Perceptions and Experiences of Heart Failure Patients and Clinicians on the Use of Mobile Phone-Based Telemonitoring

Abstract

BackgroundPrevious trials of heart failure telemonitoring systems have produced inconsistent findings, largely due to diverse interventions and study designs.ObjectivesThe objectives of this study are (1) to provide in-depth insight into the effects of telemonitoring on self-care and clinical management, and (2) to determine the features that enable successful heart failure telemonitoring.MethodsSemi-structured interviews were conducted with 22 heart failure patients attending a heart function clinic who had used a mobile phone-based telemonitoring system for 6 months. The telemonitoring system required the patients to take daily weight and blood pressure readings, weekly single-lead ECGs, and to answer daily symptom questions on a mobile phone. Instructions were sent to the patient’s mobile phone based on their physiological values. Alerts were also sent to a cardiologist’s mobile phone, as required. All clinicians involved in the study were also interviewed post-trial (N = 5). The interviews were recorded, transcribed, and then analyzed using a conventional content analysis approach.ResultsThe telemonitoring system improved patient self-care by instructing the patients in real-time how to appropriately modify their lifestyle behaviors. Patients felt more aware of their heart failure condition, less anxiety, and more empowered. Many were willing to partially fund the use of the system. The clinicians were able to manage their patients’ heart failure conditions more effectively, because they had physiological data reported to them frequently to help in their decision-making (eg, for medication titration) and were alerted at the earliest sign of decompensation. Essential characteristics of the telemonitoring system that contributed to improved heart failure management included immediate self-care and clinical feedback (ie, teachable moments), how the system was easy and quick to use, and how the patients and clinicians perceived tangible benefits from telemonitoring. Some clinical concerns included ongoing costs of the telemonitoring system and increased clinical workload. A few patients did not want to be watched long-term while some were concerned they might become dependent on the system.ConclusionsThe success of a telemonitoring system is highly dependent on its features and design. The essential system characteristics identified in this study should be considered when developing telemonitoring solutions.Key Words

The Evolution of mHealth Interventions in Heart Failure

“…Another telemonitoring systems with 50 HF patients determine its impact on: (i) self-care, (ii) clinical management and, (iii) health outcomes [30]. The quantitative findings revealed that the HF patients were empowered and the clinicians were able to more effectively manage these patients since patients' physiological data were at their disposal.…”

Team-Based Care for External Telemonitoring in Patients with Heart Failure

“…11,19 Patient and practitioner perceptions of telemonitoring services also varied. 20,21 Patients found it useful and reassuring that someone was paying attention to their clinical status, leading to a decrease in anxiety. Patients felt more aware of their HF condition and more empowered.…”

“…Alternatively, many patients were willing to partially fund telemonitoring for ongoing use. 21 Practitioners found telemonitoring useful and believed that it allowed patients to better manage themselves with access to ongoing physiologic data. 20 Practitioners believed red flag alerts provided an ability to leverage "teachable" moments in guiding patients to self-management, but were concerned about growing dependence on the device (reactive), rather than on self-management (proactive).…”

“…In a qualitative study, 14 of 22 patients (64%) reported a willingness to pay for the technology. 21 Some patients suggested that having to pay a nominal fee might increase adherence to obtaining measurements. Others patients, however, noted they would not have the financial means to pay for technology and believed this should be considered a medical expense that insurance companies should pay for, or that employers should fund as part of their work benefits.…”

Evaluation of a National Broadband Network-enabled Telehealth trial for older people with chronic disease

“…17 It has the potential to empower and motivate individuals, giving them greater control over their disease management. [18][19][20][21] However, a review investigating the role of knowledge, self-efficacy and self-care behaviour in Telehealth patients with heart failure concluded that there was insufficient evidence to support or disprove that clinical outcomes and quality of life are affected by these factors. 22 This paper reports the findings from the evaluation of an NBN Telehealth trial of Feros Care's My Health Clinic at Home (MHCAH) system.…”