# The Effect of Telehomecare on Patients’ Health-Related Quality of Life, Satisfaction, Disease Self-Management Skills, Provider Satisfaction, and Informal Caregiver Strain: Longitudinal Cohort and Cross-Sectional Study

## TL;DR

Telehomecare improves health-related quality of life for heart failure patients and reduces caregiver strain, but effects may decline with age.

## Contribution

This study provides longitudinal evidence on telehomecare's impact on patient outcomes, caregiver strain, and nurse satisfaction.

## Key findings

- Heart failure patients showed significant HRQoL improvement at 12 months.
- Caregivers reported low strain scores throughout the telehomecare program.
- Nurses reported moderate satisfaction with telehomecare services.

## Abstract

Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are responsible for a significant amount of the economic and chronic disease burden that impacts the Ontario health system. Telehomecare, a home self-management program launched by the Ontario Telemedicine Network (OTN), was created to improve access to quality care and limit health care use. However, few data are available on patient-, caregiver-, and provider-reported outcomes of telehomecare.

This study aims to evaluate the impact of the OTN telehomecare program on the health-related quality of life (HRQoL), disease-management skills, and satisfaction of patients with HF and those with COPD; informal caregiver strain index; and nurse satisfaction with telehomecare.

We used a prospective longitudinal cohort design, including patients with HF and those with COPD enrolled in Ontario’s telehomecare program, informal caregivers of patients in the program, and nurses providing services in telehomecare. Patients and informal caregivers were administered telephone surveys at baseline, month 3, month 6, and month 12 follow-up from July 2016 to December 2019. The outcomes for the longitudinal surveys were patient-perceived HRQoL, disease self-management skills, perception of telehomecare (ease of use and usefulness), satisfaction with telehomecare, and informal caregiver-perceived strain. Cross-sectional surveys were conducted with nurses to assess nurse perception and satisfaction with telehomecare. Participant data were analyzed using general linear mixed models in SAS Statistical Software (version 9.4; SAS Institute Inc).

Overall, a total of 194 patients (HF, n=117; COPD, n=77), 62 caregivers, and 24 nurses participated, with an overall response rate of 51% (280/551). The average age of patients with HF and those with COPD was 71 (SD 11.3) years and 70 (SD 11.1) years, respectively, and 52% (100/194) were men. A significant improvement in overall HRQoL was observed among patients with HF at month 12 (−18.37, P<.001). Minimal clinically important differences were observed across all HRQoL domains for people with HF, indicating clinically meaningful improvement over the study period. No statistically significant improvement in HRQoL was observed among patients with COPD; however, minimal clinically important differences were observed in the physical functioning dimension. Patients reported being confident in self-managing their diseases throughout the study, but as patients aged, their perception of and satisfaction with telehomecare was shown to decrease (P=.002 and P=.002, respectively). Caregivers reported relatively low strain scores (mean 10.3, SD 5.9) throughout the program, and nurses reported moderate levels of satisfaction (mean 6.7, SD 1.5) with telehomecare at follow-up.

In this population, telehomecare demonstrated an ability to improve the HRQoL of patients with HF and those with COPD. However, the long-term sustainability of HRQoL improvements in patients following telehomecare requires further investigation. Furthermore, telehomecare was shown to decrease informal caregiver-perceived strain, and nurses described moderate levels of satisfaction and perceived quality of care with telehomecare.