg ( nondiabetic ) and < or = 130/80 mm Hg ( diabetics ) measured at 6-month intervals over 18 months ( 4 total measurements ) . CONCLUSIONS Given the increasing prevalence of hypertension and our inability to achieve adequate BP control using traditional models of care , testing novel interventions in patients ' homes may improve access , quality , and outcomes Abstract Purpose : Although self-measurement of home blood pressure ( HBP ) is common in Japan and HBP telemonitoring via the Internet is possible , whether telemonitoring improves HBP control better than conventional practice remains unclear . Furthermore , hypertension care with online communication using telemonitored HBP is feasible , whereas the efficacy and safety of such telemedicine have not been established . We aim to compare traditional care , care with office visits using HBP telemonitoring , and antihypertensive telemedicine based on HBP telemonitoring . Methods and design : In total , 444 patients with uncontrolled hypertension will be recruited and r and omly assigned to three groups : ( 1 ) control : usual care with office visits and HBP self-report , ( 2 ) telemonitoring : weekly assessment of transmitted HBP by physicians and treatment adjustment upon office visits , or ( 3 ) telemedicine : online communication instead of office visits to adjust medication using telemonitored HBP . Primary outcome is the time to control of HBP , and secondary outcomes include achieved HBP levels , adherence , treatment intensity , adverse events , patient satisfaction and cost-effectiveness . Discussion : Hypertension care with telemonitoring and telemedicine are expected to require shorter time to achieve HBP control compared to usual care . Combining HBP telemonitoring with telemedicine may lower the hurdles for starting and persisting to hypertension treatment and eventually reduce cardiovascular events BACKGROUND Hypertension is a major risk factor for the long-term complications of diabetes . Mobile , self-measurement of blood pressure is emerging as a method to manage blood pressure in general , but its impact in patients with diabetes is unclear . METHODS We r and omized 137 patients with diabetes and hypertension to either  mobile telemonitoring  ( n = 72 ) or usual care ( n = 65 ) . Clinic blood pressure was recorded at baseline and after 6 months . Patients in the intervention arm transmitted weekly blood pressure readings wirelessly , using adapted sensors via mobile phones to a central server . Clinicians received the data in real-time and using a web-based application provided management advice to the patient and their physicians . RESULTS Systolic blood pressure fell significantly in the patients in the intervention group ( mean [ 95 % confidence interval ] , -6.5 [ -0.8 to -12.2 ] mm Hg ; P = 0.027 ) and remained unchanged in the control group ( 2.1 [ 9.3 to -5.0 ] mm Hg ; P = 0.57 ) . Patients within the intervention arm of African origin seemed to benefit more from the intervention . In addition , those who achieved a systolic blood pressure of < 120 mm Hg had lower average blood sugars than those with higher readings ( 7.8 [ SD 1.6 ] vs. 8.9 [ SD 2.2 ] mmol/L ; P = 0.02 ) . CONCLUSIONS In patients with diabetes , mobile telemonitoring has potential for delivering intensified care to improve blood pressure control , and its use may be associated with reduced exposure to hyperglycemia RATIONALE , AIMS AND OBJECTIVES The aim of the study was to evaluate the effects on , and the relationship between , asthma symptoms , asthma-specific quality of life and medical consumption of a nurse-led telemonitoring intervention compared with regular care in asthma in the Netherl and s. METHODS One hundred and nine asthmatic out patients ( 56 children ; 53 adults ) were r and omly assigned to the treatment arms ( 12-month follow-up ) . The control group received regular outpatient care , while the intervention group used an asthma monitor with modem at home with an asthma nurse as the main caregiver .  Clinical asthma symptoms and medical consumption were measured by using diaries . Asthma-specific quality of life was measured by the ( Paediatric ) Asthma Quality of Life Question naire . RESULTS The study population generally represented mild to moderate asthmatics . The results show improvement in follow-up , but no statistically significant difference between the groups was observed . Moderate to high correlations were found within the outcome parameters , but the most remarkable was the low and statistically significant correlation between asthma-specific quality of life ( daily functioning ) and the self-reported beta-2 agonists . CONCLUSION Overall , the telemonitoring programme evaluated in this study did not significantly decrease asthma symptoms or medical consumption , or improve asthma-specific quality of life . The results showed that a telemonitoring programme on its own is not a guarantee of success . The patients ' perception of asthma-specific quality of life ( daily functioning ) should be a key element in asthma telemonitoring programmes BACKGROUND To determine which of 3 interventions was most effective in improving  blood pressure ( BP ) control , we performed a 4-arm r and omized trial with 18-month follow-up at the primary care clinics at a Veterans Affairs Medical Center . METHODS Eligible patients were r and omized to either usual care or 1 of 3 telephone-based intervention groups : ( 1 ) nurse-administered behavioral management , ( 2 ) nurse- and physician-administered medication management , or ( 3 ) a combination of both . Of the 1551 eligible patients , 593 individuals were r and omized ; 48 % were African American . The intervention telephone calls were triggered based on home BP values transmitted via telemonitoring devices . Behavioral management involved promotion of health behaviors . Medication management involved adjustment of medications by a study physician and nurse based on hypertension treatment guidelines . RESULTS The primary outcome was change in BP control measured at 6-month intervals over 18 months . Both the behavioral management and medication management alone showed significant improvements at 12 months-12.8 % ( 95 % confidence interval [ CI ] , 1.6%-24.1 % ) and 12.5 % ( 95 % CI , 1.3%-23.6 % ) , respectively-but not at 18 months . In subgroup analyses , among those with poor baseline BP control , systolic BP decreased in the combined intervention group by 14.8 mm Hg ( 95 % CI , -21.8 to -7.8 mm Hg ) at 12 months and 8.0 mm Hg ( 95 % CI , -15.5 to -0.5 mm Hg ) at 18 months , relative to usual care . CONCLUSIONS Overall intervention effects were moderate , but among individuals with poor BP control at baseline , the effects were larger . This study indicates the importance of identifying individuals most likely to benefit from potentially re source intensive programs . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00237692 CONTEXT The findings of systematic review s ( SRs ) and meta-analyses ( MAs ) are used for clinical decision making . The European Association of Urology has committed increasing re sources into the development of high quality clinical guidelines based on such SRs and MAs . OBJECTIVE In this paper , we have summarised the process of conducting SRs for underpinning clinical practice guidelines under the auspices of the European Association of Urology Guidelines Office . EVIDENCE ACQUISITION The process involves explicit methods and the findings should be reproducible . When conducting a SR , the essential first step is to formulate a clear and answerable research question . An extensive literature search lays the foundation for evidence synthesis . Data are extracted independently by two review ers and any disagreements are resolved by discussion or arbitration by a third review er . EVIDENCE SYNTHESIS In SRs , data for particular outcomes in individual r and omised controlled trials may be combined statistically in a meta- analysis to increase power when the studies are similar enough . Biases in studies included in a SR/MA can lead to either an over estimation or an under estimation of true intervention effect size , result ing in heterogeneity in outcome between studies . A number of different tools are available such as Cochrane Risk of Bias assessment tool for r and omised controlled trials . In circumstances where there is too much heterogeneity , or when a review has included nonr and omised comparative studies , it is more appropriate to conduct a narrative synthesis . The GRADE tool for assessing quality of evidence strives to be a structured and transparent system , which can be applied to all evidence , regardless of quality . A SR not only identifies , evaluates , and summarises the best available evidence , but also the gaps to be targeted by future studies . CONCLUSIONS SRs and MAs are integral in developing sound clinical practice guidelines and recommendations . PATIENT SUMMARY Clinical practice guidelines should be evidence based , and systematic review s and meta-analyses are essential in their production . We have discussed the key steps of conducting systematic review s and meta-analyses in this paper Background Heart failure ( HF ) patients suffer from frequent and repeated hospitalizations , causing a substantial economic burden on society . Hospitalizations can be reduced considerably by better compliance with self-care . Home telemonitoring has the potential to boost patients ’ compliance with self-care , although the results are still contradictory . Objective A r and omized controlled trial was conducted in order to study whether the multidisciplinary care of heart failure patients promoted with telemonitoring leads to decreased HF-related hospitalization . Methods HF patients were eligible whose left ventricular ejection fraction was lower than 35 % , NYHA functional class ≥2 , and who needed regular follow-up . Patients in the telemonitoring group ( n=47 ) measured their body weight , blood pressure , and pulse and answered symptom-related questions on a weekly basis , reporting their values to the heart failure nurse using a mobile phone app . The heart failure nurse followed the status of patients weekly and if necessary contacted the patient . The primary outcome was the number of HF-related hospital days . Control patients ( n=47 ) received multidisciplinary treatment according to st and ard practice s. Patients ’ clinical status , use of health care re sources , adherence , and user experience from the patients ’ and the health care professionals ’ perspective were studied . Results Adherence , calculated as a proportion of weekly su bmi tted self- measurements , was close to 90 % . No difference was found in the number of HF-related hospital days ( incidence rate ratio [IRR]=0.812 , P=.351 ) , which was the primary outcome . The intervention group used more health care re sources : they paid an increased number of visits to the nurse ( IRR=1.73 , P<.001 ) , spent more time at the nurse reception ( mean difference of 48.7 minutes , P<.001 ) , and there was a greater number of telephone contacts between the nurse and intervention patients ( IRR=3.82 , P<.001 for nurse-induced contacts and IRR=1.63 , P=.049 for patient-induced contacts ) . There were no statistically significant differences in patients ’ clinical health status or in their self-care behavior . The technology received excellent feedback from the patient and professional side with a high adherence rate throughout the study . Conclusions Home telemonitoring did not reduce the number of patients ’ HF-related hospital days and did not improve the patients ’ clinical condition . Patients in the telemonitoring group contacted the Cardiology Outpatient Clinic more frequently , and on this way increased the use of health care re sources . Trial Registration Clinical trials.gov NCT01759368 ; http:// clinical trials.gov/show/NCT01759368 ( Archived by WebCite at http://www.webcitation.org/6UFxiCk8Z ) UNLABELLED In June 2008 , the Medical Advisory Secretariat began work on the Diabetes Strategy Evidence Project , an evidence -based review of the literature surrounding strategies for successful management and treatment of diabetes . This project came about when the Health System Strategy Division at the Ministry of Health and Long-Term Care subsequently asked the secretariat to provide an evidentiary platform for the Ministry 's newly released Diabetes Strategy .After an initial review of the strategy and consultation with experts , the secretariat identified five key areas in which evidence was needed . Evidence -based analyses have been prepared for each of these five areas : insulin pumps , behavioural interventions , bariatric surgery , home telemonitoring , and community based care . For each area , an economic analysis was completed where appropriate and is described in a separate report . To review these titles within the Diabetes Strategy Evidence series , please visit the Medical Advisory Secretariat Web site , http://www.health.gov.on.ca/english/providers/program/mas/mas_about.html,DIABETES STRATEGY EVIDENCE PLATFORM : Summary of Evidence -Based AnalysesContinuous Subcutaneous Insulin Infusion Pumps for Type 1 and Type 2 Adult Diabetics : An Evidence -Based Analysis Behavioural Interventions for Type 2 Diabetes : An Evidence -Based Analysis BARIATRIC SURGERY FOR PEOPLE WITH DIABETES AND MORBID OBESITY : An Evidence -Based Summary Community-Based Care for the Management of Type 2 Diabetes : An Evidence -Based Analysis Home Telemonitoring for Type 2 Diabetes  : An Evidence -Based Analysis Application of the Ontario Diabetes Economic Model ( ODEM ) to Determine the Cost-effectiveness and Budget Impact of Selected Type 2 Diabetes Interventions in Ontario OBJECTIVE The objective of this report is to determine the efficacy of specialized multidisciplinary community care for the management of type 2 diabetes compared to usual care . CLINICAL NEED TARGET POPULATION AND CONDITION Diabetes ( i.e. diabetes mellitus ) is a highly prevalent chronic metabolic disorder that interferes with the body 's ability to produce or effectively use insulin . The majority ( 90 % ) of diabetes patients have type 2 diabetes . ( 1 ) Based on the United Kingdom Prospect i ve Diabetes Study ( UKPDS ) , intensive blood glucose and blood pressure control significantly reduce the risk of microvascular and macrovascular complications in type 2 diabetics . While many studies have documented that patients often do not meet the glycemic control targets specified by national and international guidelines , factors associated with glycemic control are less well studied , one of which is the provider(s ) of care . Multidisciplinary approaches to care may be particularly important for diabetes management . According guidelines from the Canadian Diabetes Association ( CDA ) , the diabetes health care team should be multi- and interdisciplinary . Presently in Ontario , the core diabetes health care team consists of at least a family physician and /or diabetes specialist , and diabetes educators ( registered nurse and registered dietician ) . Increasing the role played by allied health care professionals in diabetes care and their collaboration with physicians may represent a more cost-effective option for diabetes management . Several systematic review s and meta-analyses have examined multidisciplinary care programs , but these have either been limited to a specific component of multidisciplinary care ( e.g. intensified education programs ) , or were conducted as part of a broader disease management program , of which not all were multidisciplinary in nature . Most review s also do not clearly define the intervention(s ) of interest , making the evaluation of such multidisciplinary community programs challenging . EVIDENCE -BASED ANALYSIS METHODS RESEARCH QUESTIONS What is the evidence of efficacy of specialized multidisciplinary community care provided by at least a registered nurse , registered dietician and physician ( primary care and /or specialist ) for the management of type 2 diabetes compared to usual care ? [ Henceforth referred to as Model 1]What is the evidence of efficacy of specialized multidisciplinary community care provided by at least a pharmacist and a primary care physician for the management of type 2 diabetes compared to usual care ? [ Henceforth referred to as Model 2 ] INCLUSION CRITERIA English language full-reportsPublished between January 1 , 2000 and September 28 , 2008R and omized controlled trials ( RCTs ) , systematic review s and meta-analysesType 2 diabetic adult population ( ≥18 years of age)Total sample size ≥30Describe specialized multidisciplinary community care defined as ambulatory-based care provided by at least two health care disciplines ( of which at least one must be a specialist in diabetes ) with integrated communication between the care providers . Compared to usual care ( defined as health care provision by non-specialist(s ) in diabetes , such as primary care providers ; may include referral to other health care professionals/services as necessary)≥6 months follow-up EXCLUSION CRITERIA Studies where discrete results on diabetes can not be abstract edPredominantly home-based interventions Inpatient-based interventions OUTCOMES OF INTEREST The primary outcomes for this review were glycosylated hemoglobin ( rHbA1c ) levels and systolic blood pressure ( SBP ) . SEARCH STRATEGY A literature search was performed on September 28 , 2008 using OVID MEDLINE , MEDLINE In-Process and Other Non-Indexed Citations , EMBASE , the Cumulative Index to Nursing & Allied Health Literature ( CINAHL ) , the Cochrane Library , and the International Agency for Health Technology Assessment ( INAHTA ) for studies published between January 1 , 2000 and September 28 , 2008 . Abstract s were review ed by a single review er and , for those studies meeting the eligibility criteria , full-text articles were obtained . Reference lists were also examined for any additional relevant studies not identified through the search . Articles with unknown eligibility were review ed with a second clinical epidemiologist , then a group of epidemiologists until consensus was established . The quality of evidence was assessed as high , moderate , low or very low according to GRADE methodology . Given the high clinical heterogeneity of the articles that met the inclusion criteria , specific models of specialized multidisciplinary community care were examined based on models of care that are currently being supported in Ontario , models of care that were commonly reported in the literature , as well as suggestions from an Expert Advisory Panel Meeting held on January 21 , 2009 . SUMMARY OF FINDINGS The initial search yielded 2,116 unique citations , from which 22 RCTs trials and nine systematic review s published were identified as meeting the eligibility criteria . Of these , five studies focused on care provided by at least a nurse , dietician , and physician ( primary care and /or specialist ) model of care ( Model 1 ; see Table ES 1 ) , while three studies focused on care provided by at least a pharmacist and primary care physician ( Model 2 ; see Table ES 2 ) . Based on moderate quality evidence , specialized multidisciplinary community care Model 2 has demonstrated a statistically and clinical ly significant reduction in HbA1c of 1.0 % compared with usual care . The effects of this model on SBP , however , are uncertain compared with usual care , based on very-low quality evidence . Specialized multidisciplinary community care Model 2 has demonstrated a statistically and clinical ly significant reduction in both HbA1c of 1.05 % ( based on high quality evidence ) and SBP of 7.13 mm Hg ( based on moderate quality evidence ) compared to usual care . For both models , the evidence does not suggest a preferred setting of care delivery ( i.e. , primary care vs. hospital outpatient clinic vs. community clinic ) . Table ES1 : Summary of Results of Meta-Analyses of the Effects of Multidisciplinary Care Model 1 Outcome Estimate of effect(95 % CI)Heterogeneity I(2)(p-value ) GRADE Glycosylated Hemoglobin ( HbA1c [%])-1.00 [ -1.27 , -0.73]4 % (p=0.37)Moderate- quality Subgroup : Moderate-to-High Quality -0.91 [ -1.19 , -0.62]0 % (p=0.74)Systolic Blood Pressure ( mm Hg)-2.04 [ -13.80 , 9.72]89 % (p=0.002)Very-low quality * Mean change from baseline to follow-up between intervention and control groupsTable ES2 : Summary of Results of Meta-Analyses of the Effects of Multidisciplinary Care Model 2 Outcome Estimate of effect(95 % CI)Heterogeneity I(2)(p-value ) GRADE Glycosylated Hemoglobin ( HbA1c [%])-1.05 [ -1.57 , -0.52]0 % (p=0.75)High- quality Systolic Blood Pressure ( mm Hg)-7.13 [ -11.78 , -2.48]46 % (p=0.17)Moderate quality * Mean change from baseline to follow-up between intervention and control groups Objectives To compare the costs and cost-effectiveness of managing patients with uncontrolled blood pressure ( BP ) using telemonitoring versus usual care from the perspective of the National Health Service ( NHS ) . Design Within trial post hoc economic evaluation of data from a pragmatic r and omised controlled trial using an intention-to-treat approach . Setting 20 socioeconomically diverse general practice s in Lothian , Scotl and . Participants 401 primary care patients aged 29–95 with uncontrolled daytime ambulatory blood pressure ( ABP ) ( ≥135/85 , but < 210/135 mm Hg ) . Intervention Participants were central ly r and omised to 6 months of a telemonitoring service comprising of self-monitoring of BP transmitted to a secure website for review by the attending nurse/doctor and patient , with optional automated patient decision-support by text/email ( n=200 ) or usual care ( n-201 ) . R and omisation was undertaken with minimisation for age , sex , family practice , use of three or more hypertension drugs and self-monitoring history . Main outcome measures Mean difference in total NHS costs between trial arms and blinded assessment of mean cost per 1 mm Hg systolic BP point reduced .  Results Home telemonitoring of BP costs significantly more than usual care ( mean difference per patient £ 115.32 ( 95 % CI £ 83.49 to £ 146.63 ; p<0.001 ) ) . Increased costs were due to telemonitoring service costs , patient training and additional general practitioner and nurse consultations . The mean cost of systolic BP reduction was £ 25.56/mm Hg ( 95 % CI £ 16.06 to £ 46.89 ) per patient . Conclusions Over the 6-month trial period , supported telemonitoring was more effective at reducing BP than usual care but also more expensive . If clinical gains are maintained , these additional costs would be very likely to be compensated for by reductions in the cost of future cardiovascular events . Longer-term modelling of costs and outcomes is required to fully examine the cost-effectiveness implication s. Trial registration International St and ard R and omised Controlled Trials , number IS RCT N72614272 AIMS Heart failure chiefly affects the elderly , with frequent emergency admissions . Telemonitoring can identify worsening heart failure but previous r and omized trials have enrolled selected patient population s. The Home-HF study examined the impact of home telemonitoring on typical heart failure patients discharged from three acute hospitals in North West London , UK . METHODS AND RESULTS Patients hospitalized with heart failure were r and omized to telemonitoring or usual specialist care . Primary outcome measures were days alive and out of hospital . Secondary outcome measures were number and duration of heart failure hospitalizations , clinic visits , and quality of life .  We recruited 182 patients . There was no difference in the primary outcome measure in the two groups , but there were significantly fewer unplanned hospitalizations for heart failure decompensation , and a reduction in clinic and emergency room visits in the telemonitoring group . There was no statistically significant difference in the mean direct health service costs . CONCLUSION Home telemonitoring in a typical elderly population of heart failure patients produces a similar outcome to ' usual ' specialist care , but reduces clinic and emergency room visits and unplanned heart failure rehospitalizations at little additional cost . This method of disease monitoring may allow specialist services to increase the number of patients under their care Background Self blood pressure monitoring at home may improve blood pressure control and patients ' compliance with treatment , but its implementation in daily practice faces difficulties . Teletransmission facilities may offer a more efficient approach to long-term home blood pressure monitoring . Methods Twelve general practitioners screened 391 consecutive uncontrolled mild – moderate hypertensive patients ( 80 % treated ) , 329 of whom ( 58 ± 11 years , 54 % men ) were r and omized to either usual care on the basis of office blood pressure ( group A , n = 113 ) or to integrated care on the basis of teletransmitted home blood pressure  ( group B , n = 216 ) . Twenty-four-hour ambulatory blood pressure monitoring  was performed at baseline and after 6 months , during which treatment was optimized according to either office ( group A ) or home ( group B ) blood pressure values . We compared differences between groups in the rate of daytime ambulatory blood pressure normalization ( < 130/80 mmHg ) , need of treatment changes during follow-up , quality of life scores , and healthcare costs . Results Baseline office blood pressures were 149 ± 12/89 ± 9 and 148 ± 13/89 ± 7 mmHg in groups A ( n = 111 ) and B ( n = 187 ) respectively , the corresponding daytime values being 140 ± 11/84 ± 8 and 139 ± 11/84 ± 8 mmHg . The percentage of daytime blood pressure normalization was higher in group B ( 62 % ) than in group A ( 50 % ) ( P < 0.05 ) . There were less frequent treatment changes in group B than in group A ( 9 vs. 14 % , P < 0.05 ) . Quality of life tended to be higher and costs lower in group B. Conclusion Patients ' management based on home blood pressure teletransmission led to a better control of ambulatory blood pressure than with usual care , with a more regular treatment regimen Background Evidence that home telemonitoring for patients with chronic heart failure ( CHF ) offers clinical benefit over usual care is controversial as is evidence of a health economic advantage . Methods Between January 2010 and June 2013 , patients with a confirmed diagnosis of CHF were enrolled and r and omly assigned to 2 study groups comprising usual care with and without an interactive bi-directional remote monitoring system ( Motiva ® ) . The primary endpoint in CardioBBEAT is the Incremental Cost-Effectiveness Ratio ( ICER ) established by the groups ’ difference in total cost and in the combined clinical endpoint “ days alive and not in hospital nor inpatient care per potential days in study ” within the follow-up of 12 months . Results A total of 621 predominantly male patients were enrolled , whereof 302 patients were assigned to the intervention group and 319 to the control group .  Ischemic cardiomyopathy was the leading cause of heart failure . Despite r and omization , subjects of the control group were more often in NYHA functional class III – IV , and exhibited peripheral edema and renal dysfunction more often . Additionally , the control and intervention groups differed in heart rhythm disorders . No differences existed regarding risk factor profile , comorbidities , echocardiographic parameters , especially left ventricular and diastolic diameter and ejection fraction , as well as functional test results , medication and quality of life . While the observed baseline differences may well be a play of chance , they are of clinical relevance . Therefore , the statistical analysis plan was extended to include adjusted analyses with respect to the baseline imbalances . Conclusions CardioBBEAT provides prospect i ve outcome data on both , clinical and health economic impact of home telemonitoring in CHF . The study differs by the use of a high evidence level r and omized controlled trial ( RCT ) design along with actual cost data obtained from health insurance companies . Its results are conducive to informed political and economic decision-making with regard to home telemonitoring solutions as an option for health care . Overall , it contributes to developing advanced health economic evaluation instruments to be deployed within the specific context of the German Health Care System . Trial registration Clinical Trials.gov NCT02293252 ; date of registration : 10 November 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 test the effects of telephone counseling and telemonitoring on weight loss . METHODS A r and omized-controlled trial was conducted over 18 months . Participants were assigned to an immediate or delayed-start group . The intervention included a Thin-Link((R ) ) home telemonitoring scale and biweekly telephone counseling over 6 months . RESULTS The immediate group lost significantly more weight relative to the delayed group over the first 6 months ( -7.5 versus + 1.3 pounds ) and at subsequent visits . CONCLUSION Compared to no treatment , the intervention was effective at producing weight loss . Home telemonitoring may enhance st and ard weight-loss counseling Background Physical training has beneficial effects on exercise capacity , quality of life and mortality in patients after a cardiac event or intervention and is therefore a core component of cardiac rehabilitation . However , cardiac rehabilitation uptake is low and effects tend to decrease after the initial rehabilitation period . Home-based training has the potential to increase cardiac rehabilitation uptake , and was shown to be safe and effective in improving short-term exercise capacity . Long-term effects on physical fitness and activity , however , are disappointing . Therefore , we propose a novel strategy using telemonitoring guidance based on objective training data acquired during exercise at home . In this way , we aim to improve self-management skills like self-efficacy and action planning for independent exercise and , consequently , improve long-term effectiveness with respect to physical fitness and physical activity . In addition , we aim to compare costs of this strategy with centre-based cardiac rehabilitation . Methods / design This r and omized controlled trial compares a 12-week telemonitoring guided home-based training program with a regular , 12-week centre-based training program of equal duration and training intensity in low to moderate risk patients entering cardiac rehabilitation after an acute coronary syndrome or cardiac intervention . The home-based group receives three supervised training sessions before they commence training with a heart rate monitor in their home environment . Participants are instructed to train at 70 - 85 % of their maximal heart rate for 45–60 minutes , twice a week . Patients receive individual coaching by telephone once a week , based on measured heart rate data that are shared through the internet . Primary endpoints are physical fitness and physical activity , assessed at baseline , after 12 weeks and after one year . Physical fitness is expressed as peak oxygen uptake , assessed by symptom limited exercise testing with gas exchange analysis ; physical activity is expressed as physical activity energy expenditure , assessed by tri-axial accelerometry and heart rate measurements . Secondary endpoints are training adherence , quality of life , patient satisfaction and cost-effectiveness . Discussion This study will increase insight in long-term effectiveness and costs of home-based cardiac rehabilitation with telemonitoring guidance . This strategy is in line with the trend to shift non-complex healthcare services towards patients ’ home environments . Trial registration Dutch Trial Register : NTR3780 . Clinical trials.gov register : 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 Home telemonitoring can augment home health care services during a patient 's transition from hospital to home . Home health care agencies commonly use telemonitors for patients with heart failure although studies have shown mixed results in the use of telemonitors to reduce rehospitalizations . This r and omized trial investigated if older patients with heart failure admitted to home health care following a hospitalization would have a reduction in rehospitalizations and improved health status if they received telemonitoring .  Patients were followed up to 180 days post-discharge from home health care services . Results showed no difference in the time to rehospitalization or emergency visit between those who received telemonitoring versus usual care .  Older heart failure patients who received telemonitoring had better health status by home health care discharge than those who received usual care . Therefore , for older adults with heart failure , telemonitoring may be an important adjunct to home health care services to improve health status BACKGROUND Telemedicine is one approach to managing patients with chronic illness . Several telephone-based monitoring studies of diabetes patients have shown improved glycosylated hemoglobin ( HbA1c ) , blood pressure ( BP ) , and low-density lipoprotein ( LDL ) levels . The purpose of this study was to evaluate an investigational in-home telemetry device for improving glucose and BP control over 6 months for patients with type 2 diabetes . The device was used to transmit weekly blood glucose , weight , and BP readings to a diabetes care manager . SUBJECTS AND METHODS We conducted a two-arm , parallel-comparison , single-blind , r and omized controlled trial among Kaiser Permanente Northern California members 18 - 75 years old with type 2 diabetes mellitus and entry HbA1c levels between 7.5 % and 10.0 % . Participants were r and omly assigned to either the telemonitoring arm or the usual care arm . RESULTS We observed very small , nonsignificant changes in fructosamine ( telemonitoring , -54.9 μmol ; usual care , -59.4 μmol ) and systolic BP ( telemonitoring , -6.3 mm Hg ; usual care , -3.2 mm Hg ) from baseline to 6 weeks in both groups . At 6 months , we observed no significant intergroup differences in change from baseline for HbA1c , fructosamine , or self-efficacy . However , LDL cholesterol in the telemonitoring arm decreased more than in the usual care arm ( -17.1 mg/dL versus -5.4 mg/dL ; P=0.045 ) . CONCLUSIONS Although HbA1c improved significantly over 6 months in both groups , the difference in improvement between the groups was not significant . This lack of significance may be due to the relatively healthy status of the volunteers in our study and to the high level of care provided by the care managers in the Santa Rosa , CA clinic . Further study in subgroups of less healthy diabetes patients is recommended Background There is a lack of literature on how to adapt new evidence -based interventions for maternal and newborn care into local health systems and policy for rapid scale-up , particularly for community-based interventions in low-income setting s. The Ug and a Newborn Study ( UNEST ) was a cluster r and omised control trial to test a community-based care package which was rapidly taken up at national level . Underst and ing this process may help inform other studies looking to design and evaluate with scale-up in mind . Objective This study aim ed to describe the process of using evidence to design a community-based maternal and newborn care package in rural eastern Ug and a , and to determine the dissemination and advocacy approaches used to facilitate rapid policy change and national uptake . Design We review ed UNEST project literature including meeting reports and minutes , supervision reports , and annual and midterm reports . National stakeholders , project and district staff were interviewed regarding their role in the study and perceptions of what contributed to uptake of the package under evaluation . Data related to UNEST formative research , study design , implementation and policy influence were extracted and analysed . Results An advisory committee of key players in development of maternal and newborn policies and programmes in Ug and a was constituted from many agencies and disciplines . Baseline qualitative and quantitative data collection was done at district , community and facility level to examine applicability of aspects of a proposed newborn care package to the local setting . Data were summarised and presented to stakeholders to adapt the intervention that was ultimately tested . Quarterly monitoring of key activities and events around the interventions were used to further inform implementation . The UNEST training package , home visit schedule and behaviour change counselling material s were incorporated into the national Village Health Team and Integrated Community Case Management packages while the study was ongoing . Conclusions Design ing interventions for national scale-up requires strategies and planning from the outset . Use of evidence alongside engagement of key stakeholders and targeted advocacy about the burden and potential solutions is important when adapting interventions to local health systems and communities . This approach has the potential to rapidly translate research into policy , but care must be taken not to exceed available evidence while seizing the policy opportunity We conducted a six-month r and omised controlled trial of home telemonitoring for patients with chronic obstructive pulmonary disease ( COPD ) . A total of 40 stable patients with moderate to severe COPD who had completed pulmonary rehabilitation took part . They were r and omised to receive st and ard care ( controls ) or st and ard care plus home telemonitoring ( intervention ) . During the monitoring period , patients in the telemonitoring group recorded their symptoms and physical observations twice daily . The data were transmitted automatically at night via the home telephone line . Nurses could access the data through a website and receive alerting email messages if certain conditions were detected . The patients completed the St George 's Respiratory Question naire , Hospital Anxiety and Depression and the EuroQoL EQ-5D quality of life scores before and after pulmonary rehabilitation , and then periodically during the trial . There were significant and clinical ly important improvements in the scores immediately following pulmonary rehabilitation , but thereafter there were no differences in quality of life scores between the groups at any time , or consistently within either group over time . The study showed that telemonitoring was safe but , despite being well used , it was not associated with changes in quality of life in patients who had stable COPD Efforts to increase blood pressure ( BP ) control rates in blacks , a traditionally underserved high-risk population must address both provider practice and patient adherence issues . The home-based BP Intervention for blacks study is a 3-arm r and omized controlled trial design ed to test 2 strategies to improve hypertension management and outcomes in a de central ized service setting serving a vulnerable and complex home care population . The primary study outcomes are systolic BP , diastolic BP , and BP control ; secondary outcomes are nurse adherence to hypertension management recommendations and patient adherence to medication , healthy diet  , and other self-management strategies .  Nurses ( n=312 ) in a nonprofit Medicare-certified home health agency are r and omized along with their eligible hypertensive patients ( n=845 ) . The 2 interventions being tested are ( 1 ) a " basic " intervention delivering key evidence -based reminders to home care nurses and patients while the patient is receiving traditional postacute home health care ; and ( 2 ) an " augmented " intervention that includes that same as the basic intervention , plus transition to an ongoing Hypertension Home Support Program that extends support for 12 months . Outcomes are measured at 3 and 12 months after baseline interview . The interventions will be assessed relative to usual care and to each other . Systems change to improve BP management and outcomes in home health will not easily occur without new intervention models and rigorous evaluation of their impact . Results from this trial will provide important information on potential strategies to improve BP control in a low-income chronically ill patient population
For those surrogate outcomes , low-strength evidence failed to show difference .
In subgroup analysis , high strength evidence supported a lower BP with HBPT that lasted for 6 or 12 months and was accompanied with counselling support from study personnel .
HBPT can improve BP control in the hypertensive patients .
It may be more efficacious when a proactive additional support is provided during the intervention process
To summarise evidence about the effectiveness of home blood pressure telemonitoring ( HBPT )  and identify the key components of intervention .