Structured Telephone Support or Telemonitoring Programs, Article Critique Example

Inglis, S.C., Clark, R.A., McAlister, F.A, Ball, J, Lewinter, C, Cullington, D, Stewart, S, Cleland, JG. (2011). Structured telephone support or telemonitoringprogrammefor patients with chronic heart failure. Cochrane Collaboration Review.

Background

The following article critique focuses on a Cochrane Review article on the topic of “Structured telephone support or telemonitoring programs for patients with chronic heart failure.”  The Cochrane Collaboration, based in the United Kingdom, focuses on a systematic review of evidence on important clinical issues.

Problem

Overall, the article presents an appropriate scope and objective for the article.  That is, the article provides a background on the topic of interest: Specialized disease management programs for chronic health failure normally improve the rate of survival and reduces health care utilization.  The study will examine randomized control trials that deal with one of the most popular specialized disease management: structured telephone support or telemonitoring. Typically, this type of intervention focuses on providing individuals with direct access to clinical advice that might not otherwise make necessary clinical visits or ask for advice.  Thus, many in the medical and policy community posit that the use of such interventions will lead to better medical outcomes.  The article looks at roughly 25 randomized control trials that attempt to answer this question among different populations.  This topic is extremely important for nursing as well in that nurses may participate in some of the interventions for their patients.  The meta-analysis method was appropriate and used in the right context in which to explore this topic.

Search Strategy

Overall, the authors did a good job of describing their search strategy.  The authors clearly stated that they searched for articles between the dates of January 1966 and May 2006.  The electronic searches were carried out for a number of databases: 1) CENTRAL; 2) MEDLINE; 3) EMBASE; 4) CINAHL; 5) AMED; 6) Science Citation Index.   The authors made use of various terms in the search including “heart failure”, “telecardiac failure” and “tele” for other databases such as IEE X plore, Oalster, Informit, Vivismo/ Clusty, Australian and Proquest Digital Dissertations.  The study also included a PRISMA-like flow chart that showed how and why various studies were included in the systematic literature review.  Finally, in order to check for possible bias, the study quality and risk was assessed independently by two other organizations.

The Sample

The inclusion and exclusion criteria were appropriate based on the scope of the review. That is, the review determined the inclusion and exclusion criteria based on the scope and primary /secondary outcomes determined by the Cochrane Collaboration.  Some of those inclusion criteria included blindness, completeness to follow up, and statistical follow up issues.

Quality Appraisal

The authors did appraise the general quality of the studies included: in addition to having clear inclusion and exclusion strategies, they also commented on the strengths and weaknesses of each study.  The studies are individually transcribed in order to address the findings and the quality of each study.  It should also be noted there is a quality control mechanism in the inclusion/ exclusion criteria and statistical tests associated with the meta-analysis.

 Data Extraction

The Cochrane Collaboration has set strict standards for the extraction and the compilation of data from the selected studies.  In addition to having individuals extract the data, there are other individuals put in charge of checking the entries for accuracy.  Although some of the data points were different in the RCTs, the systematic review made a point to extract the main effects and intervals from the metrics.  The main findings of the studies were abstracted in the database, and ultimately the paper.

Data Analysis General

The authors were clear about how and under what circumstances the meta-analysis took place.  That is, how they aggregated the data from the randomized control trials into a final meta-analysis.  The data analysis was thorough and credible to the extent the RCTs examined met the quality points enumerated in the beginning.  Finally, tables and figures were used throughout the 140 page document- particularly in describing key findings.  Figures were not only used in describing in how studies were chosen, but also for the showing the research findings.

Data analysis was qualitative since prior knowledge of the research question was based on constructivist perspective and interpretive approach to answering specific research questions. This involved presentation of data to the risk ratios at a confidence level of 95 %. The primary outcomes of consideration were the all-cause mortality as well as CHF-related cases of hospitalization. Additional outcomes were length of stay, cost, quality of life as well as acceptability.