Despite these caveats, the study reports are themselves positive about their results. However, given the risk of bias in the design and scale of the evaluations we conclude that the benefit of telemonitoring for COPD is not yet proven and that further work is required before wide-scale implementation be supported.
To develop effective telemonitoring for patients with chronic disease, more attention needs to be given to agreeing the central aim of early detection and, to ensure potential implementation, engaging a wide range of stakeholders in the design process, especially patients and clinicians.
Patients with chronic disease may suffer frequent acute deteriorations and associated increased risk of hospitalisation. Earlier detection of these could enable successful intervention, improving patients' well-being and reducing costs; however, current telemonitoring systems do not achieve this effectively. We conducted a qualitative study using stakeholder interviews to define current standards of care and user requirements for improved early detection telemonitoring. We determined that early detection is not a concept that has informed technology or service design and that telemonitoring is driven by the available technology rather than by users' needs. We have described a set of requirements questions to inform the design and implementation of telemonitoring systems and suggested the research needed to develop successful early detection telemonitoring. User-centred design and genuine interdisciplinary approaches are needed to create solutions that are fit for purpose, sustainable and address the real needs of patients, clinicians and healthcare organisations.
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