Effectiveness of telemonitoring-enhanced support over structured telephone support in reducing heart failure-related healthcare utilization in a multi-ethnic Asian setting.

AIMS: Our study aimed to compare the effectiveness of telemonitoring over structured telephone support in reducing heart failure-related healthcare utilization. METHODS: This was a non-randomised controlled study comparing 150 recently discharged heart failure patients enrolled into telemonitoring and 55 patients who only received structured telephone support after rejecting telemonitoring. Patient activation, knowledge and self-management levels were measured at baseline and the one year upon programme completion using the Patient Activation Measure, the Dutch Heart Failure Knowledge Scale and the Self-Care of Heart Failure Index respectively. Differences in heart failure-related and all-cause hospitalization rates, total bed days and mortality rates at 180 days and at one year, knowledge and self-management scores and total cost of care between groups at one year were analysed. RESULTS: Average age of telemonitoring was 57.9 years and 63.9 years for structured telephone support. Significant difference in adjusted 180-day all-cause bed days (telemonitoring: five days versus structured telephone support: 9.8 days), heart failure-related bed days (telemonitoring: 1.2 days versus structured telephone support: six days) and adjusted one-year heart failure-related bed days (telemonitoring: 2.2 days versus structured telephone support: 6.6 days) were observed. Telemonitoring was associated with reduced all-cause one-year mortality (hazard ratio 0.32, p = 0.02). Estimated mean maintenance and confidence scores were significantly higher in the telemonitoring group at one year. No differences in all-cause and HF-related readmission rates and knowledge levels were observed. The one-year total cost of care was predicted to be Singapore dollars (SG$) 2774.4 lower (p = 0.07) in telemonitoring. CONCLUSION: In conclusion, telemonitoring was associated with lower all-cause and heart failure-related total bed days at 180 days, lower heart failure-related total bed days and total cost of care at one year as compared with structured telephone support.

Factors influencing living kidney donation in Singapore.

CONTEXT: Kidney transplantation is the best treatment option for kidney failure, but the supply of donor kidneys remains small. OBJECTIVE: To understand the public's attitude toward living donor kidney donation in Singapore. DESIGN, SETTING AND PARTICIPANTS, INTERVENTION, OUTCOME MEASURES: A crosssectional study of a convenience sample of 1520 members of the general public seeking care at local medical centers. A self-administered questionnaire included questions on demographics and subjects' willingness and unwillingness to donate a kidney. Respondents were aged at least 18 years and did not have underlying chronic kidney disease, end-stage renal disease requiring dialysis, or history of kidney transplant. RESULTS: Overall mean age of respondents was 49 (SD, 15) years and 50% were male. Response rate to the question on "willingness to donate kidney while alive" was 96% (1460); 707 (48.4%) were willing to donate a kidney while alive. Respondents who were willing to donate were younger (<40 years; P<.001); had above a secondary level education (P<.001); had monthly household income 2000 SGD (or US$1660; exchange rate at 1 SGD = US$0.83) or higher (P<.001); were not married, single, or divorced (P<.001); and were professionals (P<.001). Fear of surgical risks (86.5% strongly agree or agree) and poorer health consequent to donation (87.5% strongly agree or agree) were the main reasons for not considering being a living kidney donor. Demographic factors and concerns of surgical risks and ill health after transplant influenced willingness to donate a kidney while alive. Addressing these concerns may alleviate anxiety with regard to living kidney donation.