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. 2012 Mar;21(1):57-64.
doi: 10.4104/pcrj.2011.00065.

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

Jenny Ure  1 , Hilary Pinnock, Janet Hanley, Gillian Kidd, Emily McCall Smith, Alex Tarling, Claudia Pagliari, Aziz Sheikh, William MacNee, Brian McKinstry
Affiliations

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

Jenny Ure et al. Prim Care Respir J. 2012 Mar.

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.

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Conflict of interest statement

Although supported by Intel and Tunstall, neither organisation had influence on the design, conduct or reporting of the study. AS is a consultant to ALK and Phadia. He has advised the Scottish Government and House of Lords Allergy Inquiry. He is the Royal College of General Practitioners Clinical Champion in Allergy. AS is the Joint Editor-in-Chief of the PCRJ, but was not involved in the editorial review of, nor the decision to publish, this article.

Figures

Figure 1
Figure 1. The chronic disease management pyramid showing the boundary between professional and self-care (reproduced with permission from Kielmann et al.)
Figure 2
Figure 2. The COPD tele-monitoring system
Figure 3
Figure 3. NHS Lothian Telehealth Project Call Centre algorithm
Figure 4
Figure 4. Number of emergency prescriptions issued during the pilot study (2008) and to the same patients in the same 6- month period in 2007
Figure 5
Figure 5. Number of primary care consultations for COPD during the pilot study (2008) and in the same 6-month period in 2007
Figure 6
Figure 6. Use of secondary care services for COPD during the pilot study (2008) and in the same 6-month period in 2007
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Comment in

References

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    1. Department of Health. Our Health, Our Care, Our Say: A New Direction for Community Services. London: The Stationery Office, 2006. - PubMed
    1. Scottish Executive Health Department. A National Framework for Service Change in the NHS in Scotland. Building a Health Service Fit for the Future. Edinburgh: Scottish Executive, 2005.
    1. Department of Health. The Expert Patient: A New Approach to Chronic Disease Management for the 21st Century. London: Department of Health, 2001.
    1. Scottish Executive Health Department. Delivering for Health. Edinburgh: Scottish Executive, 2005.

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