Evaluating the Impact of a Patient-centered Remote Monitoring Program on Adherence to Negative Pressure Wound Therapy

A remote therapy monitoring (RTM) system has been developed for use with a negative pressure wound therapy (NPWT) unit for patients in the home care setting. In conjunction with RTM, a network of trained professionals call patients when their NPWT usage is low and provide education to assist with therapy adherence. Objective. The objective of this evaluation is to examine the relationship between the RTM system and patient adherence. Materials and Methods. One hundred ninety-eight home care patients receiving NPWT with RTM between December 2016 and April 2017 were included. Results. A total of 979 calls were made, with an average of 4.9 calls per patient. Among 198 patients, 195 received a welcome call, 157 received a call due to low adherence, and 35 had an escalation call made to their treating nurse. Of the 157 patients who required at least 1 call due to low adherence, 153 were successfully contacted at least once. The day following the patient call, adherence increased 73% of the time by an average of 8.5 hours. Conclusions. This evaluation suggests there is an ability to influence patient adherence through active engagement, potentially improving outcomes and reducing wound costs.

The World Health Organization has estimated that 50% of those living with chronic illness are nonadherent to their prescribed therapy.¹ Estimates indicate that wounds account for nearly 4% of health care system costs, and that number is rising.² In an internal retrospective study of more than 1800 patients, increasing adherence to negative pressure wound therapy (NPWT) use has been shown to facilitate wound closure (unpublished data, 2017). This led to a hypothesis that with active patient engagement, the rate of adherence to therapy could be affected. Recently, a proprietary remote therapy monitoring (RTM) system (iOn PROGRESS Remote Therapy Monitoring; Acelity, San Antonio, TX) has been developed to provide timely feedback on patient adherence to wound management. The RTM system works in conjunction with a NPWT system (ACTIV.A.C. Therapy System; Acelity) to monitor patient compliance beyond the hospital setting.

The objective of this evaluation is to examine the relationship between RTM and patient adherence to NPWT.

This study included 198 patients receiving NPWT with RTM between December 2016 and April 2017. A connectivity module on the NPWT device enabled continuous RTM for patients receiving NPWT at home (Figure 1). In conjunction with RTM, a network of trained professionals (iOn PROGRESS Care Network, Acelity) was available to contact patients and provide education to assist with therapy adherence. Patients with therapy usage < 16 hours in 1 day received an adherence call. Therapy usage leading up to and following the adherence call was measured using the RTM data. Failure to initially reach a patient or consistent noncompliance (ie, patient not reached following second adherence call within a 7-day period) triggered an escalation call to the patient’s caregiver to discuss therapy adherence.

A total of 979 calls were made, with an average of 4.9 calls per patient (Figure 2). Among 198 patients, 195 (98.5%) received a welcome call, 157 (79.3%) received a call due to low adherence, and 35 (17.7%) had an escalation call made to their treating nurse. Of the patients who required at least 1 call due to low adherence, 153 of 157 (97.5%) were successfully contacted at least once. On low therapy days triggering an adherence call (< 16 hours/day), the mean therapy usage was 8.1 hours. Therapy use decreased leading up to the adherence phone call and increased after the call (Figure 3). The day following a successful patient call (n = 283), patients participated in more than 12 therapy hours in 199 (70.3%) cases, with adherence exceeding 22 hours in 158 (55.8%) cases. (Figure 4). On the first day after successful contact, adherence increased in 73% of cases by an average of 8.5 hours, improving to an average 9.8-hour increase by day 7 (Figure 5). As the length of therapy increased, the average number of adherence calls also increased (Table).

Low patient compliance with therapy is a known and complex problem in health care. To address this challenge among patients prescribed NPWT, an RTM system was used to drive adherence through active engagement when there was a decrease in therapy usage. After patient contact, therapy usage was shown to increase on average immediately following the phone call. This is the first stage of a larger, more extensive evaluation the authors plan to undertake to ultimately determine if an increase in adherence to therapy can affect wound-related clinical and economic outcomes.

Though the results from this study are encouraging, this is only an initial review of the RTM program in the first 5 months of application with 198 patients. A reevaluation with a larger enrollment will be necessary to validate these preliminary findings. This study also is limited in that it does not compare RTM program patients to patients that do not receive RTM to estimate the true effect on adherence, and it does not provide data correlating adherence to wound-related clinical outcomes.

This evaluation suggests there is an ability to influence patient adherence through active engagement, potentially improving outcomes and reducing wound care costs. Additional studies are needed to validate the impact of RTM on patient therapy adherence and clinical outcomes. 

Affiliation: Acelity, San Antonio, TX

Correspondence: Leah Griffin, MS; Acelity, 12930 West Interstate 10, San Antonio, TX 78249; Leah.Griffin@kci1.com

Disclosure: Financial support for this research was provided by Kinetic Concepts Inc, an Acelity Company, San Antonio, TX. Mikaela Sifuentes, PhD, (Acelity) provided medical writing support.