JMIR Publications

ABSTRACT

Background:

The COVID-19 pandemic unprecedently challenged public health systems, with 95% of cases in Quebec, Canada, sent home for self-isolation. To ensure continuous care, we implemented a patient-portal (Opal) supported intervention to remotely monitor at-home COVID-19 patients with daily self-reports of symptoms, vital signs, and mental health reviewed by healthcare professionals.

Objective:

In this manuscript, our objectives are to describe the : 1) intervention’s implementation process; 2) implementation outcomes, including feasibility, fidelity, acceptability, usability, and perceived response burden ; 3) implementation barriers and facilitators encountered by stakeholders.

Methods:

The implementation followed a co-design approach operationalized through patient and stakeholder engagement. The intervention included a 14-day follow-up for each patient. In a mixed-methods study conducted at the McGill University Health Centre (Montreal, Canada), participants completed a sociodemographic questionnaire on Day 1, and research questionnaires on implementation outcomes on Days 1, 7, and 14. Feasibility, fidelity, and perceived response burden were summarized using frequency counts and proportions, along with minimum, maximum, and mean (SD) values for acceptability and usability (ease of use, usefulness, and satisfaction) scores. All outcomes were examined for predefined success thresholds. Linear Mixed Models were employed to assess changes in acceptability and usability over time and whether they differed between selected sociodemographic groups (gender, age, and racial group). Generalized Estimating Equations were used to assess perceived response burden and fidelity. For qualitative analysis, semi-structured interviews were conducted with expert patients, healthcare professionals, and coordinators and submitted to thematic analysis guided by the Consolidated Framework for Implementation Research.

Results:

From December 2020 to March 2021, 51 participants were enrolled, of whom 49 were included in the quantitative analysis. For feasibility, the observed recruitment and retention rates (98% and 96%, respectively) met the 75% success threshold. Over 80% of participants found it “quite/very easy” to complete the daily self-report, with over 75% completion rate (fidelity), which showed a slight but non-significant decreasing trend over time (P=.21). Mean acceptability and usability exceeded the threshold of 4 at all timepoints. A significant increase in acceptability was found between at least two timepoints (P=.04). Participants over age 50 reported significantly lower mean ease of use than younger participants (P=.004). 28 stakeholders were interviewed between June and September 2021. Facilitators included a structured implementation process, a focus on stakeholders’ recommendations and the adjustability of the intervention, and the team’s emphasis on safety. However, Opal’s thorough privacy protection measures and acute follow-up capacities were identified as barriers, along with implementation delays due to institutional barriers related to data security.

Conclusions:

The intervention attained targets across all studied implementation outcomes. Qualitative findings highlighted the importance of stakeholder engagement. Telehealth tools have the potential for remote follow-up of acute health conditions. Clinical Trial: ClinicalTrials.gov identifier NCT04978233