Abstract 2087: Does an Internet-Based Intervention Reduce Use of Emergency Services Among Patients with Chronic Cardiac Disease?
Background: Immediate post-hospital support, using Visiting Nurse Association (VNA) services, improves self-management for patients with chronic cardiac disease. Patients who need nurse-directed coaching and symptom management in the home may benefit from complementary internet-based services.
Objective: We compared usual post-hospital VNA services with technology-enhanced VNA practice (TEP) that combined nursing care with a 6 month web-based coaching and symptom management service and examined its effect on emergency service use.
Methods: Patients (N=281) admitted to VNA service post-hospital for management of chronic cardiac diseases were randomly assigned to one of two groups: usual care or TEP. In both groups, VNA service ranged from two days to two months; the nurses coached patients to use self-management skills of knowledge-seeking, self-monitoring, and symptom management. Patients in the usual care group (N=135, 48%) used paper-based teaching materials such as booklets and diaries to improve self-management. Patients in the TEP group (N=146, 52%) received VNA and HeartCareII services, which included using a computer to find information, monitor symptoms, and solve symptom problems. The outcome of emergency service use was measured by patient recall and verified by medical record review when possible.
Results: The typical patient was 64 years old; male (61%), post-heart surgery (64%), NYHA Class III (61%). Thirty-five percent had heart failure as the primary diagnosis. There were no baseline differences between groups on demographic and clinical variables. Patients in the TEP group used the Web resource an average of 13 times during the 6 months that it was available. Overall, emergency service use was low in this population over six months of follow-up (N=260 uses/1463 measurement points=17.8%). A total of 120 (42%) patients sought emergency care, and patients in the TEP group (N=54, 45%) were just as likely as patients in the usual care group (N=66, 55%) to use emergency services throughout the 6 months after study enrollment.(X2=.76, df=1, p=NS).
Conclusions: Emergency service use was low overall. Access to coaching and self-monitoring tools provided through a patient-directed internet resource did not affect emergency service use.