Examining disparities relating to service reach and patient engagement with COVID-19 remote home monitoring services in England: a mixed methods rapid evaluation

Abstract

Background: The adoption of remote methods of care has been accelerated by the COVID-19 pandemic, but concerns exist relating to the potential impact on health disparities. This evaluation explores the implementation of COVID-19 remote home monitoring services across England, focussing on patients experiences and engagement with the service. Methods: The study was a rapid, multi-site, mixed methods evaluation. Data were collected between January and June 2021. We conducted qualitative interviews with staff service leads, and patients and carers receiving the service. We conducted quantitative surveys with staff delivering the service, and patients and carers receiving the service across 28 sites in England, UK. Qualitative data were analysed using thematic analysis and quantitative data were analysed using univariate and multivariate methods. Findings: Many sites designed their service to be inclusive to the needs of their local population. Strategies included widening eligibility criteria, prioritising vulnerable groups, and creating referral pathways. Many sites also adapted their services according to patient needs, including providing information in different languages or more accessible formats, offering translation services, offering non-digital options, or providing face-to-face assessments. Despite these adaptions, disparities were reported across patient groups (e.g. age, health status, ethnicity, level of education) in their experience of and engagement with the service. Interpretation: Services must determine how best to design and implement remote monitoring services to be of value to all populations. National guidance should play a role in supporting services to best serve the needs of their populations, and patients and staff must play an active role in service design.

Patients' experiences of, and engagement with, remote home monitoring services for COVID‐19 patients: A rapid mixed‐methods study

“…Our findings provide some tangible recommendations from the patients' perspective on how to improve remote home monitoring services (see Appendix ), many of which support wider themes reported in the patient experience literature (e.g., the importance of information provision) 65,66 . Our findings, together with our wider findings on effectiveness, 67,68 cost, 64 implementation, 64 workforce, 64 disparities 47 and mode, 48 may be helpful in the development of wider remote home monitoring services, for example, virtual ward services that are currently being rolled out across England for a range of conditions 69,70…”

“… In addition to the descriptive analysis presented in this manuscript, we also conducted further multivariate and univariate analyses on disparities and differences between different participant groups in relation to engagement and tech‐vs analogue modes, but these findings are presented elsewhere. 47 , 48 For data relating to patient experience and engagement, all cases were analysed (whether carer, patient or unknown). ‘Unknown’ cases refer to cases in which it was not clear whether the patient or carer had completed the survey.…”

“…In addition to the descriptive analysis presented in this manuscript, we also conducted further multivariate and univariate analyses on disparities and differences between different participant groups in relation to engagement and tech‐vs analogue modes, but these findings are presented elsewhere. 47 , 48…”

“… The quantitative survey data were analysed using SPSS statistical software (version 25). Descriptive statistics were calculated to compare patient experiences of the service across patient groups and service models (as reported by patients and carers). In addition to the descriptive analysis presented in this manuscript, we also conducted further multivariate and univariate analyses on disparities and differences between different participant groups in relation to engagement and tech‐vs analogue modes, but these findings are presented elsewhere 47,48 For data relating to patient experience and engagement, all cases were analysed (whether carer, patient or unknown).…”

Undertaking rapid evaluations during the COVID-19 pandemic: Lessons from evaluating COVID-19 remote home monitoring services in England

“…• A rapid scoping review to explore the use of COVID-19 remote home monitoring services (Vindrola-Padros et al, 2021c) • An empirical implementation study of COVID-19 remote home monitoring services in England (in 8 sites) (Vindrola-Padros et al, 2021b) Phase 2 Completed within one year-data collection took less than 6 months • Effectiveness studies of COVID-19 remote home monitoring services-we used routinely available data, hospital administrative data and other information produced by the programme to explore impact and effectiveness of services, relating to hospitalisations and mortality (Georghiou et al, 2022;Sherlaw-Johnson et al, 2022) • Cost analysis-We collected aggregated data on patient numbers, staffing models and allocation of resources from 26 sites to explore costs of setting up and running services (NIHR Rapid Service Evaluation team, 2021;Fulop et al, 2021) • National Study of implementation, patient and staff experience in England (in 28 sites)-we conducted documentary analysis, interviews with 5 national leads, surveys with staff leading and delivering services in 28 sites and surveys with patients receiving COVID-19 remote home monitoring services (Crellin et al, 2021;NIHR Rapid Service Evaluation team, 2021;Fulop et al, 2021;Herlitz et al, 2022;Sidhu et al, forthcoming a) • Case studies of implementation, patient and staff experience in England (in 17 of the 28 sites)-we conducted interviews with staff leading and delivering services and patients receiving COVID-19 remote home monitoring services (Crellin et al, 2021;NIHR Rapid Service Evaluation team, 2021;Fulop et al, 2021;Herlitz et al, 2022;Sidhu et al, forthcoming a) Care homes study Completed within 10 months-data collection took 3 months 1. When and how is pulse oximetry being employed in care homes for managing the health care of residents with COVID-19 and other health conditions?…”