Background The TELESCOT randomised control trial, is investigating the impact of a telemonitoring service for COPD with the primary aim of reducing hospitalisation.
Aim The nested qualitative study explored the views of patients and professionals on models of telemetric service delivery and the impact on self-management.
Method Semi-structured interviews with patient and professional participants at different time points in the TELESCOT trial were transcribed, coded and analysed thematically. Interpretation was supported by multidisciplinary discussion.
Results 38 patients (47% male, mean age 67.5 years) and 32 healthcare professionals provided 70 interviews. Both patients and professionals considered that home telemonitoring had the potential to reduce the risk of hospital admission.
Patients generally appreciated being ‘watched over’ by the telemonitoring, which gave them confidence to manage their own condition. They used tele-data to improving their understanding of COPD, determine their current state of health and influence decisions about their daily activities. Numerical data (e.g. oxygen saturations) were particularly valued. Changes in readings validated their decisions to adjust treatment or seek timely professional advice, and eased access to clinical care.
Professionals emphasised the potential role of telemetry in encouraging prompt compliance with medically defined behaviours and attitudes, though there was concern that ‘fixation’ on monitoring physiological parameters (especially oxygen saturation levels), promoted a medical model of the disease and might increase dependence on services in some patients.
The GPs and community nursing or physiotherapy teams who provided home telemonitoring support services emphasised the importance of ‘knowing the patient’ and ‘knowing what’s normal for the individual’ in using their clinical skills to interpret incoming telemonitoring data.
Conclusion Enthusiasm for telemonitoring as a means of facilitating self-management and thereby reducing admissions is tempered by concerns about increased medicalisation and dependence on support services. Tele-monitoring provides data which can be used to support self-management decisions and act as a channel for seeking professional support. The patient-practitioner relationship, personalisation and continuity of care were prioritised as important elements in delivering clinical support for telemonitoring services by patients and professionals.
Funding Chief Scientist Office, Scottish Government.
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