Continuity, but at what cost? The impact of telemonitoring COPD on continuities of care: a qualitative study

Fairbrother, Peter; Pinnock, Hilary; Hanley, James A.; McCloughan, Lucy; Sheikh, Aziz; Pagliari, Claudia; McKinstry, Brian

doi:10.4104/pcrj.2012.00068

Cited by 67 publications

(95 citation statements)

References 12 publications

(15 reference statements)

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“…34 Wootton 35 conducted a literature review on the use of telemedicine for the most common chronic diseases over the last 20 years and concluded that the evidence base for the value of telemedicine in managing chronic diseases is weak and contradictory. 19,36 Common among this and our previous studies are the patients' experiences of improved communication with, and trust toward, the professional caregivers and a sense of increased security. However, the success of telehealth depends on several factors, of which the type of technology is one.…”

Section: Discussionsupporting

confidence: 52%

Old—and With Severe Heart Failure

Lind

Carlgren

Karlsson

2016

CIN: Computers, Informatics, Nursing

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Telehealth programs for heart failure have been studied using a variety of techniques. Because currently a majority of the elderly are nonusers of computers and Internet, we developed a home telehealth system based on digital pen technology. Fourteen patients (mean age, 84 years [median, 83 years]) with severe heart failure participated in a 13-month pilot study in specialized homecare. Participants communicated patient-reported outcome measures daily using the digital pen and health diary forms, submitting a total of 3 520 reports. The reports generated a total of 632 notifications when reports indicated worsening health. Healthcare professionals reviewed reports frequently, more than 4700 times throughout the study, and acted on the information provided. Patients answered questionnaires and were observed in their home environment when using the system. Results showed that the technology was accepted by participants: patients experienced an improved contact with clinicians; they felt more compliant with healthcare professionals' advice, and they felt more secure and more involved in their own care. Via the system, the healthcare professionals detected heart failure-related deteriorations at an earlier stage, and as a consequence, none of the patients were admitted into hospital care during the study.

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Section: Discussionsupporting

confidence: 52%

Old—and With Severe Heart Failure

Lind

Carlgren

Karlsson

2016

CIN: Computers, Informatics, Nursing

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“…; Mair, Hiscock, and Beaton ; Fairbrother et al. , ). After all, daily in‐home visits are not feasible, especially when patients live in remote or rural areas.…”

Section: Resultsmentioning

confidence: 99%

“…Knowing the patient allowed for contextualizing the tele‐homecare data relative to the individual patient's current health status, capability, and situation as well as for targeting nursing interventions to the patient's specific needs (Fairbrother et al. , ; Peeters et al. ; Sanders et al.…”

Section: Resultsmentioning

confidence: 99%

Barriers and Facilitators for Sustainability of Tele‐Homecare Programs: A Systematic Review

Radhakrishnan

Xie

Berkley³

et al. 2015

Health Services Research

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Objective. To identify the barriers and facilitators for sustainability of tele-homecare programs implemented by home health nursing agencies for chronic disease management. Data Sources. English-language articles on home telehealth in the CINAHL, PubMed/MEDLINE, PsychInfo, Web of Science, and Cochrane Reviews databases published from January 1996 to December 2013. Study Design. We performed a systematic literature review. Data extraction using PRISMA guidelines and quality appraisal using the Mixed Methods Appraisal Tool (MMAT) were conducted on relevant empirical studies. Thematic analysis across the studies and narrative summaries were used to synthesize the findings from the included studies. Principal Findings. Of the initial 3,920 citations, we identified 16 articles of moderate quality meeting our inclusion criteria. Perceptions on effectiveness of tele-homecare programs for achieving intended outcomes; tailoring of tele-homecare programs to patient characteristics and needs; relationship and communication between patient, nurse, and other health care professional users of tele-homecare; home health organizational process and culture; and technology quality, capability, and usability impacted the sustainability of tele-homecare programs. Conclusions. The findings of this systematic review provide implications for sustained usage of tele-homecare programs by home health nursing agencies and can help such programs realize their potential for chronic disease management.

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“…In our outpatient setting, COPD patients depending on disease severity are evaluated 1-4 times per year (meaning 0.5-2 h of consultations per year). According to our national reimbursement system, with our proposed system it would cost 80 Swiss francs per patient-year to detect one AECOPD early, so that the herein expended effort is not disproportionate, which has been a possible concern [10,12,17]. It is also conceivable to replace outpatient visits in stable patients by THC in the future to save resources.…”

Section: Discussionmentioning

confidence: 99%

Telehealthcare for Chronic Obstructive Pulmonary Disease in Switzerland Is Feasible and Appreciated by Patients

et al. 2016

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Background: Earlier detection of acute exacerbations (AE) of chronic obstructive pulmonary disease (COPD) could reduce emergency admissions and hospitalisations. Studies investigating COPD management programs supported by telehealthcare (THC) have shown conflicting results. Objectives: To test the feasibility, safety and acceptance of THC for COPD. Methods: Patients daily filled out an online questionnaire focused on the detection of AECOPD. The THC platform is integrated in a comprehensive electronic patient data repository, which has to be available for all patients in Switzerland by law by 2017. The study team called the patient by phone in case of suspected AECOPD. Results: Of 339 screened patients, 14% were included. Main reasons for exclusion were missing technical equipment and unwillingness to participate in a study (50%). Data completeness was 88%; 94% completed the study. The current THC approach triggered 230 telephone calls, which led to the verification of 60 AECOPD in 22 patients. Three AECOPD were not detected. Sensitivity, specificity, positive and negative predictive value of the questionnaire-based THC approach in detecting AECOPD was 95, 98, 26 and 99.9%, respectively. Overall patient satisfaction in respect to their health condition improved significantly (VAS 8-8.7; p = 0.002). Conclusions: Adding THC to state-of-the-art COPD management is feasible in a selected subgroup of patients. We estimate that up to 50% of COPD patients could be eligible for a THC strategy. Patient compliance, acceptance and satisfaction were very high. With the proposed approach, we missed only very few AECOPD events. However, a telephone-based verification of THC alerts was required. Overall, in this proof-of-concept study, we experienced a positive effort-to-benefit ratio.

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Continuity, but at what cost? The impact of telemonitoring COPD on continuities of care: a qualitative study

Abstract: Managers and healthcare professionals face major challenges in meeting demands for both relationship continuity and continuity of clinical management in the development of telemonitoring services.

Cited by 67 publications

References 12 publications

Old—and With Severe Heart Failure

Old—and With Severe Heart Failure

Barriers and Facilitators for Sustainability of Tele‐Homecare Programs: A Systematic Review

Telehealthcare for Chronic Obstructive Pulmonary Disease in Switzerland Is Feasible and Appreciated by Patients

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