Telemonitoring associated with synchronous video consultation in patients on home mechanical ventilation: is it an efficient and effective intervention?

Telemonitoring combined with synchronous video consultation is an increasingly used strat-egy in the management of patients on home mechanical ventilation (HMV). The aim of this study was to evaluate ventilation parameters and healthcare resource utilization in a tele-monitoring program (TG) compared to usual care (UG). A retrospective comparative study was conducted, comparing HMV patients assigned to telematic follow-up with a historical cohort receiving standard in-person follow-up. Ventilation parameters included apnea-hypopnea index (AHI), average daily use (h/day), and mean leak (L/min). Efficiency was as-sessed by the total number of hospital visits and in-person hospital visits. Average daily use (8.3±2.9 h/day vs. 8.5±3.4 h/day; p=0.714) and mean leak (6.4±11.9 L/min vs. 6.3±9.6 L/min; p=0.701) did not differ significantly between groups. The TG showed a lower AHI compared with the UG [4.1±5.0/hour vs. 7.9±12.2/hour; respectively (p=0.008)]. The TG was also associated with fewer annual total visits (3.5±2.4 vs. 6.9±5.0; p<0.001) and fewer annual in-person visits (2.1±1.6 vs. 6.9±5.0; p<0.001). Kaplan-Meier curves were used for descriptive purposes. In multivariable Cox regression adjusted for age category, diagnostic group, baseline arterial blood carbon dioxide pressure, and sex, the TG was associated with a lower hazard of death (0.51; 95% confidence interval 0.24-1.09; p=0.08). These findings indicate that telemonitoring combined with synchronous video consultation was associated with better ventilatory control (lower AHI) and lower use of in-person healthcare visits, with-out evidence of impaired adherence or safety.