Implementation and use of technology-enabled remote monitoring for chronic obstructive pulmonary disease: a rapid qualitative evaluation

Background: Chronic obstructive pulmonary disease affects around 2% United Kingdom population. Timely identification of patients at risk of deterioration is crucial. Technology-enabled remote monitoring may help prevent deterioration, support chronic obstructive pulmonary disease patients at home and appropriate use of National Health Service services. Evidence on the adoption, use and experience of technology-enabled remote monitoring in the chronic obstructive pulmonary disease pathway is currently limited, impeding efforts to inform effective technology-enabled remote monitoring design and implementation. Objective: To understand what supports good practice in the implementation and use of technology-enabled remote monitoring in the chronic obstructive pulmonary disease care pathway and draw transferable lessons that can inform spread and scale up. Design and methods: Rapid evaluation, combining qualitative interviews, focused case studies and stakeholder workshops. Patient and public voices informed evaluation design, conduct and co-design of resources. Setting and participants: Scoping interviews with a purposive sample of 29 national and regional stakeholders informed selection of four case study sites involved in delivering technology-enabled remote monitoring for chronic obstructive pulmonary disease. Case studies combined interviews with 19 staff and review of 18 documents. Analysis was informed by the non-adoption, abandonment and challenges to scale-up, spread and sustainability of technology framework. A stakeholder workshop ( = 23 participants) refined emerging findings. Interviews with respiratory patients and a co-design workshop informed development of patient-facing resources. Results: Technology-enabled remote monitoring for chronic obstructive pulmonary disease occurs along a continuum of scope and scale. Technology-enabled care pathways have some common overarching features, but variation is seen across contexts and patient cohorts. Technology-enabled remote monitoring services influence care provision on a system level. Effective implementation is underpinned by service characteristics affecting its use, technology functionalities and organisational capabilities and capacities. Technology-enabled remote monitoring success also depends on defining the data-driven purpose and value proposition, ensuring buy-in, organising the workforce and workload in sustainable ways, data and IT platform interoperability, support for patients in using the service safely and appropriately, utilising existing resources, team buy-in, financial resourcing and clear policy incentives, and openness to ongoing learning. Patients value technology-enabled remote monitoring services that help them feel more connected to healthcare providers and provide timely information and support. Healthcare staff value high-quality patient care, services value affordability and sustainable workload impact. Limitations: Small-scale qualitative evaluation conducted at pace. Conclusions: Technology can support remote monitoring but is only one aspect of an effective technology-enabled remote monitoring service. It needs to be embedded in the chronic obstructive pulmonary disease pathway and align with service needs and existing capacity in cost-effective ways and with proportionate oversight of quality and safety. Decision-makers need to consider which aspects of the technology are essential, how they can be effectively embedded and supported by an appropriately equipped workforce, and needs of different patient cohorts. Future work: There is a need for evidence on longer-term effectiveness and cost-effectiveness of technology-enabled remote monitoring for chronic obstructive pulmonary disease, impact on patient and staff experience, and issues of equity of access. Qualitative and quantitative approaches are needed to appreciate varied technology and evolving use in different settings/groups. Funding: This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR154231. Chronic obstructive pulmonary disease affects about 2% of the United Kingdom population. Managing the condition effectively is critical to preventing worsening symptoms. One approach is technology-enabled remote monitoring, which uses medical devices (e.g. an inhaler or oximeter) to help monitor patients with chronic obstructive pulmonary disease at home. While these services have potential, we need to understand how they can be used well. We examined how, where, why and by whom these services are being used to care for patients with chronic obstructive pulmonary disease. We interviewed 19 people working across four United Kingdom areas that offered technology-enabled remote monitoring for chronic obstructive pulmonary disease. We shared and refined findings in a workshop with 23 healthcare staff, interviewed 6 patients and ran another workshop to ask 9 patients for their help in designing resources that healthcare teams might use to support patients. We found that technology-enabled remote monitoring is usually introduced in response to local patient needs. These services aim to monitor and support patients with chronic obstructive pulmonary disease remotely in the comfort of their own home, but how services work varies in the technology used and nature of support provided. To work well, technology-enabled remote monitoring services need to have a clear purpose, appropriate technology characteristics, value for NHS staff and patients and be user-friendly. Patients value services that help them feel more connected to healthcare providers and provide timely information and support. Healthcare staff want to support high-quality patient care but also need to consider technology-enabled service affordability and how it affects their workload. In conclusion, technology-enabled remote monitoring can benefit chronic obstructive pulmonary disease care but must be thoughtfully included in existing healthcare systems, making sure that the technology complements current services, is affordable, and maintains quality and safety. More research is needed on the long-term effectiveness and affordability of such services, and potential impact on patient access and equity.