Telehealth at scale can improve chronic disease management in the community during a pandemic: an experience at the time of COVID-19
Open accessAbstract
BACKGROUND: During the COVID-19 pandemic, telehealth became a vital resource to contain the virus's spread and ensure continuity of care of patients with a chronic condition, notably arterial hypertension and heart disease. This paper reports the experience based on a telehealth platform used at scale to manage chronic disease patients in the Italian community. METHODS AND FINDINGS: Patients' health status was remotely monitored through ambulatory blood pressure monitoring (ABPM), resting or ambulatory electrocardiogram (ECG), spirometry, sleep oximetry, and cardiorespiratory polysomnography performed in community pharmacies or general practitioners' offices. Patients also monitored their blood pressure (BP), heart rate (HR), blood oxygen saturation (SpO2), body temperature, body weight, waist circumference, blood glucose, and lipids at home through a dedicated smartphone app. All data conveyed to the web-based telehealth platform were used to manage critical patients by doctors promptly. Data were analyzed and compared across three consecutive periods of 2 months each: i) before the national lockdown, ii) during the lockdown (from March 9 to May 17, 2020), and iii) after the end of the containment measures. Overall, 13,613 patients visited community pharmacies or doctors' offices. The number of overall tests dropped during and rose after the lockdown. The overall proportion of abnormal tests was larger during the outbreak. A significant increase in the prevalence of abnormal ECGs due to myocardial ischemia, contrasted by a significantly improved BP control, was observed. The number of home users and readings exchanged increased during the pandemic. In 226 patients, a significant increase in the proportion of SpO2 readings and a significant reduction in the entries for all other parameters, except BP, was observed. The proportion of abnormal SpO2 and BP values was significantly lower during the lockdown. Following the lockdown, the proportion of abnormal body weight or waist circumference values increased. CONCLUSIONS: Our study results support the usefulness of a telehealth solution to detect deterioration of the health status during the COVID-19 pandemic. TRIAL REGISTRATION: The study is registered with ClinicalTrials.gov at number NCT03781401.
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Glucometers and CGMs demonstrated a symmetrical distribution between workflow and literacy challenges, illustrating the dual burden of learning invasive or semi-invasive peripheral operation alongside data-logging routines.
“Glucometers and CGMs demonstrated a symmetrical distribution between workflow and literacy challenges [2,4], illustrating the dual burden of learning invasive or semi-invasive peripheral operation alongside data-logging routines.”
From Clinical Efficacy and Patient Adherence Hurdles of Remote Patient Monitoring (RPM) Frameworks in Managing Hypertension and Type 2 Diabetes: A Scoping Review (2026) · cites this paper as [2]
The Materials and methods section (page not provided) lists glucometers among home devices and says patients manually entered readings in an app. The Discussion notes that manual entry may have limited app use among older patients. Neither passage reports CGMs, a symmetrical distribution of workflow and literacy challenges, or difficulties learning invasive device operation. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe clinical value proposition of RPM systems is well-documented; systematically tracking physiological metrics allows for early detection of clinical deterioration, optimization of pharmacological regimens, and reduction of emergency department utilization.
“The clinical value proposition of these systems is well-documented; systematically tracking physiological metrics allows for the early detection of clinical deterioration, optimization of pharmacological regimens, and reduction of emergency department utilization [2,4].”
From Clinical Efficacy and Patient Adherence Hurdles of Remote Patient Monitoring (RPM) Frameworks in Managing Hypertension and Type 2 Diabetes: A Scoping Review (2026) · cites this paper as [2]
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MethodResearch Landscape of Diabetes mHealth Technologies
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Patient perspectives on telehealth access among people experiencing homelessness: a rapid review
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“Our findings are similar to the international literature which identifies that telehealth in the setting of chronic disease management and telemental health is an accepted form of healthcare provision [41–44].”
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- Authors
- Omboni, S., Ballatore, T., Rizzi, F., Tomassini, F., Panzeri, E., & Campolo, L.
- Affiliations
- Sechenov University (RU)
- Italian Institute of Telemedicine (IT)
- Corresponding author
- Omboni, Stefano
- ORCID
- Omboni, Stefano
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2021-09-29
- Volume
- 16
- Issue
- 9
- Pages
- e0258015
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC8480747
- OpenAlex
- W3203873265
- Cited by
- 51
- References
- 46
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 17 · 2023: 13 · 2022: 8 · 2021: 3
- FWCI
- 8.88
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Oncology › COVID-19 and healthcare impacts
- Keywords
- telemedicine, chronic disease management, COVID-19 pandemic, hypertension, heart disease, remote patient monitoring, ambulatory blood pressure monitoring, electrocardiogram, community pharmacy, home monitoring, mobile application, oxygen saturation, electrocardiographic abnormalities, myocardial ischemia, blood pressure control, lockdown, continuity of care
- MeSH terms
- Physical Distancing, COVID-19, SARS-CoV-2, Adult, Chronic Disease, Communicable Disease Control, Female, Humans, Italy, Male, Middle Aged, Telemedicine, Disease Management, Pandemics
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