J. Med. Internet Res. - Perceptions and experiences of heart failure patients and clinicians on the use of mobile phone-based telemonitoring.

Tópicos

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Resumo

CKGROUND: Previous trials of heart failure telemonitoring systems have produced inconsistent findings, largely due to diverse interventions and study designs.OBJECTIVES: The objectives of this study are (1) to provide in-depth insight into the effects of telemonitoring on self-care and clinical management, and (2) to determine the features that enable successful heart failure telemonitoring.METHODS: Semi-structured interviews were conducted with 22 heart failure patients attending a heart function clinic who had used a mobile phone-based telemonitoring system for 6 months. The telemonitoring system required the patients to take daily weight and blood pressure readings, weekly single-lead ECGs, and to answer daily symptom questions on a mobile phone. Instructions were sent to the patient's mobile phone based on their physiological values. Alerts were also sent to a cardiologist's mobile phone, as required. All clinicians involved in the study were also interviewed post-trial (N = 5). The interviews were recorded, transcribed, and then analyzed using a conventional content analysis approach.RESULTS: The telemonitoring system improved patient self-care by instructing the patients in real-time how to appropriately modify their lifestyle behaviors. Patients felt more aware of their heart failure condition, less anxiety, and more empowered. Many were willing to partially fund the use of the system. The clinicians were able to manage their patients' heart failure conditions more effectively, because they had physiological data reported to them frequently to help in their decision-making (eg, for medication titration) and were alerted at the earliest sign of decompensation. Essential characteristics of the telemonitoring system that contributed to improved heart failure management included immediate self-care and clinical feedback (ie, teachable moments), how the system was easy and quick to use, and how the patients and clinicians perceived tangible benefits from telemonitoring. Some clinical concerns included ongoing costs of the telemonitoring system and increased clinical workload. A few patients did not want to be watched long-term while some were concerned they might become dependent on the system.CONCLUSIONS: The success of a telemonitoring system is highly dependent on its features and design. The essential system characteristics identified in this study should be considered when developing telemonitoring solutions.

Resumo Limpo

ckground previous trial heart failur telemonitor system produc inconsist find larg due divers intervent studi designsobject object studi provid indepth insight effect telemonitor selfcar clinic manag determin featur enabl success heart failur telemonitoringmethod semistructur interview conduct heart failur patient attend heart function clinic use mobil phonebas telemonitor system month telemonitor system requir patient take daili weight blood pressur read week singlelead ecg answer daili symptom question mobil phone instruct sent patient mobil phone base physiolog valu alert also sent cardiologist mobil phone requir clinician involv studi also interview posttrial n interview record transcrib analyz use convent content analysi approachresult telemonitor system improv patient selfcar instruct patient realtim appropri modifi lifestyl behavior patient felt awar heart failur condit less anxieti empow mani will partial fund use system clinician abl manag patient heart failur condit effect physiolog data report frequent help decisionmak eg medic titrat alert earliest sign decompens essenti characterist telemonitor system contribut improv heart failur manag includ immedi selfcar clinic feedback ie teachabl moment system easi quick use patient clinician perceiv tangibl benefit telemonitor clinic concern includ ongo cost telemonitor system increas clinic workload patient want watch longterm concern might becom depend systemconclus success telemonitor system high depend featur design essenti system characterist identifi studi consid develop telemonitor solut

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