Experiences and views of patients, carers and healthcare professionals on using modems in domiciliary non-invasive ventilation (NIV): a qualitative study

Abstract

BackgroundAdvances in technology means that domiciliary non-invasive ventilation (NIV) devices can be remotely monitored via modems in patients’ homes. Possible benefits and challenges of modem technology have yet to be established. This study explored the perspectives and experiences of patients, their carers and healthcare professionals (HCPs) on the addition of modem technology in managing home NIV.MethodsA qualitative study using a combination of focus groups for HCPs and interviews for carers/patients was undertaken. 12 HCPs and 22 patients/carers participated. These focus groups and interviews were audio-recorded, transcribed verbatim and analysed thematically.ResultsFive main themes were identified. ‘Surveillance: a paradox of findings’: HCPs were concerned about unduly scrutinising patients’ lives, potentially impacting on HCP patient relationships. Conversely, patients welcomed modem monitoring and did not express concerns regarding invasion of privacy. ‘Sanctions’: HCPs reported the modem increased access to care and allowed appropriate assessment of ongoing treatment. ‘Complacency and ethics’: HCPs expressed concerns patients may become complacent in seeking help due to expectations of modem monitoring, as well as being concerned regarding the ethics of modems. There was a suggestion patients and carers' expectations of monitoring were different to that of clinical practice, resulting in complacency in some cases. ‘Increased time for patient focused care’: HCPs in the focus groups described a number of ways in which using modems was more efficient. ‘Confidence: can be improved with technology’: patients and carers were positive about the impact of the modems on their health and well-being, particularly their confidence.ConclusionHCPs expressed concerns about surveillance were not corroborated by patients, suggesting acceptability of remote monitoring. Data suggests a need for increased clarity to patients/carers regarding clinical practice relating to responsiveness to modem data. The issue of complacency requires further consideration. Modem technology was acceptable and considered a useful addition by HCPs, patients and carers.Trial registration numberNCT03905382

Benefits and Challenges of Remote Patient Monitoring as Perceived by Health Care Practitioners: A Systematic Review

“…Moreover, health care practitioners mention that patients may feel they are constantly being watched, 13,18 with one study noting that this can potentially impact the patient–clinician relationship. 16 On the other hand, the health care practitioners in the study by Korpershoek et al 14 believed constant monitoring would enhance the relationship because patients will feel heard and supported by their health care practitioners through individualized care, which is in agreement with the patients’ reported perceptions. 33,34 …”

“…Mansell et al 16 recruited 12 health care practitioners to participate in being interviewed on the use of noninvasive ventilation (NIV) with a modem technology to monitor tidal volume, leak, respiratory rate, minute ventilation, patient-triggered breaths, achieved pressure, and compliance of patients diagnosed with chronic hypercapnic respiratory failure. The study found that modern technology was generally considered a feasible addition in managing home NIV that increases the patient’s access to care.…”

“… 10,11,14,15,18,20 Prompt care of patients, especially the ones with chronic conditions, allows for better outcomes and habit changes for more preventative care. Additionally, remote monitoring can decrease unnecessary clinic visits if the patient is recovering well 16,19 or, if visits do occur, the health care practitioners will be more efficient due to the supplied data. 16 For example, in a patient with a common diagnosis, such as chronic heart failure, who is monitored remotely through telemonitoring applications, clinicians are able to observe any changes in their condition throughout the week.…”

“…Additionally, remote monitoring can decrease unnecessary clinic visits if the patient is recovering well 16,19 or, if visits do occur, the health care practitioners will be more efficient due to the supplied data. 16 For example, in a patient with a common diagnosis, such as chronic heart failure, who is monitored remotely through telemonitoring applications, clinicians are able to observe any changes in their condition throughout the week. If the patient’s condition starts to deteriorate, the clinicians are able to identify it earlier and provide prompt care.…”

Telemonitoring for Home-assisted Ventilation: A Narrative Review

“…Home ventilator monthly downloads in 44 patients with chronic obstructive pulmonary disease suggested that elevated respiratory rate and percentage of patient-triggered breaths may help predict respiratory exacerbations ( 27 ). Patients, home caregivers, and clinicians reported favorable experience of cloud-based monitoring in a qualitative study ( 28 ).…”