A Patient-centered Remote Therapy Monitoring Program Focusing on Increased Adherence to Wound Therapy: A Large Cohort Study

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

A Patient-centered Remote Therapy Monitoring Program Focusing on Increased Adherence to Wound Therapy: A Large Cohort Study

Patient noncompliance with treatment is a serious problem, as indicated by a World Health Organization report that adherence among patients with a chronic illness is estimated to be only 50%.¹ In an internal retrospective study of more than 1800 patients, an increase in adherence to negative pressure wound therapy (NPWT) was associated with wound progression (unpublished data, 2017).

A remote therapy monitoring (RTM; iOn PROGRESS Remote Therapy Monitoring; KCI, an Acelity Company, San Antonio, TX) system has been developed for use with a NPWT unit (ACTIV.A.C. Therapy System, KCI, an Acelity Company; Figure 1) for patients in the home care setting. In conjunction with RTM, a network of virtual therapy specialists call patients when their therapy usage is low and provide education to assist with therapy adherence.

The objective of this study was to examine the relationship between RTM and patient adherence and to examine the relationship between patient adherence and wound progression.

The evaluation included 510 patients who were prescribed NPWT with RTM between December 2016 and October 2017 and had a minimum of 2 wound measurement timepoints recorded on company (KCI, an Acelity company) clinical progress reports. Wound types included surgical wounds (66.5%), diabetic ulcers (11.2%), and pressure ulcers (9.8%). The distribution of all wound types is described in Table 1. A connectivity module on the NPWT device (Figure 1) enabled continuous RTM for patients receiving NPWT at home.

Patient data were transmitted to the care network (iOn PROGRESS Care Network; KCI, an Acelity Company), and a case was flagged when therapy usage dropped below 16 hours in 1 day. A virtual therapy specialists reviewed the patient’s therapy history and then made an adherence phone call to the patient to resolve any issues leading to low usage. Therapy usage leading up to and following the adherence call was measured using the RTM data. Multiple failed attempts to contact the patient or consistent noncompliance triggered an escalation call to the patient’s caregiver to discuss the wound management plan.

The percent change in wound volume and area was calculated based on the change from initial measurement to the last measurement reported on the clinical progress report.

A total of 3261 calls were made with an average of 6.4 calls per patient. Among the 510 patients, 98% received a welcome call, 87% received at least 1 call due to low adherence, and 30% had an escalation call made to their treating nurse. The number of calls and days between calls was higher among patients treated for a longer duration (Figure 2).

The distribution of therapy hours that triggered an adherence call is depicted in Figure 3. On average, therapy was used 8.7 hours on the low therapy day, triggering an adherence call. The day after the adherence call, 73.5% of patients increased therapy use, with an average increase of 7.9 hours (Figure 4). The average total hours of NPWT before, on, and after the day of an adherence call is documented in Figure 5. Over the course of treatment, NPWT was used 78% of the time with an average of 18.6 hours per day.

Figure 6 shows the number of patients and successful (contact made with patient) adherence phone calls throughout therapy by percent adherence. The number of therapy days by percent adherence is reported in Table 2.

As adherence to NPWT increased, the rate of daily reduction in wound size also increased. For patients with < 60% therapy use, the percent reduction in wound volume per day was 1.42%; patients with 90% to 100% therapy use had an average daily reduction rate of 2.23% (Figure 7). For patients with < 60% therapy use, the percent reduction in the wound surface area per day was 0.86% compared with patients with 90% to 100% therapy use who had an average daily reduction rate of 1.45% (Figure 8).

Patient noncompliance with treatment is a known problem in health care, and it presents a challenge for NPWT administered in the home setting. To address this, an RTM system was developed to encourage adherence through active engagement when a decrease in therapy usage was detected. After patient contact, the authors observed an increase in therapy usage immediately following the adherence phone call. This was accompanied by a positive correlation between NPWT use and reduction in wound volume and surface area. This study includes data for more than 500 patients during an 11-month period and builds upon a smaller cohort that has been published previously.²

The primary limitation of this study is that it does not compare therapy adherence and the outcomes on wound dimensions between patients receiving NPWT with RTM to patients receiving NPWT without RTM. Future studies comparing NPWT-RTM wound management with a non-RTM group will be needed to measure the direct effect of RTM on clinical outcomes.

These data suggest RTM can be used to influence patient behavior, and there may be a potential relationship between patient behavior and wound healing outcomes. Additional studies are needed to elucidate the relationship between RTM and wound outcomes.

Affiliation: Acelity, San Antonio, TX

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

Disclosure: The authors are employees of Acelity, San Antonio, TX. Financial support for this research was provided by KCI, an Acelity Company. Mikaela Sifuentes, PhD (Acelity), provided medical writing support. Data were presented at the 2018 Symposium on Advanced Wound Care Spring in Charlotte, NC.