Background: This study examines the efficacy of a home health care intervention utilizing telephone and patient monitoring to assess its clinical value, particularly in vulnerable patient populations.
Methodology: Comprehensive literature review and telephone interviews were conducted to gather data.
Results: Findings revealed both positive and negative responses from patients and practitioners.
Conclusions: Home health monitoring for chronic conditions offers promising potential to enhance patient health outcomes through various interventional strategies.

Home health monitoring, Telemedicine, Telehealth, Video, Nurses.

In collaboration with the transitional home assistance (THA) group, a network of in-home healthcare entities incorporating remote monitoring technology, we conducted a two-phase quality improvement project. Our aim was to assess the perceived clinical value of integrating bi-directional video capability into THA’s existing system of telephone-supplemented home visitation and monitoring, with a focus on reducing the need for in-home visits. Additionally, we explored circumstances where video use would be advantageous and patients’ willingness to bear associated costs.

Phase 1 involved a comprehensive literature review utilizing the Ovid MEDLINE and PubMed databases to identify studies that compared video-enhanced telephone communication with telephone-only communication in the remote monitoring of patients with chronic diseases. Search terms included video monitoring, telehealth, chronic disease, home health, video visits, video-enhanced remote monitoring, and video-enhanced vital signs monitoring. Initially, the search was restricted to studies that specifically compared telephone-only supplementation of home health visits with video-enhanced telephonic supplementation. However, due to a limited number of relevant studies, the criteria were broadened to include research on home video monitoring without a direct comparison to telephone-based monitoring. Recent systematic reviews and meta-analyses highlight the growing role of video technology in remote patient management, particularly for chronic conditions such as heart failure and COPD.[1,2]

Phase 2 comprised semi-structured telephone interviews with 15 THA home healthcare patients with congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD), four home health nurses, and nine concierge primary care physicians.  The interview questions were developed specifically for this study, and responses were recorded for analysis. Participants were asked about their perceptions of the potential benefits of integrating bi-directional video capabilities into the current telephone-supported home monitoring system and their willingness to pay for such enhancements. Using open-ended questions, we explored their views on the strengths and limitations of telephone-based monitoring, the perceived advantages or disadvantages of incorporating video communication, their openness to trying video technology, specific reasons for perceiving potential benefits, and their willingness to cover associated costs. Prior research suggests that video-based telehealth interventions may improve patient engagement and clinical outcomes, particularly in managing chronic conditions remotely.[3,4]

Patient responses were varied. Positive feedback emphasized the added information and comfort of face-to-face interaction, albeit concerns about inconvenience and cost were raised. Nurses recognized the potential for added insight and improved patient engagement with video, while also highlighting challenges such as clinician skill and patient willingness to pay. Primary care physicians expressed skepticism about the added value of video communication, emphasizing their familiarity with patients and concerns about cost.

Representative positive responses:

• “It’s hard for me to tell what requires me to take him to the ER. If she (the nurse) could see him when it’s happening, she would be able to tell me easily.”
• “Changes in color, edema, or breathing could be seen. Spouses can’t pick up on differences that nurses could, if they saw the patient on video.”
• “I like talking to people face-to-face. I would be more forthcoming with information if I could see who it is I’m talking to.”
• “I know I try to hide my reactions, and I’m good at it over the phone. If she could see me, she would probably know, especially if it was the same nurse every time.”
• “Nurses have me do a neurological exam and describe what he’s doing over the phone. It would be easier if they saw the exam over video.”
• “Oh yeah! He’s had to go to a rehab facility for a stroke a few times. I would pay extra to be protected.” More than $20 per month: “It could not be more than $50 per month. Because we are both on a limited income, it would just not be worth it at that point.”

Representative negative responses:

• “With video, I would have to make myself presentable – shower and change first.”
• “I already must get up to record my weight and vitals. If I had to videoconference in, it would just add to the hassle.”
• “I know what is normal. When it gets bad, I call them. For them to see me on video would not add anything.”
• “I don’t want to have to change function settings.”
• “We are both on limited income.”

Nurses
Representative positive responses:

• “See changes not necessarily noticeable by patients or family.”
• “Video can help you see changes that a patient might not recognize. Patients can ignore symptoms when they start gradually and slowly progress.”
• “I can read body language and assess things I wouldn’t be able to do over the phone. When we are looking at each other, they feel it is more of a visit and learning opportunity.”
• “The patient might not be truthful or unaware of the issues if they are only required to say ‘yes’ or ‘no’ every time to the same questions on the telephone.”
• “The video challenges you to ask questions, reduces the patient’s anxiety, and helps develop a better trusting relationship.”

Representative negative responses:

• “A poor clinician with poor interview skills would do no better than with a telephone. In fact, the video might make it easier to let the skills they did have slip away.”
• “Telephone communication is sufficient. Video would not add benefit.”
• “I don’t think patients will be willing to pay for this, regardless of cost, because it would be something they take for granted.”
• “Patients in lower socio-economic brackets would rather use that money toward necessities for the family.”

Primary care (Concierge) physicians:
“We know our patients and see them both regularly and immediately when required.” “Video adds only cost.”

Our findings align with existing literature demonstrating the effectiveness of home health monitoring in managing chronic diseases, reducing hospital readmissions, and generating long-term cost savings.[5-10] However, research specifically assessing the value of video-enhanced remote monitoring remains limited, with no direct comparisons to telephone-only monitoring. This gap in the literature makes it difficult to determine whether video-supported telehealth provides significant advantages over traditional telephone-based approaches.

Insights gathered from semi-structured interviews with home health nurses, patients, and concierge physicians suggest that bi-directional video communication has the potential to enhance remote monitoring by improving patient engagement, increasing clinical oversight, and facilitating more comprehensive assessments. Prior research has shown that virtual home care visits can be effective in improving patient outcomes and satisfaction.[5,6,9] Studies have also demonstrated that telehomecare programs can substitute in-person visits, leading to better resource utilization while maintaining quality care.[7,9,10] While evidence comparing video-assisted and telephone-only monitoring remains scarce, our quality improvement initiative suggests that video technology can be beneficial and cost-effective for select patient populations over defined periods. However, its routine implementation without careful consideration of its utility and cost-effectiveness may not yield optimal outcomes.

The successful integration of video-based monitoring requires a focus on user-friendliness, adaptability, and measurable improvements in patient quality of life while minimizing additional financial burdens. Telehomecare interventions have been associated with high patient satisfaction, provided they offer a seamless and intuitive user experience.[6,8] Cost savings should be evident not only for healthcare systems but also for providers, achieved through reductions in unnecessary in-home visits, complications, and hospitalizations.[10] Moreover, maintaining continuity in video monitoring by ensuring that patients interact with the same healthcare provider throughout the monitoring period is crucial for consistency, timely assessments, and improved clinical outcomes.

Future research should aim to address the existing knowledge gap by conducting direct comparative studies between video-enhanced and telephone-only remote monitoring. Additionally, studies should explore which patient populations derive the greatest benefit from video-based monitoring and assess the long-term economic and clinical impact of its implementation. As telehealth continues to evolve, optimizing the use of video technology in home healthcare will require balancing accessibility, efficiency, and cost-effectiveness to enhance patient care while ensuring sustainability for healthcare systems.

Home health monitoring can be implemented through multiple modalities, including telephone, video, and in-person visits. However, additional research is needed to evaluate the effectiveness of each approach, particularly among patient populations experiencing barriers that may influence health outcomes.

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Ashruta Patel
Department of Internal Medicine
Philadelphia College of Osteopathic Medicine, Georgia, USA
Email: ashrutapa@pcom.edu

The author contributed to the conceptualization, investigation, and data curation by acquiring and critically reviewing the selected articles and was involved in the writing – original draft preparation and writing – review & editing to refine the manuscript.

All experiments were performed in accordance with relevant guidelines and regulations. All experimental protocols were approved by the licensing ethics committee at Augusta University.

The authors declare no conflicts of interest.

None

https://doi.org/10.63096/medtigo30623123

Ashruta P. Value of Bi-Directional Video-Enhanced Communication for Monitoring and Management in Telehomecare: Perspectives of Physicians, Nurses, and Patients. medtigo J Med. 2025;3(1):e30623123. doi:10.63096/medtigo30623123 Crossref