Experiences of Complex Patients With Telemonitoring in a Nurse-Led Model of Care: Multimethod Feasibility Study

Gordon, Kayleigh; Dainty, Katie N.; Gray, Carolyn Steele; DeLacy, Jane; Shah, Amika; Resnick, Myles; Seto, Emily

doi:10.2196/22118

Cited by 9 publications

(9 citation statements)

References 64 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Office workers accepted and adopted the WorkMyWay system, as demonstrated with a 100% retention with an 8-week delivery protocol and 83% (25/30) adherence on tracking, which were exemplary for technology-based interventions compared with previous studies [31,41]. Bluetooth disconnection was identified as the major issue impacting on the quality of data and fidelity of delivery, echoing observations from other studies on digital interventions [42]. Nonetheless, this did not deter our participants, as 73% (11/15) continued to use WorkMyWay in their own interests after the study ended.…”

Section: Principal Findingsmentioning

confidence: 68%

Feasibility and Acceptability of an Internet of Things–Enabled Sedentary Behavior Intervention: Mixed Methods Study

Huang¹,

Benford²,

Price³

et al. 2023

J Med Internet Res

View full text Add to dashboard Cite

Background Encouraging office workers to break up prolonged sedentary behavior (SB) at work with regular microbreaks can be beneficial yet challenging. The Internet of Things (IoT) offers great promise for delivering more subtle and hence acceptable behavior change interventions in the workplace. We previously developed an IoT-enabled SB intervention, called WorkMyWay, by applying a combination of theory-informed and human-centered design approaches. According to the Medical Research Council’s framework for developing and evaluating complex interventions such as WorkMyWay, process evaluation in the feasibility phase can help establish the viability of novel modes of delivery and identify facilitators and barriers to successful delivery. Objective This study aims to evaluate the feasibility and acceptability of the WorkMyWay intervention and its technological delivery system. Methods A mixed methods approach was adopted. A sample of 15 office workers were recruited to use WorkMyWay during work hours for 6 weeks. Questionnaires were administered before and after the intervention period to assess self-report occupational sitting and physical activity (OSPA) and psychosocial variables theoretically aligned with prolonged occupational SB (eg, intention, perceived behavioral control, prospective memory and retrospective memory of breaks, and automaticity of regular break behaviors). Behavioral and interactional data were obtained through the system database to determine adherence, quality of delivery, compliance, and objective OSPA. Semistructured interviews were conducted at the end of the study, and a thematic analysis was performed on interview transcripts. Results All 15 participants completed the study (attrition=0%) and on average used the system for 25 tracking days (out of a possible 30 days; adherence=83%). Although no significant change was observed in either objective or self-report OSPA, postintervention improvements were significant in the automaticity of regular break behaviors (t14=2.606; P=.02), retrospective memory of breaks (t14=7.926; P<.001), and prospective memory of breaks (t14=–2.661; P=.02). The qualitative analysis identified 6 themes, which lent support to the high acceptability of WorkMyWay, though delivery was compromised by issues concerning Bluetooth connectivity and factors related to user behaviors. Fixing technical issues, tailoring to individual differences, soliciting organizational supports, and harnessing interpersonal influences could facilitate delivery and enhance acceptance. Conclusions It is acceptable and feasible to deliver an SB intervention with an IoT system that involves a wearable activity tracking device, an app, and a digitally augmented everyday object (eg, cup). More industrial design and technological development work on WorkMyWay is warranted to improve delivery. Future research should seek to establish the broad acceptability of similar IoT-enabled interventions while expanding the range of digitally augmented objects as the modes of delivery to meet diverse needs.

show abstract

Section: Principal Findingsmentioning

confidence: 68%

Feasibility and Acceptability of an Internet of Things–Enabled Sedentary Behavior Intervention: Mixed Methods Study

Huang¹,

Benford²,

Price³

et al. 2023

J Med Internet Res

View full text Add to dashboard Cite

show abstract

“…In contrast to the fee-for-service model for physicians, all HCPs in this study noted that the salaried remuneration of nurses offered greater flexibility needed to monitor patients with MCCs through telemonitoring. Indeed, when the same MCC telemonitoring system was applied in a different study within a multidisciplinary nurse-led model of care [51], telemonitoring was not only perceived positively by patients with MCCs but was also normalized within their daily life and routines [52], which was a finding that was only observed among the patients with HF and HCPs in this trial, who also benefited from a nurse-led model. What may explain the stark contrast in the results between these studies is the differences in their underlying program theory.…”

Section: Principal Findingsmentioning

confidence: 71%

Challenges of Telemonitoring Programs for Complex Chronic Conditions: Randomized Controlled Trial With an Embedded Qualitative Study

Ware¹,

Shah²,

Ross³

et al. 2022

J Med Internet Res

View full text Add to dashboard Cite

Background Despite the growing prevalence of people with complex conditions and evidence of the positive impact of telemonitoring for single conditions, little research exists on telemonitoring for this population. Objective This randomized controlled trial and embedded qualitative study aims to evaluate the impact on and experiences of patients and health care providers (HCPs) using a telemonitoring system with decision support to manage patients with complex conditions, including those with multiple chronic conditions, compared with the standard of care. Methods A pragmatic, unblinded, 6-month randomized controlled trial sought to recruit 146 patients with ≥1 diagnosis of heart failure (HF), uncontrolled hypertension (HT), and insulin-requiring diabetes mellitus (DM) from outpatient specialty settings in Toronto, Ontario, Canada. Participants were randomized into the control and telemonitoring groups, with the latter being instructed to take readings relevant to their conditions. The telemonitoring system contained an algorithm that generated decision support in the form of actionable self-care directives to patients and alerts to HCPs. The primary outcome was health status (36-Item Short Form Health Survey questionnaire). Secondary outcomes included anxiety and depression, self-efficacy in chronic disease management, and self-reported health service use. HF-related quality of life and self-care measures were also collected from patients followed for HF. Within- and between-group change scores were analyzed for statistical significance (P<.05). A convenience sample of HCPs and patients in the intervention group was interviewed about their experiences. Results A total of 96 patients were recruited and randomized. Recruitment was terminated early because of implementation challenges and the onset of the COVID-19 pandemic. No significant within- and between-group differences were found for the main primary and secondary outcomes. However, a within-group analysis of patients with HF found improvements in self-care maintenance (P=.04) and physical quality of life (P=.046). Opinions expressed by the 5 HCPs and 13 patients who were interviewed differed based on the monitored conditions. Although patients with HF reported benefitting from actionable self-care guidance and meaningful interactions with their HCPs, patient and HCP users of the DM and HT modules did not think telemonitoring improved the clinical management of those conditions to the same degree. These differing experiences were largely attributed to the siloed nature of specialty care and the design of the decision support, whereby fluctuations in the status of HT and DM typically required less urgent interventions compared with patients with HF. Conclusions We recommend that future research conceive telemonitoring as a program and that self-management and clinical decision support are necessary but not sufficient components of such programs for patients with complex conditions and lower acuity. We conclude that telemonitoring for patients with complex conditions or within multidisciplinary care settings may be best operationalized through nurse-led models of care. Trial Registration ClinicalTrials.gov NCT03127852; https://clinicaltrials.gov/ct2/show/NCT03127852 International Registered Report Identifier (IRRID) RR2-10.2196/resprot.8367

show abstract

“…Although specialist appointments and routine primary care visits were not halted during the study period, the NP-led care model was intended to be the central coordinator for care, aiming to achieve clinical stabilization and optimization before repatriation back to routine primary care. In 2019, the smartphone-based TM platform Medly was integrated into the NP-led CCC model, enabling patients with multimorbidities including heart failure (HF), hypertension (HTN), and/or diabetes mellitus (DM) to record physiological metrics including blood pressure, weight, heart rate, blood sugar, and symptoms [42]. Although this list is not inclusive of all conditions associated with multimorbidity, they are common conditions that can be used as a foundation to realize a broader conceptualization of the tool in the future.…”

Section: Study Settingmentioning

confidence: 99%

“…Because of the importance of nurses' role in the delivery of care in this model, it was important to understand their perspectives on implementing and using multicondition TM systems over 6 months and identify any barriers or facilitators. The feasibility and patient adherence to TM in nurse-led care, as well as the characteristics of the patients who used the TM app in the model have already been published [42].…”

Section: Introductionmentioning

confidence: 99%

Normalizing Telemonitoring in Nurse-Led Care Models for Complex Chronic Patient Populations: Case Study

Gordon¹,

Seto²,

Dainty³

et al. 2022

JMIR Nursing

Self Cite

View full text Add to dashboard Cite

Background The implementation of telemonitoring (TM) has been successful in terms of the overall feasibility and adoption in single disease care models. However, a lack of available research focused on nurse-led implementations of TM that targets patients with multiple and complex chronic conditions (CCC) hinders the scale and spread to these patient populations. In particular, little is known about the clinical perspective on the implementation of TM for patients with CCC in outpatient care. Objective This study aims to better understand the perspective of the clinical team (both frontline clinicians and those in administrative positions) on the implementation and normalization of TM for complex patients in a nurse-led clinic model. Methods A pragmatic, 6-month implementation study was conducted to embed multicondition TM, including heart failure, hypertension, and diabetes, into an integrated nurse-led model of care. Throughout the study, clinical team members were observed, and a chart review was conducted of the care provided during this time. At the end of the study, clinical team members participated in qualitative interviews and completed the adapted Normalization Measure Development questionnaires. The Normalization Process Theory guided the deductive data analysis. Results Overall, 9 team members participated in the study as part of a larger feasibility study of the TM program, of which 26 patients were enrolled. Team members had a shared understanding of the purpose and value of TM as an intervention embedded within their practice to meet the diverse needs of their patients with CCC. TM aligned well with existing chronic care practices in several ways, yet it changed the process of care delivery (ie, interactional workability subconstruct). Effective TM normalization in nurse-led care requires rethinking of clinical workflows to incorporate TM, relationship development between the clinicians and their patients, communication with the interdisciplinary team, and frequent clinical care oversight. This was captured well through the subconstructs of skill set workability, relational integration, and contextual integration of the Normalization Process Theory. Conclusions Clinicians successfully adopted TM into their everyday practice such that some providers felt their role would be significantly and negatively affected without TM. This study demonstrated that smartphone-based TM systems complemented the routine and challenging clinical work caring for patients with CCC in an integrated nurse-led care model.

show abstract

Experiences of Complex Patients With Telemonitoring in a Nurse-Led Model of Care: Multimethod Feasibility Study

Cited by 9 publications

References 64 publications

Feasibility and Acceptability of an Internet of Things–Enabled Sedentary Behavior Intervention: Mixed Methods Study

Feasibility and Acceptability of an Internet of Things–Enabled Sedentary Behavior Intervention: Mixed Methods Study

Challenges of Telemonitoring Programs for Complex Chronic Conditions: Randomized Controlled Trial With an Embedded Qualitative Study

Normalizing Telemonitoring in Nurse-Led Care Models for Complex Chronic Patient Populations: Case Study

Contact Info

Product

Resources

About