A randomised clinical trial of the safety, cost effectiveness and patient experience of nurse‐led telemonitoring of chronic hepatitis B patients. Issue 5 (10th October 2019) - Kumar, Rajneesh
Summary: Introduction: Chronic Hepatitis B (CHB) remains important health concern in Singapore with approximately 3.6% population affected and remains common condition requiring follow‐up by Gastroenterologist. Virtual monitoring has been used at many centres for various diseases, however, safety, effectiveness is still not explored. Aim: Assess if virtual monitoring of patients with CHB is safe, acceptable and cost‐effective. Methods: Prospective randomised‐control trial to assess the safety, efficacy and patient satisfaction of virtual monitoring of liver tests by trained nurse‐clinician. Patients were randomised to either monitoring by doctor alternating with the nurses (NHTMS), or follow‐up by doctors (Control). Randomisation was by sealed envelope method. Primary clinical end point was (a) cirrhosis (b) Hepatocellular carcinoma or (c) Raised ALT requiring medications, whereas patient's acceptance and cost effectiveness were secondary end points. Patients were asked to fill questionnaire on satisfaction and acceptance of care at 1, 2 years in the nurse‐led monitoring arm. 333 patients were recruited, 311 completed 2 years follow‐up. Results: No significant difference was seen in the clinical outcome of patients in either arm with combined primary end point reached in 10 patients in each arm. However, there was significant difference in cost saved on transport with the NHTMS patients saving $20.23 on transport cost and 103 minutes of time by reducing the visits. 83.9% of NHTMS patients felt that NHTMS was better than being followed up by doctors, whereas 84.5% preferred the NHTMS model. Conclusion: Nurse‐led virtual‐telemonitoring of stable CHB patients is safe, acceptable by patients and reduces cost on health care.