JMIR Publications

ABSTRACT

Background:

Telemonitoring (TM) interventions have been designed to support care delivery and engage patients in their care at home, but little research exists on TM of complex chronic conditions (CCC). Given the growing prevalence of patients with CCC, an evaluation of multi-condition TM is needed to expand TM interventions, as well as tailor opportunities to manage complex chronic care needs.

Objective:

The objective of this study was to evaluate the feasibility and patients’ perceived usefulness of a multi-condition TM platform in a nurse-led model of care.

Methods:

A pragmatic, multi-method feasibility study was conducted with patients with heart failure (HF), hypertension (HTN), and/or diabetes (DM). Patients were asked to take physiological readings at home via a smartphone-based TM application for 6 months. The recommended frequency of taking readings was dependent on the condition, and adherence data was obtained through the TM system database. Patient questionnaires were administered and patient interviews were conducted at the end of the study. Inductive analysis was performed and codes were then mapped to Normalization Process Theory and Proctor’s Implementation Outcomes constructs.

Results:

Twenty-six participants were recruited, 17 of which used the TM system over 6 months. Qualitative interviews were conducted with 14 patients, and 8 were conducted with their informal caregiver present. Patient adherence was high, with patients with HF taking readings 76% of the days they were asked to use the system and patients with DM taking 72% of the readings. The HTN adherence rate was 55% of the days they were asked to use the system. The qualitative findings of the patient experience can be grouped into 4 main themes and 13 subthemes. The main themes were: (1) making sense of the purpose of TM, (2) engaging and investing in TM, (3) implementing and adopting TM, and (4) perceived usefulness and the perceived benefits of TM in CCC.

Conclusions:

Multi-condition TM in nurse-led care was found to be feasible and was perceived as useful. Patients accepted and adopted the technology by demonstrating a moderate to high-level of adherence across conditions. These results demonstrate how TM can address the needs of patients with CCC through virtual TM assessments in a nurse-led care model by supporting patient self-care and keeping patients connected to their clinical team.