Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.
J Med Internet Res. 2020 Sep 28;22(9):e19550. doi: 10.2196/19550.
The new generation of implantable cardioverter-defibrillators (ICDs) supports wireless technology, which enables remote patient monitoring (RPM) of the device. In Sweden, it is mainly registered nurses with advanced education and training in ICD devices who handle the arrhythmias and technical issues of the remote transmissions. Previous studies have largely focused on the perceptions of physicians, and it has not been explored how the patients' and nurses' experiences of RPM correspond to each other.
Our objective is to describe, explore, and compare the experiences and perceptions, concerning RPM of ICD, of patients with heart failure (HF) and nurses performing ICD follow-up.
This study has a cross-sectional, descriptive, mixed methods design. All patients with HF and an ICD with RPM from one region in Sweden, who had transitioned from office-based visits to implementing RPM, and ICD nurses from all ICD clinics in Sweden were invited to complete a purpose-designed, 8-item questionnaire to assess experiences of RPM. The questionnaire started with a neutral question: "What are your experiences of RPM in general?" This was followed by one positive subscale with three questions (score range 3-12), with higher scores reflecting more positive experiences, and one negative subscale with three questions (score range 3-12), with lower scores reflecting more negative experiences. One open-ended question was analyzed with qualitative content analysis.
The sample consisted of 175 patients (response rate 98.9%) and 30 ICD nurses (response rate 60%). The majority of patients (154/175, 88.0%) and nurses (23/30, 77%) experienced RPM as very good; however, the nurses noted more downsides than did the patients. The mean scores of the negative experiences subscale were 11.5 (SD 1.1) for the patients and 10.7 (SD 0.9) for the nurses (P=.08). The mean scores of the positive experiences subscale were 11.1 (SD 1.6) for the patients and 8.5 (SD 1.9) for the nurses (P=.04). A total of 11 out of 175 patients (6.3%) were worried or anxious about what the RPM entailed, while 15 out of 30 nurses (50%) felt distressed by the responsibility that accompanied their work with RPM (P=.04). Patients found that RPM increased their own (173/175, 98.9%) and their relatives' (169/175, 96.6%) security, and all nurses (30/30, 100%) answered that they found RPM to be necessary from a safety perspective. Most patients found it to be an advantage with fewer office-based visits. Nurses found it difficult to handle different systems with different platforms, especially for smaller clinics with few patients. Another difficulty was to set the correct number of alarms for the individual patient. This caused a high number of transmissions and a risk to miss important information.
Both patients and nurses found that RPM increased assurance, reliance, and safety. Few patients were anxious about what the RPM entailed, while about half of the nurses felt distressed by the responsibility that accompanied their work with RPM. To increase nurses' sense of security, it seems important to adjust organizational routines and reimbursement systems and to balance the workload.
新一代植入式心脏复律除颤器 (ICD) 支持无线技术，可实现设备的远程患者监测 (RPM)。在瑞典，主要由接受过 ICD 设备高级教育和培训的注册护士来处理心律失常和远程传输的技术问题。之前的研究主要集中在医生的看法上，而尚未探讨患者和护士对 RPM 的体验如何相互对应。
我们的目的是描述、探讨和比较心力衰竭 (HF) 患者和执行 ICD 随访的护士对 RPM 的体验和看法。
本研究采用了横断面、描述性、混合方法设计。所有来自瑞典一个地区、使用 RPM 的 HF 患者和具有 RPM 功能的 ICD 患者，以及瑞典所有 ICD 诊所的 ICD 护士，均被邀请完成一份经过精心设计的、包含 8 个问题的调查问卷，以评估 RPM 的体验。问卷以一个中立的问题开始：“您对 RPM 的总体体验是什么？”接下来是一个积极的子量表，其中包含三个问题（评分范围 3-12），分数越高反映出更积极的体验，还有一个消极的子量表，其中包含三个问题（评分范围 3-12），分数越低反映出更消极的体验。一个开放式问题通过定性内容分析进行分析。
样本包括 175 名患者（应答率为 98.9%）和 30 名 ICD 护士（应答率为 60%）。大多数患者（154/175，88.0%）和护士（23/30，77%）认为 RPM 非常好；然而，与患者相比，护士注意到的不利方面更多。患者的负性体验子量表的平均得分为 11.5（SD 1.1），护士的平均得分为 10.7（SD 0.9）（P=.08）。患者的正性体验子量表的平均得分为 11.1（SD 1.6），护士的平均得分为 8.5（SD 1.9）（P=.04）。共有 11 名患者（6.3%）对 RPM 所涉及的内容感到担忧或焦虑，而 15 名护士（50%）对伴随 RPM 工作而来的责任感到困扰（P=.04）。患者认为 RPM 增加了他们自己（173/175，98.9%）和他们亲属（169/175，96.6%）的安全感，所有护士（30/30，100%）均认为从安全角度来看，RPM 是必要的。大多数患者认为 RPM 减少了就诊次数是一个优势。护士发现，处理不同平台的不同系统很困难，尤其是对于患者较少的小型诊所。另一个困难是为每个患者设置正确的报警次数。这会导致大量的传输，并有可能错过重要信息。
患者和护士均认为 RPM 增加了保证、信赖和安全性。很少有患者对 RPM 所涉及的内容感到焦虑，而大约一半的护士对伴随 RPM 工作而来的责任感到困扰。为了增加护士的安全感，似乎需要调整组织惯例和报销系统，并平衡工作量。
