Patients’ and carers’ experiences of, and engagement with remote home monitoring services for COVID-19 patients: a rapid mixed-methods study

Abstract

IntroductionRemote home monitoring models were implemented during the COVID-19 pandemic to shorten hospital length of stay, reduce unnecessary hospital admission, readmission and infection, and appropriately escalate care. Within these models, patients are asked to take and record readings and escalate care if advised. There is limited evidence on how patients and carers experience these services. This study aimed to evaluate patient experiences of, and engagement with, remote home monitoring models for COVID-19.MethodsA rapid mixed-methods study in England. We conducted a cross-sectional survey and interviews with patients and carers. Interview findings were summarised using rapid assessment procedures sheets and grouping data into themes (using thematic analysis). Survey data were analysed using descriptive statistics.ResultsWe received 1069 surveys (18% response rate) and conducted interviews with patients (n=59) and carers (n=3). ‘Care’ relied on support from staff members, and family/friends. Patients and carers reported positive experiences and felt that the service and human contact reassured them and was easy to engage with. Yet, some patients and carers identified problems with engagement. Engagement was influenced by: patient factors such as health and knowledge, support from family/friends and staff, availability and ease-of-use of informational and material resources (e.g. equipment), and service factors.ConclusionRemote home monitoring models place responsibility on patients to self-manage symptoms in partnership with staff; yet many patients required support and preferred human contact (especially for identifying problems). Caring burden and experiences of those living alone, and barriers to engagement should be considered when designing and implementing remote home monitoring services.Patient or public contributionFor this evaluation, members of the study team met with service user and public members of the BRACE PPI group and Health and Care Panel and patient representatives from RSET in a series of workshops. These workshops informed study design, data collection tools, data interpretation and to discuss study dissemination for Phase 2. For example, patient facing documents, such as the consent form, topic guides, patient survey and patient information sheet were reviewed by this group. Additionally, PPI members helped to pilot patient surveys and interview guides with the research team. We also asked some members of the public to pilot the patient survey. Members of the PPI group were given the opportunity to comment on the manuscript. One PPI member commented on the manuscript and the manuscript was amended accordingly.

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

“…We also consider patient feedback from interviews and open-text survey responses relating to patient views and experiences of the impact of service adaptations aimed at addressing inequalities. Details relating to patient experience and engagement, more broadly, are reported elsewhere 31 .…”

Population-level impact of a pulse oximetry remote monitoring programme on mortality and healthcare utilisation in the people with COVID-19 in England: a national analysis using a stepped wedge design

“…Sensitivity analyses considered time-varying CCG-level effects, with almost identical results compared with the primary analysis, suggesting minimal impact of time-varying differences between CCGs. Across England, CO@h sites implemented different types of model, run by different sectors of the healthcare system, and with different recommendations for the frequency of monitoring 4 8. National population effect estimates as presented here may therefore mask variation in the effectiveness between sites.…”

“…People enrolled were provided with a pulse oximeter and encouraged to record regular oxygen saturation readings with advice to call emergency services for readings of 92% or less, or to contact primary care services for readings of 93%–94%. There was no single model for CO@h, with differences across sites in how readings were recorded and reported (eg, via an app or via paper and telephone) and in the frequency of staff contact 4 7 8…”