Role of mid-level health providers in telemedical care system for patients with congestive heart failure

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Abstract

The growing number of patients with congestive heart failure (CHF), especially in rural populations, increases the burden on the healthcare system and requires effective economic, medical and social solutions. The introduction of telemedical care technologies and the redistribution of responsibilities between doctors and mid-level health providers are key modern trends with significant social and organizational implications. The involvement of mid-level health providers in telemedical care increases the availability of services, expands their responsibilities, and strengthens their professional status in the healthcare system.

This work aimed to compare foreign and national models of involving mid-level health providers in telemedical care for patients with CHF to identify opportunities for integrating the most effective foreign practices in the national healthcare system.

The review was based on clinical guidelines and original study reports from MedLine, Web of Science, Scopus, The Cochrane Library, eLibrary.Ru, and PubMed databases. The review analyzed 50 sources.

A comparative analysis of international and national practice showed that the responsibilities of mid-level health providers in telemedical care for CHF cover a wide range of tasks. National practice utilizes technologies for transmitting electrocardiograms and blood pressure data, remote weight and symptom monitoring, and video appointments. A difference was found between the levels of healthcare; in federal and regional centers, mid-level providers primarily prepare patients for appointments, manage online communications, and monitor compliance under the supervision of a physician. However, in towns and rural areas, their responsibilities expand to include regular monitoring and management of communications with area specialists.

A comparative analysis showed that mid-level health providers play a key role in telemedical care for CHF. The study systematizes data on the involvement of mid-level health providers in online care for CHF and demonstrates their integrative role, which goes beyond conventional responsibilities.

About the authors

Tatyana M. Bogdanova

Saratov State Medical University named after V.I. Razumovsky

Author for correspondence.
Email: Bogtanmih@mail.ru
ORCID iD: 0000-0002-9203-451X
SPIN-code: 8224-5777

MD, Cand. Sci. (Medicine), Assistant Professor

Russian Federation, Saratov

References

  1. Lippi G, Sanchis-Gomar F. Global epidemiology and future trends of heart failure. AME Med J. 2020;5:15. doi: 10.21037/amj.2020.03.03 EDN: OKWQKV
  2. Ziaeian B, Fonarow GC. Epidemiology and aetiology of heart failure. Nat Rev Cardiol. 2016;13(6):368–378. doi: 10.1038/nrcardio.2016.25 EDN: WPPQDD
  3. Eruslanova KA, Malaya IP, Kotovskaya YuV. Heart failure clinic: the role of nurses. Russian journal of geriatric medicine. 2023;1(13):63–66. doi: 10.37586/2686-8636-1-2023-63-66 EDN: SSSJPC
  4. Nesterov VS, Urvantseva IA, Vorob'ev AS. Chronic heart failure: current problems and solutions. Lechaschi vrach. 2018;(7):11–14. (In Russ.) EDN: XYRPIT
  5. Drapkina OM, Boytsov SA, Omelyanovskiy VV, et al. Socio-economic impact of heart failure in Russia. Russian journal of cardiology. 2021;26(6):81–89. doi: 10.15829/1560-4071-2021-4490 EDN: PUEROH
  6. Drennan IR, Blanchard IE, Buick JE. Opportunity for change: is it time to redefine the role of paramedics in healthcare? CJEM. 2021;23(2):139–140. doi: 10.1007/s43678-021-00105-y EDN: XIGPHR
  7. Kaspruk LI, Zhdanov RR. The role of medical assistants in the prevention and formation a healthy lifestyle among the population. Orenburgskii meditsinskii vestnik. 2018;(3(23)):46–49. EDN: YBSDDV
  8. Lipton BJ, Pesko MF. State Medicaid and private telemedicine coverage requirements and telemedicine use, 2013–2019. Health Serv Res. 2023;58(5):988–998. doi: 10.1111/1475-6773.14173 EDN: QAXPWR
  9. Hu M. Telemedicine in remote areas: possibility of establishing a telemedicine system. Highlights in Science, Engineering and Technology. 2022;23:235–240. doi: 10.54097/hset.v23i.3273 EDN: UJUIEJ
  10. Drapkina OM, Drozdova LYu, Boytsov SA, et al. Interim guidelines: "Outpatient care for patients with chronic diseases subject to outpatient care in the context of the COVID-19 pandemic". Russian journal of preventive medicine and public health. 2020;23(3-2):4–41. doi: 10.17116/profmed2020230324 EDN: OLTZIA
  11. Reshetnikov AV, Prisyazhnaya NV, Pavlov SV, Vyatkina NYu. Perception of the COVID-19 pandemic by Moscow residents. Sotsiologicheskie issledovaniya. 2020;(7):138–143. doi: 10.31857/S013216250009481-2 EDN: TSLSRR
  12. Reshetnikov A, Berdutin V, Zaporozhtsev A, et al. Predictive algorithm for the regional spread of coronavirus infection across the Russian Federation. BMC Med Inform Decis Mak. 2023;23(1):48. doi: 10.1186/s12911-023-02135-1 EDN: EIMVWG
  13. Reshetnikov A, Frolova I, Abaeva O, et al. Accessibility and quality of medical care for patients with chronic noncommunicable diseases during COVID-19 pandemic. NPJ Prim Care Respir Med. 2023;33(1):14. doi: 10.1038/s41533-023-00328-9 EDN: XJPNRN
  14. Reshetnikov A, Prisyazhnaya N, Steger F, et al. Features of social behavior and the awareness of Moscow residents about COVID-19 at the beginning of the pandemic. Social sciences. 2023;12(1):25. doi: 10.3390/socsci12010025 EDN: EVHDSP
  15. Omboni S, Padwal RS, Alessa T, et al. The worldwide impact of telemedicine during COVID-19: current evidence and recommendations for the future. Connect Health. 2022;1:7–35. doi: 10.20517/ch.2021.03 EDN: GWIOFE
  16. Brînzac MG, Kuhlmann E, Dussault G, et al. Defining medical deserts-an international consensus-building exercise. Eur J Public Health. 2023;33(5):785–788. doi: 10.1093/eurpub/ckad107 EDN: DTIVEH
  17. Garichev S, Klassen V, Natenzon M, et al. Mobile telemedicine systems with artificial medical intelligence. In: Proceedings—2019 international conference on artificial intelligence: applications and innovations, IC-AIAI 2019. New York: Institute of electrical and electronics engineers Inc.; 2019. P. 8–11. doi: 10.1109/IC-AIAI48757.2019.00008 EDN: DCIGUR
  18. Poroyskiy SV, Soboleva SYu, Golikov VV, et al. Telemedicine from the perspective of social efficiency. In: Anti-crisis approach to the provision of the environmental sustainability of economy. Singapore: Springer Singapore; 2023. P. 63–69. EDN: XECNDJ
  19. Sidorova A, Bezverkhov A, Yudin A. Prospects for the development of the Russian telemedicine market: legal aspect. Current achievements, challenges and digital chances of knowledge based economy. 2021;133:789–796. doi: 10.1007/978-3-030-47458-4_91 EDN: OFQZZH
  20. Blagoveshchenskaya O, Ilyina T, Durneva E, Krasnova M. Analysis of the Russian and world marker of telemedicine and biochipping: features and development prospects. In: Springer proceedings in business and economics. Berlin: Springer Science and Business Media B.V.; 2019. P. 77–88. doi: 10.1007/978-3-030-26284-6_8 EDN: CUMGUH
  21. Razgildieva MB, Malysheva AA. Financial support problems that telemedicine faces in Russia. In: European proceedings of social and behavioural sciences. London: European Publisher; 2022. P. 509–514. doi: 10.15405/epsbs.2022.01.81 EDN: SBXHFD
  22. Blagoveshchenskaya O, Ilina T, Zemtsov A. Methodological approaches to assessing the investment attractiveness of telemedicine. In: SHS WEB OF CONFERENCES. XVII International conference of students and young scientists “Prospects of fundamental sciences development” (PFSD-2020). Vol. 80. 2020. Parc d'Activité de Courtabœuf: EDP SCIENCES; 2020. P. 01005. doi: 10.1051/shsconf/20208001005 EDN: AGCCOW
  23. Kamrujjaman MD, Demetriou C, Cuartas Álvarez T, Castro Delgado R. The role of social work for emergency medical services (EMS): a systematic review. Prehosp Disaster Med. 2023;38(5):628–635. doi: 10.1017/s1049023x23006143 EDN: NPKHGJ
  24. Şahin D, Firat S, Gezici N. The effect of healthcare professionals’ digital literacy and knowledge of telemedicine on perception of telemedicine. International journal of health management and tourism. 2023;8(3):228–240. doi: 10.31201/ijhmt.1326835 EDN: OQCTWA
  25. Amadi-Obi A, Gilligan P, Owens N, O'Donnell C. Telemedicine in pre-hospital care: a review of telemedicine applications in the pre-hospital environment. Int J Emerg Med. 2014;7:29. doi: 10.1186/s12245-014-0029-0 EDN: JAQXPN
  26. Morozov SP, Vladzymyrskyy AV, Simenyura SS. The quality of primary direct-to-consumer telemedicine consultations (by results of testing telemedicine services). Medical doctor and IT. 2020;(1):52–62. doi: 10.37690/1811-0193-2020-152-62 EDN: IMULFW
  27. Lochmannová A, Šimon M, Hořejší P, et al. The use of virtual reality in training paramedics for a mass casualty incident. Applied sciences. 2022;12(22):11740. doi: 10.3390/app122211740 EDN: PXCMSI
  28. Sokolova E, Semenova A, Drozdova N, Sklyar T. Demand factors for telemedicine services in the Russian Federation. In: GSOM emerging markets conference 2022. Conference book. 2022. Saint Peterburg: St. Petersburg State University Graduate School of Management; 2022. P. 227–233. EDN: FFKROC
  29. Vladzymyrskyy A, Jordanova M, Lievens F. A century of telemedicine: curatio sine distantia et tempora. Sofia: Malina Jordanova, Publisher; 2016. 345 p. ISBN: 978-619-90601-0-0 EDN: QSKHXR
  30. Kho J, Gillespie N, Martin-Khan M. A systematic scoping review of change management practices used for telemedicine service implementations. BMC Health Serv Res. 2020;20(1):815. doi: 10.1186/s12913-020-05657-w EDN: UNOYQA
  31. Levanov VM, Pereslegina IA, Bezrukova VK, Zhidkov IM. Experience in using telemedicine technologies at paramedic and midwifery stations in rural areas with low population density. Russian journal of telemedicine and eHealth. 2020;(1):26–35. doi: 10.29188/2542-2413-2020-6-1-26-35 EDN: KAIEBX
  32. Fatenkov OV, Dyachkov VA, Kshnyakin PA, et al. Decade of remote monitoring for patients with chronic heart failure: an analysis of publications on the use of telemedicine technologies. Bulletin of the Medical Institute 'REAVIZ: Rehabilitation, Doctor, and Health. 2025;15(2):105–112. doi: 10.20340/vmi-rvz.2025.2.CLIN.6 EDN: RTPXEO
  33. Kovelkova MN, Iakovleva EG. Artificial intelligence in the prevention and diagnosis of cardiovascular diseases in Russia (literature review). The Siberian journal of clinical and experimental medicine. 2025;40(1):28–41. doi: 10.29001/2073-8552-2025-40-1-28-41 EDN: ZKPMNP
  34. Koehler F, Koehler K, Deckwart O, et al. Efficacy of telemedical interventional management in patients with heart failure (TIM-HF2): a randomised, controlled, parallel-group, unmasked trial. Lancet. 2018;392(10152):1047–1057. doi: 10.1016/S0140-6736(18)31880-4
  35. Umeh CA, Torbela A, Saigal S, et al. Telemonitoring in heart failure patients: systematic review and meta-analysis of randomized controlled trials. World J Cardiol. 2022;14(12):640–656. doi: 10.4330/wjc.v14.i12.640 EDN: XHGRIG
  36. Masterson Creber R, Dodson JA, Bidwell J, et al; American heart association cardiovascular disease in older populations committee of the council on clinical cardiology and the council on cardiovascular and stroke nursing; council on quality of care and outcomes research; and council on peripheral vascular disease. Telehealth and health equity in older adults with heart failure: a scientific statement from the American heart association. Circ Cardiovasc Qual Outcomes. 2023;16(11):e000123. doi: 10.1161/HCQ.0000000000000123 EDN: GOQXVP
  37. Gorenkov RV, Iwanitsky LV, Pozharov IV, et al. Medical telepatronage as a health-saving technology in the management of patients with chronic non-communicable diseases. Klinicheskaya farmakologiya i terapiya. 2021;30(2):51–58. doi: 10.32756/0869-5490-2021-2-51-58 EDN: GPUUWP
  38. Fedorov VF, Stolyar VL. Personal telemedicine. Prospects for implementation. Medical doctor and IT. 2020;(2):36–44. doi: 10.37690/1811-0193-2020-2-36-44 EDN: VTUCBD
  39. Mroczek B, Brzeźniak H, Wolińska W, et al. Social skills contributing to the behaviors of physicians, nurses, and paramedics in various professional situations. Family medicine and primary care review. 2020;22(2):126–132. doi: 10.5114/fmpcr.2020.95321 EDN: QBOZNB
  40. O'Connor S. Virtual reality and avatars in health care. Clin Nurs Res. 2019;28(5):523–528. doi: 10.1177/1054773819845824
  41. Grigorieva NS, Demkina AE, Korobeynikova AN. Digitalization in the Russian healthcare: barriers to digital maturity. Population and economics. 2024;8(1):1–14. doi: 10.3897/popecon.8.e111793 EDN: AKZFIN
  42. Vakhnenko YV, Tarasyuk ES, Tarasyuk SD. Remote monitoring of patients with chronic heart failure—rationale of application, results and prospects (literature review). Current problems of health care and medical statistics. 2025;(3):909–928. doi: 10.24412/2312-2935-2025-3-909-928 EDN: UJYPHV
  43. Nasonova SN, Lapteva AE, Zhirov IV, et al. Remote monitoring of patients with heart failure in real clinical practice. Kardiologiia. 2021;61(8):76–86. doi: 10.18087/cardio.2021.8.n1683 EDN: GRIBYY
  44. Garanin AA, Mullova IS, Shkaeva OV, et al. Remote monitoring of outpatients discharged from the emergency cardiac care department. Russian journal of cardiology. 2022;27(3S):5072. doi: 10.15829/1560-4071-2022-5072 EDN: BIRQPJ
  45. Blankova ZN, Svirida ON, Vinogradova NG, et al. Telephone monitoring of patients with chronic heart failure. Survey of nursing staff in Russian clinics. Russian cardiology bulletin. 2025;20(2):54–60. doi: 10.17116/Cardiobulletin20252002154 EDN: URENHP
  46. Kostyaev AI. Digital inequality between urban and rural population. Economic and social changes: facts, trends, forecast. 2024;17(3):50–67. doi: 10.15838/esc.2024.3.93.3 EDN: JHOZXJ
  47. Galstyan AG, Martirosyan VA. Analysis of the digital medicine market in Russia and forecasts of its development. Age of quality. 2025;(1):46–75. EDN: XJVJJA
  48. Bratishko NP, Moiseenko AA. Digital transformation of the Russian healthcare system. Economics and management. 2025;(1(52)):19–26. doi: 10.21777/2587-554X-2025-1-19-26 EDN: SYZTRX
  49. Mikheev AE. Prospects for the creation of digital medical ecosystems in Russia: digital twins and other technologies, problems and approaches. Manager zdravoohranenia. 2024;S13:4–32. doi: 10.21045/1811-0185-2024-S-4-32 EDN: ILLTYU
  50. Kaminer DD, Milushkina OYu, Sheina NI, et al. Digitalization of healthcare and health status of medical workers. Russian journal of occupational health and industrial ecology. 2023;63(8):490–502. doi: 10.31089/1026-9428-2023-63-8-490-502 EDN: KQQYCS

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