Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2016 Jul 7:16:227.
doi: 10.1186/s12913-016-1469-4.

Telemedicine-supported transition of stable coronary artery disease patients from tertiary to primary health care facilities: protocol for a randomized non-inferiority trial

Joanna d'Arc Lyra Batista  1   2   3 , Mariana Vargas Furtado  4   5 , Natan Katz  6 , Milena Rodrigues Agostinho  6 , Brasil Silva Neto  6   5 , Erno Harzheim  6   4 , Carisi Anne Polanczyk  6   4   7
Affiliations
Randomized Controlled Trial

Telemedicine-supported transition of stable coronary artery disease patients from tertiary to primary health care facilities: protocol for a randomized non-inferiority trial

Joanna d'Arc Lyra Batista et al. BMC Health Serv Res. .

Abstract

Background: Many Brazilian patients with complex diseases who are treated in tertiary referral clinics have been stable for long periods. The main needs of these patients involve monitoring of risk factors and review of drug prescriptions, which could be satisfactorily done in primary care facilities. The goal of this protocol is to evaluate the safety and effectiveness of telemedicine services to support the transition of patients with stable chronic coronary artery disease from the tertiary to the primary level of care.

Methods/design: We designed a randomized non-inferiority protocol that will include 280 patients with stable coronary artery disease (for at least 12 months). Patients will be selected from the Ischemic Heart Disease Clinic in a tertiary care hospital in southern Brazil. Enrolled participants will be randomized into one of two groups: 12 months of follow-up at the same clinic; or 12 months of follow-up at a primary care facility with clinical support from a telemedicine platform including a toll-free line for physicians (intervention group). In the intervention group, decisions to refer patients to tertiary care during follow-up will be made jointly by primary physicians and medical teleconsultants. The groups will be compared in terms of the primary outcome-maintenance of baseline functional class 1 or 2 after 12 months. Secondary outcomes include control of risk factors and instability of the disease.

Discussion: We intend to determine the effectiveness of using telemedicine to qualify the transition of patients with chronic coronary disease from the tertiary to the primary level of care. This should facilitate the access of patients to the healthcare system, since care will be provided closer to their homes, and provide more opportunities for treatment of severe cases at tertiary care hospitals that are often overcrowded.

Trial registration: ClinicalTrials.gov # NCT02489565 - trial registration date May 13, 2015.

Keywords: Coronary artery disease; Randomized clinical trial; Telemedicine.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Flow Diagram of Study Design
See this image and copyright information in PMC

References

    1. Weil BR and Canty Jr JM. Coronary Blood Flow and Myocardial Ischemia. Essential Cardiology. 2013;doi:10.1007/978%E2%80%931%E2%80%934614%E2%80%936705%E2%80%932_22.
    1. Bueno FR, Correa FR, Alves MAS, Bardin MG, Modesto JA, Dourado VZ. Physical exercise capacity and its prognostic value in postoperative cardiac surgery [Portuguese] Fisioter Mov. 2012;25(4):839–47. doi: 10.1590/S0103-51502012000400017. - DOI
    1. Mattos LAIP, Berwanger O, Santos ES, Reis HJL, Romano ER, Petriz JLF, et al. Desfechos clínicos aos 30 dias do registro brasileiro das síndromes coronárias agudas (ACCEPT) Arq Bras Cardiol. 2013;100(1):6–13. doi: 10.1590/S0066-782X2013000100003. - DOI - PubMed
    1. Starfield B. Basic concepts in population health and health care. J Epidemiol Community Health. 2011;55:452–54. doi: 10.1136/jech.55.7.452. - DOI - PMC - PubMed
    1. Starfield B. Primary care: an increasingly important contributor to effectiveness, equity, and efficiency of health services SESPAS report. Gac Sanit. 2012;26(1):20–6. doi: 10.1016/j.gaceta.2011.10.009. - DOI - PubMed

Publication types

Associated data