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. 2024 Mar 7;14(3):e077196.
doi: 10.1136/bmjopen-2023-077196.

Descriptive study of the challenges when implementing an app for patients with neovascular age-related macular degeneration to monitor their vision at home

Barnaby C Reeves  1 , Robin Wickens  2 , Sean R O'Connor  3 , Eleanor Alma Gidman  2 , E Ward  2 , Charlene Treanor  3 , Tunde Peto  4 , Ben J L Burton  5 , Paul C Knox  6 , Andrew Lotery  7 , Sobha Sivaprasad  8 , Michael Donnelly  3 , Chris A Rogers  2 , Ruth E Hogg  3
Affiliations

Descriptive study of the challenges when implementing an app for patients with neovascular age-related macular degeneration to monitor their vision at home

Barnaby C Reeves et al. BMJ Open. .

Abstract

Objectives: Remote monitoring of health has the potential to reduce the burden to patients of face-to-face appointments and make healthcare more efficient. Apps are available for patients to self-monitor vision at home, for example, to detect reactivation of age-related macular degeneration (AMD). Describing the challenges when implementing apps for self-monitoring of vision at home was an objective of the MONARCH study to evaluate two vision-monitoring apps on an iPod Touch (Multibit and MyVisionTrack).

Design: Diagnostic Test Accuracy study.

Setting: Six UK hospitals.

Methods: The study provides an example of the real-world implementation of such apps across health sectors in an older population. Challenges described include the following: (1) frequency and reason for incoming calls made to a helpline and outgoing calls made to participants; (2) frequency and duration of events responsible for the tests being unavailable; and (3) other technical and logistical challenges.

Results: Patients (n=297) in the study were familiar with technology; 252/296 (85%) had internet at home and 197/296 (67%) had used a smartphone. Nevertheless, 141 (46%) called the study helpline, more often than anticipated. Of 435 reasons for calling, all but 42 (10%) related to testing with the apps or hardware, which contributed to reduced adherence. The team made at least one call to 133 patients (44%) to investigate why data had not been transmitted. Multibit and MyVisionTrack apps were unavailable for 15 and 30 of 1318 testing days for reasons which were the responsibility of the app providers. Researchers also experienced technical challenges with a multiple device management system. Logistical challenges included regulations for transporting lithium-ion batteries and malfunctioning chargers.

Conclusions: Implementation of similar technologies should incorporate a well-resourced helpline and build in additional training time for participants and troubleshooting time for staff. There should also be robust evidence that chosen technologies are fit for the intended purpose.

Trial registration number: ISRCTN79058224.

Keywords: Aging; Medical retina; Telemedicine.

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Conflict of interest statement

Competing interests: REH reports attendance at Roche Digital Health Advisory Meeting July 2019. She also received partial PhD Studentship funding from Okko Health 2021 for home monitoring of Diabetic Retinopathy. SS reports grants from Boehringer Ingleheim, receiving consulting fees from Boehringer Ingleheim, Novartis, Apellis, Bayer, Oculis, Oxurion, Roche, and Biogen. She also received payment or honoraria from Boehringer Ingleheim and Bayer, support for attending meetings from Bayer and participation in an advisory board with Bayer. She is also a Macular Society Trustee (unpaid). TP reports grants from Boehringer Ingelheim and Novartis; receiving consulting fees from Boehringer Ingelheim, Novartis, Apellis, Bayer, Oxurion, Roche, and Sandoz. She also received payment or honoraria (speakers fee/and/or advisory board) from Boehringer Ingelheim, Bayer, Roche, Apellis, Sandoz, Heidelberg, Zeiss, Optos. PCK reports software support from Vital Art and Science who produced the My Vision Track App. AL reports receiving consulting fees from and owning stock or stock options of Gyroscope Therapeutics. RW, SRO'C, EAG, EW, CT, BJLB, CAR and BCR have no competing interests.

Figures

Figure 1
Figure 1
Time to stopping testing with mVT (top panel) and MTB apps (bottom panel). MTB, multibit; mVT, MyVisionTrack.
Figure 2
Figure 2
Technology used at least weekly by participants before starting to self-test in the study (n=297).
Figure 3
Figure 3
Reasons for incoming calls to the helpline. MIFI, a personal Wifi; mVT, MyVisionTrack.
Figure 4
Figure 4
Reasons reported by participants for their data not being received during outgoing calls. MIFI, a personal Wifi; mVT, MyVisionTrack.
See this image and copyright information in PMC

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