Piloting tele-monitoring in COPD: a mixed methods exploration of issues in design and implementation

Ure, Jenny; Ure, Jenny P; Pinnock, Hilary; Hanley, Janet; Kidd, Gillian; Smith, Emily McCall; Tarling, Alex; Pagliari, Claudia; Sheikh, Aziz; MacNee, William; McKinstry, Brian

Abstract

Background: In 2008 NHS Lothian implemented a COPD tele-monitoring service incorporating a touch-screen computer for daily
recording of symptoms and weekly oximetry and spirometry measurement. Data were transmitted by secure broadband link to a call centre where trained workers monitored data and contacted clinicians according to an agreed algorithm.

Aims: To explore the perceptions of patients and professionals about the pilot implementation of the COPD tele-monitoring service.

Methods: In-depth interviews were undertaken with patients and professionals before and after installation of the tele-monitoring equipment. Interviews were recorded, transcribed and thematically analysed. Data on use of healthcare resources were obtained from primary care records.

Results: Twenty of the 27 patients in the pilot and 25 professionals participated. (n=55 interviews and one focus group). Patients were generally positive about the technology, which they perceived enabled earlier recognition of exacerbations and facilitated access to clinical advice. In contrast, clinicians had concerns about false positive symptom scores, difficulties in interpreting physiological data, overtreatment (reflected in a large increase in antibiotics and steroid prescribing), and an increased workload.

Conclusions: Tele-monitoring was perceived by patients as improving access to professional care, but raised concerns for clinicians about possible over-treatment and how best to organise services to support the technology.

Citation

Ure, J., Ure, J. P., Pinnock, H., Hanley, J., Kidd, G., Smith, E. M., …McKinstry, B. (2012). Piloting tele-monitoring in COPD: a mixed methods exploration of issues in design and implementation. Primary Care Respiratory Journal, 21(1), 57-64. https://doi.org/10.4104/pcrj.2011.00065

• Journal Article Type: Article
• Online Publication Date: Jul 22, 2011
• Publication Date: 2012
• Deposit Date: Jun 21, 2013
• Print ISSN: 1471-4418
• Electronic ISSN: 1475-1534
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 21
• Issue: 1
• Pages: 57-64
• DOI: https://doi.org/10.4104/pcrj.2011.00065
• Keywords: COPD; exacerbation; primary care; qualitative; quantitative; Telehealth
• Public URL: http://researchrepository.napier.ac.uk/id/eprint/6135
• Publisher URL: http://dx.doi.org/10.4104/pcrj.2011.00065