“It’s sort of a lifeline”: Chronic obstructive pulmonary disease patients’ experiences of home telehealth.

Gorst, Sarah L.; Coates, Elizabeth; Armitage, Christopher J.

doi:10.1037/hea0000246

Cited by 30 publications

(83 citation statements)

References 27 publications

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“…Telehealth can empower patients to self-manage their condition through facilitating increased knowledge of the condition and its symptoms [25], which supports the argument that participants in this study gained knowledge, became better at managing their condition, and triggered fewer alerts. However, it is also argued that telehealth may increase dependence on health care services, with reassurance provided through being “watched over” by health care professionals and the knowledge that they will intervene if something goes wrong [24].…”

Section: Discussionsupporting

confidence: 73%

Does Telehealth Monitoring Identify Exacerbations of Chronic Obstructive Pulmonary Disease and Reduce Hospitalisations? An Analysis of System Data

et al. 2017

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BackgroundThe increasing prevalence and associated cost of treating chronic obstructive pulmonary disease (COPD) is unsustainable. Health care organizations are focusing on ways to support self-management and prevent hospital admissions, including telehealth-monitoring services capturing physiological and health status data. This paper reports on data captured during a pilot randomized controlled trial of telehealth-supported care within a community-based service for patients discharged from hospital following an exacerbation of their COPD.ObjectiveThe aim was to undertake the first analysis of system data to determine whether telehealth monitoring can identify an exacerbation of COPD, providing clinicians with an opportunity to intervene with timely treatment and prevent hospital readmission.MethodsA total of 23 participants received a telehealth-supported intervention. This paper reports on the analysis of data from a telehealth monitoring system that captured data from two sources: (1) data uploaded both manually and using Bluetooth peripheral devices by the 23 participants and (2) clinical records entered as nursing notes by the clinicians. Rules embedded in the telehealth monitoring system triggered system alerts to be reviewed by remote clinicians who determined whether clinical intervention was required. We also analyzed data on the frequency and length (bed days) of hospital admissions, frequency of hospital Accident and Emergency visits that did not lead to hospital admission, and frequency and type of community health care service contacts—other than the COPD discharge service—for all participants for the duration of the intervention and 6 months postintervention.ResultsPatients generated 512 alerts, 451 of which occurred during the first 42 days that all participants used the equipment. Patients generated fewer alerts over time with typically seven alerts per day within the first 10 days and four alerts per day thereafter. They also had three times more days without alerts than with alerts. Alerts were most commonly triggered by reports of being more tired, having difficulty with self-care, and blood pressure being out of range. During the 8-week intervention, and for 6-month follow-up, eight of the 23 patients were hospitalized. Hospital readmission rates (2/23, 9%) in the first 28 days of service were lower than the 20% UK norm.ConclusionsIt seems that the clinical team can identify exacerbations based on both an increase in alerts and the types of system-generated alerts as evidenced by their efforts to provided treatment interventions. There was some indication that telehealth monitoring potentially delayed hospitalizations until after patients had been discharged from the service. We suggest that telehealth-supported care can fulfill an important role in enabling patients with COPD to better manage their condition and remain out of hospital, but adequate resourcing and timely response to alerts is a critical factor in supporting patients to remain at home.Trial RegistrationInternational Standard R...

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Section: Discussionsupporting

confidence: 73%

Does Telehealth Monitoring Identify Exacerbations of Chronic Obstructive Pulmonary Disease and Reduce Hospitalisations? An Analysis of System Data

et al. 2017

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“…Availability of an HCP mediated by TM technology provided the patients with a more predictable daily life (Barken et al, ). Follow‐up by TM also led to a reduction in health care needs (Gorst et al, ), was more personal (Barken et al, ; Fairbrother et al, ), and was experienced as an improvement over standard care (Fairbrother et al, ; Gorst et al, ).…”

Section: Resultsmentioning

confidence: 99%

“…Patients in nine of the studies (Table ) found that assessing clinical measurements provided them with an insight into their health, which in turn increased their awareness of their individual data. Furthermore, regular measurements increased their clinical understanding of their illness (Gale & Sultan, ; Gorst et al, ) and encouraged them to become more involved and engaged (Barken et al, ), thereby promoting a more structured approach to their health (Huniche et al, ; Williams et al, ).…”

Section: Resultsmentioning

confidence: 99%

“…An important aspect of the patients’ understanding of their illness was the sharing of their self‐measured data with the HCP, promoting a shared concern (Huniche et al, ) and receiving support through advice and guidance (Barken et al, ; Nissen & Lindhardt, ; Vatnøy et al, ). Sharing their clinical data endorsed a mutual and horizontal clinical language (Barken et al, ; Williams et al, ) that improved collaboration and dialogue with the HCP (Barken et al, ) and encouraged active participation in the management of their illness (Gorst et al, ; Vatnøy et al, ; Williams et al, ). Similarly, increased understanding was used to validate their own health status, assist their judgement regarding when to contact the HCP (Gale & Sultan, ; Huniche et al, ), and establish a nurse‐patient relationship based on trust and close personal contact (Barken et al, ; Nissen & Lindhardt, ).…”

Section: Resultsmentioning

confidence: 99%

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A sense of belonging: A meta‐ethnography of the experience of patients with chronic obstructive pulmonary disease receiving care through telemedicine

Barken

Söderhamn

Thygesen

2019

Journal of Advanced Nursing

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Aim To synthesize the qualitative research in the literature addressing how patients with chronic obstructive pulmonary disease experience care received by telemedicine. Design Meta‐ethnography. Data Sources Twelve studies, published from 2013 – 2018, were identified by a search of relevant systematic databases in June 2017, including updated searches performed in June 2018. Review Methods The studies were reviewed and critically appraised independently by three researchers. The review followed the seven steps of meta‐ethnography developed by Noblit and Hare, including a line‐of‐argument synthesis. Results The synthesis revealed three second‐order constructs: presence, transparency, and ambivalence. Using a line‐of‐argument synthesis, a model was developed that showed patients’ experience of a sense of belonging when receiving care by telemedicine. Conclusion This meta‐ethnography contributes to the existing and contradictory evidence base of telemedicine to chronic obstructive pulmonary disease patients. It addresses and adds renewed understanding of who would benefit from telemedicine and why, by illustrating the interrelationship between the conditions of telemedicine care, the severity of COPD, and the need for connectedness and emphasizes that the need to belong in telemedicine care increases with the progression of illness burden and severity. Impact The present study endorses the view that the patients with a severe illness burden are likely to benefit the most when receiving care by telemedicine. However, the benefits rely on the fact that the telemedicine interventions involve emotional, social, and clinical support, including regular contact with healthcare professionals, to meet the requirements to belong.

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“…Furthermore, self‐management is highlighted as an important aspect for individuals living with COPD to become more active and involved in their illness (Simpson & Rocker, ). Further, several studies (Gorst et al., ; Vatnøy et al., ; Williams et al., ) have emphasised that TM can promote self‐management.…”

Section: Discussionmentioning

confidence: 99%

Unlocking the limitations: Living with chronic obstructive pulmonary disease and receiving care through telemedicine—A phenomenological study

Barken

Thygesen

Söderhamn

2017

Journal of Clinical Nursing

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Aims and objectives: To describe the lived experiences of quality of life among a group of patients living with chronic obstructive pulmonary disease who were included in a telemedical intervention after hospitalisation for disease exacerbation.Background: Patients with chronic obstructive pulmonary disease have high symptom burden, poor control of symptoms and a need for greater requirements in care.Telemedicine can provide benefits for patients with chronic obstructive pulmonary disease by improving self-management.Design: Descriptive phenomenological approach.Methods: Ten in-depth interviews were conducted with chronic obstructive pulmonary disease patients participating in a telemedical intervention. The collected data were analysed using a descriptive phenomenological research method.Results: Living with chronic obstructive pulmonary disease was experienced as creating physical and mental limitations of the diseased body and an increasing identity as a patient, which led to impaired quality of life. Being included in the telemedicine intervention increased accessibility to healthcare services and support from telemedicine nurses. Self-measurement of health data increased participants' clinical insight and created a mutual clinical language in dialogue with telemedicine nurses, which led to increased quality of life. However, receiving care through telemedicine was also experienced as a dual chore. Relevance to clinical practice: Telemedicine can be beneficial when rethinking care for chronic obstructive pulmonary disease by providing knowledge on how living with chronic obstructive pulmonary disease can affect the experience of

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“It’s sort of a lifeline”: Chronic obstructive pulmonary disease patients’ experiences of home telehealth.

Cited by 30 publications

References 27 publications

Does Telehealth Monitoring Identify Exacerbations of Chronic Obstructive Pulmonary Disease and Reduce Hospitalisations? An Analysis of System Data

Does Telehealth Monitoring Identify Exacerbations of Chronic Obstructive Pulmonary Disease and Reduce Hospitalisations? An Analysis of System Data

A sense of belonging: A meta‐ethnography of the experience of patients with chronic obstructive pulmonary disease receiving care through telemedicine

Unlocking the limitations: Living with chronic obstructive pulmonary disease and receiving care through telemedicine—A phenomenological study

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