Multi-disciplinary teams and an integrated care approach are frequently used in home telehealth for COPD. However, nurses tend to have primary responsibility for case management and daily monitoring of patients’ data transmissions.
The average amount of time required to implement and administer a home telehealth program is rarely reported and is therefore difficult to determine. In the 2 studies that provide information on provider time, providers needed approximately 60-90 minutes per patient per month to complete intervention-related duties. It was not clear whether this was offset by reduced in-person appointment time.
Home telehealth for COPD management usually includes a remote monitoring component. In some cases, the system used incorporates a disease management algorithm that provides basic feedback to patients and generates alerts for providers when patients’ data transmissions are outside of a pre-determined range. While these algorithms might be expected to relieve providers of much of the burden of day-to-day patient management, no concrete evidence on their effects on workflow is available.
Information on providers’ perceptions of home telehealth is severely lacking. There is some evidence that high patient satisfaction rates do not necessarily indicate high provider satisfaction rates. In one intervention, a group of nurses using videoconferencing-based case management had markedly negative views of the service. Patients, on the other hand, were quite happy. These findings suggest that further research into provider experiences is strongly advisable. We did retrieve a recent study that examines provider experiences in more detail than most, as well as offering some considerations for those considering implementing home telehealth for COPD management. As this study was retrieved in a final scan of 2011-2012 literature and was not subject to the same level of analysis as the other studies included in this review, we refer the reader to Roberts et al. (2012) for more information.
Uptake and Use of Technology
Summary: Uptake and use of technology outcomes were reported 2 studies. Results suggest that provider experiences vary dramatically with the design of the intervention. The negative views reported by Mair et al. (2005) indicate that provider satisfaction should not be taken as a given.
Study Details: Trappenburg et al. (2008) report that telemonitoring activities fit well into nurses’ daily activities. However, it is not clear whether this information is based on systematic observations or formal surveying.
Mair et al. (2005) carried out a strongly designed study that examined provider and patient experiences with an intervention that used videoconferencing-based management. Information was gathered from questionnaires and logbooks. The 14 nurses who delivered the intervention had markedly negative perceptions of the videoconferencing experience. Interestingly, patients’ views were considerably more positive. This was true for all aspects of the intervention: audiovisual quality, security and safety of care system, comprehensiveness of care, comfort, and ease of use in measuring and transmitting their blood pressure, temperature, and other clinical values. More research is required to determine the implications of this difference in perceptions, its ramifications for provider uptake and use of telehealth interventions, and whether it is unique to videoconferencing or COPD management.
|And on the qualitative side . . .In work by Mair et al. (2008), key findings from ethnographic interviews revealed that while nurses were initially enthusiastic about the project, they experienced frustration with the time-consuming and technical aspects of installing the equipment. Some were uneasy with the level of responsibility given to patients, although the patients themselves appreciated the autonomy and reported feeling safe. In addition, nurses were concerned about the impact that widespread adoption of telehealth might have on their professional identity and on the future of nursing.
Other barriers to uptake were legal in nature: nurses felt that sub-optimal image and audio quality might compromise the accuracy clinical assessments, leading to improper patient care.
Effects on Practice and Patient Care
Summary: Only 1 study reported on effects on practice and patient care (de Toledo et al., 2006). Findings indicated that these effects were positive, but generalizability cannot be determined at this point.
Study Details: Comments by the case manager implied that the intervention allowed for the prompt detection of symptoms by providers, preventing exacerbations and facilitating an increase in prescribed treatment changes for the intervention group (de Toledo et al., 2006). The case manager was not blind to group assignment. No other studies examined effects on practice or patient care, although Mair et al. (2005) reported on nurses’ perceptions of videoconferencing for patient appointments.
Recent Developments: A scan of material from 2011-2012, a time period not covered by our initial searches, found 1 article that addressed effects on practice and patient care (Roberts et al., 2012). The authors used examples from the Argyll & Bute telehealth program to illustrate their description of essential considerations for the implementation of home telehealth for COPD management. Provider experiences are discussed. As this study was not subject to the same level of analysis as the other studies included in this review, we will not attempt further analysis. See Roberts et al. (2012) for more details.
Cost and Time Savings
No cost or time savings outcomes were reported.