Adherence, adaptation and acceptance of elderly chronic heart failure patients to receiving healthcare via telephone-monitoring

Background: Although the potential to reduce hospitalisation and mortality in chronic heart failure (CHF) is well reported, the feasibility of receiving healthcare by structured telephone support or telemonitoring is not. Aims: To determine; adherence, adaptation and acceptability to a national nurse-coordinated telephone-monitoring CHF management strategy. The Chronic Heart Failure Assistance by Telephone Study (CHAT). Methods: Triangulation of descriptive statistics, feedback surveys and qualitative analysis of clinical notes. Cohort comprised of standard care plus intervention (SC + I) participants who completed the first year of the study. Results: 30 GPs (70% rural) randomised to SC + I recruited 79 eligible participants, of whom 60 (76%) completed the full 12 month follow-up period. During this time 3619 calls were made into the CHAT system (mean 45.81 SD ± 79.26, range 0-369), Overall there was an adherence to the study protocol of 65.8% (95% CI 0.54-0.75; p = 0.001) however, of the 60 participants who completed the 12 month follow-up period the adherence was significantly higher at 92.3% (95% CI 0.82-0.97, p ≤ 0.001). Only 3% of this elderly group (mean age 74.7 ±9.3 years) were unable to learn or competently use the technology. Participants rated CHAT with a total acceptability rate of 76.45%. Conclusion: This study shows that elderly CHF patients can adapt quickly, find telephone-monitoring an acceptable part of their healthcare routine, and are able to maintain good adherence for a least 12 months. © 2007.

AskNow Instant Messaging: innovation in virtual reference

In late 2006, the National Library of Australia implemented a trial Instant Messaging service that ran in parallel with the AskNow chat reference service for a six month period. The trial was a resounding success, proving both a demand for an IM service and the suitability of the medium for reference service provision in a collaborative environment. The trial also allowed the collection of a significant body of data on user expectations, librarian experience and the nature of enquiries. This article begins by introducing the concept of IM and discusses the impetus for its use as a channel for reference service provision. It presents and analyses data collected from user surveys, session transcripts, usage statistics, staff surveys and other staff feedback mechanisms, and explores the issues arising from the data analysis. The article concludes by discussing the IM system architecture that the NLA is currently developing, which will allow the Library to move forward with an ongoing IM service.