Comparison of patient perceptions of Telehealth-supported and specialist nursing interventions for early stage COPD: a qualitative study

Abstract

BackgroundThe increasing prevalence and associated cost of treating Chronic Obstructive Pulmonary Disease (COPD) is unsustainable, and focus is needed on self-management and prevention of hospital admissions. Telehealth monitoring of patients’ vital signs allows clinicians to prioritise their workload and enables patients to take more responsibility for their health. This paper reports the results of a qualitative study embedded within a feasibility and pilot Randomised Controlled Trial (RCT) of Telehealth-supported care within a community-based COPD supported-discharge service. The aim of the study was to qualitatively explore the experiences of patients with COPD who had received either a Telehealth-supported or a specialist nursing intervention following their discharge from hospital after an admission for a COPD exacerbation.MethodsPatients were invited to either participate in semi-structured interviews or to complete a semi-structured self-administered questionnaire on completion of the intervention. Nine patients were interviewed (67 % female) and seventeen patients completed the questionnaires. In addition, three clinicians responsible for the delivery of both interventions were interviewed to obtain their perspectives on the new services.ResultsSeven underlying themes emerged from the patient interviews and were further explored in the questionnaires: (1) patient demographics; (2) information received by the participants; (3) installation of the Telehealth technology; (4) Telehealth service functionality; (5) visits; (6) service withdrawal; and (7) service perceptions. Recipients of both services reported feelings of safety derived from the delivery of an integrated, community-based service.ConclusionsAlthough recipients of the Telehealth service received 50 % fewer home visits from the clinicians than recipients of a more traditional community-based nursing intervention, the patients were enthusiastic about the service, with some describing it as the best service they had ever received. This suggests that a Telehealth intervention is an acceptable alternative to a more traditional home nursing visit model for monitoring community-based patients with COPD following their discharge from hospital.Trial registrationCurrent Controlled Trials ISRCTN68856013Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1623-z) contains supplementary material, which is available to authorized users.

Does Telehealth Monitoring Identify Exacerbations of Chronic Obstructive Pulmonary Disease and Reduce Hospitalisations? An Analysis of System Data

“…The ease of use of the equipment was later confirmed in interviews with the patients following completion of the intervention and discharge from the clinical service [23]. …”

A sense of belonging: A meta‐ethnography of the experience of patients with chronic obstructive pulmonary disease receiving care through telemedicine

“…The studies were of moderate to high quality. Two of the studies (Fitzsimmons, Thompson, Bentley, & Mountain, 2016;Mathar, Fastholm, & Sandholm, 2015) were appraised as low quality because of insufficient analytic rigor; however, their findings were similar to those of the studies of strong quality, so were included in the review. During the quality appraisal, we found limited reporting of ethics and descriptions of the analysis process in several studies, but most had a clear statement of findings.…”

“…Despite the distance, patients in 10 studies experienced digital proximity (Table 4). The experience of digital proximity was described as a feeling of being watched over (Fairbrother et al, 2012;Ure et al, 2012;Williams et al, 2014) that provided safety (Fitzsimmons et al, 2016) and reassurance (Fairbrother et al, 2013;Williams et al, 2014) and reduced worry and was explained as "sort of a lifeline" (Gorst et al, 2016). Digital proximity was further strengthened when performing video consultations as part of the TM intervention (Barken et al, 2018;Mathar et al, 2015;Nissen & Lindhardt, 2017;Vatnøy et al, 2017).…”

“…Failure of technology was another restriction (Barken et al, 2018;Fitzsimmons et al, 2016;Ure et al, 2012). Furthermore, some participants commented on removal of TM equipment (Fitzsimmons et al, 2016) when they were dependent on the technology as well as a need to "rewire the panic button again" (Gale & Sultan, 2013).…”

Developing a strategic understanding of telehealth service adoption for COPD care management: A causal loop analysis of healthcare professionals

“…In all CLDs, "Adoption by patient" or "Perceived value by patient" was a variable affecting other variables, indirectly leading to intervention adoption. This suggests that patients should not only participate in pilot studies, [43,45] but participate as well in change management procedures.…”