JMIR Publications

ABSTRACT

Background:

The use of telemonitoring to maintain renal function in chronic kidney disease (CKD) patients is recommended by health authorities. Despite these recommendations, telemonitoring adoption by health professionals and patients presents many challenges.

Objective:

To describe barriers and facilitators of the implementation of a telemonitoring program according to health professionals and CKD patients and to identify factors that are associated with the adoption of the program. This study is a process evaluation alongside a cost-effectiveness trial (NeLLY trial).

Methods:

A mixed survey combining a quantitative questionnaire and semi-structured interviews was conducted among nurses, nephrologists, and patients with stages 3 and 4 of CKD in 10 renal care centers that have implemented telemonitoring in France. The Technology Acceptance Model (TAM) and the Consolidated Framework for Implementation Research (CFIR) were used to build questionnaires and interview guides. The dimensions investigated were: ease of use, perceived usefulness and intention of use (TAM), and characteristics of the Intervention, local and general context, individual factors and processes (CFIR). The adoption of telemonitoring was measured using the frequency of connection of patients to the telemonitoring device. Determinants of telemonitoring use were analyzed using the non-parametric tests of Wilcoxon Mann-Whitney and Kruskall Wallis. Thematic analysis of semi-structured interviews transcription was conducted. Quantitative and qualitative results as well as patients and professionals’ results were combined to get a comprehensive picture of factors associated with the use of remote monitoring in CKD.

Results:

A total of 42 professionals and 128 patients with CKD responded to our questionnaire. Among these, 11 professionals and 13 patients took were interviewed. The nurses, in charge of patient follow-up, regularly used telemonitoring (61.5% at least once a month), while the nephrologists, responsible for prescribing it, were mainly occasional users (62.5% less than once a month). Among professionals, the main obstacles were the heavy workload generated by telemonitoring, the lack of training and the lack of support for nurses. Among the patients, 35.9% used the application at least once a week, the main obstacles being problems related to the use of computers, the lack of feedback and communication with the professionals. The main levers perceived by professionals and patients for using telemonitoring were the empowerment of patients regarding the monitoring of their health and the reduction of the burden of CKD.

Conclusions:

Improving adherence to telemonitoring in the context of CKD requires joint implementation efforts on the side of professionals and patients. Our results give clues to design effective theory-driven interventions to improve telemonitoring adoption and use.