Thoracic Medicine, Royal Free London NHS Foundation Trust, London, UK
Therapy Services, Royal Free London NHS Foundation Trust, London, UK.
BMJ Open Respir Res. 2020 Mar;7(1). doi: 10.1136/bmjresp-2019-000510.
Advances in technology means that domiciliary non-invasive ventilation (NIV) devices can be remotely monitored via modems in patients' homes. Possible benefits and challenges of modem technology have yet to be established. This study explored the perspectives and experiences of patients, their carers and healthcare professionals (HCPs) on the addition of modem technology in managing home NIV.
A qualitative study using a combination of focus groups for HCPs and interviews for carers/patients was undertaken. 12 HCPs and 22 patients/carers participated. These focus groups and interviews were audio-recorded, transcribed verbatim and analysed thematically.
Five main themes were identified. 'Surveillance: a paradox of findings': HCPs were concerned about unduly scrutinising patients' lives, potentially impacting on HCP patient relationships. Conversely, patients welcomed modem monitoring and did not express concerns regarding invasion of privacy. 'Sanctions': HCPs reported the modem increased access to care and allowed appropriate assessment of ongoing treatment. 'Complacency and ethics': HCPs expressed concerns patients may become complacent in seeking help due to expectations of modem monitoring, as well as being concerned regarding the ethics of modems. There was a suggestion patients and carers' expectations of monitoring were different to that of clinical practice, resulting in complacency in some cases. 'Increased time for patient focused care': HCPs in the focus groups described a number of ways in which using modems was more efficient. 'Confidence: can be improved with technology': patients and carers were positive about the impact of the modems on their health and well-being, particularly their confidence.
HCPs expressed concerns about surveillance were not corroborated by patients, suggesting acceptability of remote monitoring. Data suggests a need for increased clarity to patients/carers regarding clinical practice relating to responsiveness to modem data. The issue of complacency requires further consideration. Modem technology was acceptable and considered a useful addition by HCPs, patients and carers.
NCT03905382.
技术的进步意味着可以通过患者家中的调制解调器远程监测家庭无创通气（NIV）设备。调制解调器技术的可能好处和挑战尚待确定。本研究探讨了患者、护理人员和医疗保健专业人员（HCP）对添加调制解调器技术管理家庭 NIV 的看法和经验。
采用 HCP 焦点小组和护理人员/患者访谈相结合的定性研究方法。共有 12 名 HCP 和 22 名患者/护理人员参与。对这些焦点小组和访谈进行了录音、逐字转录，并进行了主题分析。
确定了五个主要主题。“监测：发现的悖论”：HCP 担心过度审查患者的生活，可能会影响 HCP 与患者的关系。相反，患者欢迎调制解调器监测，并且对隐私侵犯没有表示担忧。“制裁”：HCP 报告调制解调器增加了对护理的获取，并允许对正在进行的治疗进行适当评估。“自满和伦理”：HCP 表示担心由于调制解调器监测的期望，患者可能会自满而不愿寻求帮助，并且对调制解调器的伦理问题感到担忧。有迹象表明，患者和护理人员对监测的期望与临床实践不同，导致某些情况下自满。“为以患者为中心的护理提供更多时间”：焦点小组中的 HCP 描述了使用调制解调器提高效率的几种方法。“信心：技术可以提高”：患者和护理人员对调制解调器对他们的健康和幸福感的积极影响表示认可，尤其是他们的信心。
HCP 对监测的担忧并未得到患者的证实，这表明远程监测具有可接受性。数据表明，需要增加患者/护理人员对与调制解调器数据响应相关的临床实践的清晰度。自满的问题需要进一步考虑。调制解调器技术是可接受的，并且被 HCP、患者和护理人员认为是有用的补充。
NCT03905382。
