Perceptions and experiences of telemonitoring in older patients with multimorbidity: qualitative study.

Problem

Telemonitoring (remote monitoring of patients’ clinical signs and symptoms) is increasingly being used to reduce healthcare costs and ensure safe, effective care in an aging population with higher rates of chronic disease and comorbidity. We explored older patients’ perceptions of telemonitoring in the context of the Health Information Technology Acceptance Model (HITAM), to establish the extent to which the model is appropriate for older people with multi-morbidity.

Approach

We used a qualitative design, recruiting participants from a randomised controlled trial of telemonitoring older patients with multimorbidities, specifically Chronic obstructive Pulmonary Disease (COPD) associated with Cardiovascular Disease (CHROMED study). Interviews were conducted a few days after installation of telemonitoring equipment and at the end (or withdrawal) from the study to ascertain patients’ perceptions and experiences of telemonitoring. We used a framework approach to analyse the data supported by NVivo10.

Findings

Both health professionals and patients’ ‘significant others’ were key to taking part in the study, particularly the former.

Using the equipment sometimes led to increased awareness of the severity of patients’ chronic medical conditions. Those who did not accept (or were in denial about) the severity of their illness, or had increased anxiety about their illness, were more likely to withdraw in the early stages of telemonitoring use.

Self-efficacy around use of technology was not linked to prior experience. Initial installation processes were important: those who had early difficulties using the equipment were less likely to continue. The use of a simple pictorial instruction manual helped and prompt follow-up support was also important to engender confidence.

Perceived ease of use was strongly linked to equipment design and design features were an important factor in discontinuation, e.g. sending information ‘down the line’ without feedback was likely to lead to withdrawal or reluctance to use the equipment.

Reliability was linked to lack of internet connectivity; this was mitigated by use of the patients’ own Wi-Fi where available. Differences between equipment readings and readings undertaken in the practice affected perception of reliability. Replacing broken equipment was vital.

Clinical alerts needed to be appropriate and well handled. Personalisation of the alert medical settings were helpful in avoiding false alerts. There was some patient confusion when health professionals telephoned regarding an alert without stating the reason, which led to patients recording their own readings to aid their understanding.

Consequences

The HITAM model was a useful starting point for predicting whether older people would accept and continue with telemonitoring as part of a clinical trial. Ensuring self-efficacy in this group requires equipment designers to consider older peoples’ needs and also the potential for high levels of anxiety or a greater focus on illness to cause harm in this vulnerable group.