Herlitz Lauren, Crellin Nadia, Vindrola-Padros Cecilia, Ellins Jo, Georghiou Theo, Litchfield Ian, Massou Efthalia, Ng Pei Li, Sherlaw-Johnson Chris, Sidhu Manbinder S, Tomini Sonila M, Walton Holly, Fulop Naomi J
NIHR Children and Families Policy Research Unit, Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.
Nuffield Trust, 59 New Cavendish St, London W1G 7LP, UK.
Int J Med Inform. 2023 Nov;179:105230. doi: 10.1016/j.ijmedinf.2023.105230. Epub 2023 Sep 23.
To evaluate patient and staff experiences of using technology-enabled ('tech-enabled') and analogue remote home monitoring models for COVID-19, implemented in England during the pandemic.
Twenty-eight sites were selected for diversity in a range of criteria (e.g. pre-hospital or early discharge service, mode of patient data submission). Between February and May 2021, we conducted quantitative surveys with patients, carers and staff delivering the service, and interviewed patients, carers, and staff from 17 of the 28 services. Quantitative data were analysed using descriptive statistics and both univariate and multivariate analyses. Qualitative data were interpreted using thematic analysis.
Twenty-one sites adopted mixed models whereby patients could submit their symptoms using either tech-enabled (app, weblink, or automated phone calls) or analogue (phone calls with a health professional) options; seven sites offered analogue-only data submission (phone calls or face-to-face visits with a health professional). Sixty-two patients and carers were interviewed, and 1069 survey responses were received (18 % response rate). Fifty-eight staff were interviewed, and 292 survey responses were received (39 % response rate). Patients who used tech-enabled modes tended to be younger (p = 0.005), have a higher level of education (p = 0.011), and more likely to identify as White British (p = 0.043). Most patients found relaying symptoms easy, regardless of modality, though many received assistance from family or friends. Staff considered the adoption of mixed delivery models beneficial, enabling them to manage large patient numbers and contact patients for further assessment as needed; however, they suggested improvements to the functionality of systems to better fit clinical and operational needs. Human contact was important in all remote home monitoring options.
Organisations implementing tech-enabled remote home monitoring at scale should consider adopting mixed models which can accommodate patients with different needs; focus on the usability and interoperability of tech-enabled platforms; and encourage digital inclusivity for patients.
评估在疫情期间于英格兰实施的针对新冠肺炎的启用技术（“技术赋能”）和模拟远程居家监测模式下患者及工作人员的体验。
根据一系列标准（如院前或早期出院服务、患者数据提交方式）选择了28个地点以确保多样性。在2021年2月至5月期间，我们对提供该服务的患者、护理人员和工作人员进行了定量调查，并对28项服务中的17项的患者、护理人员和工作人员进行了访谈。定量数据采用描述性统计以及单变量和多变量分析进行分析。定性数据采用主题分析进行解读。
21个地点采用了混合模式，患者可以使用技术赋能方式（应用程序、网络链接或自动电话）或模拟方式（与医护人员电话沟通）提交症状；7个地点仅提供模拟数据提交方式（与医护人员电话沟通或面对面就诊）。访谈了62名患者和护理人员，收到1069份调查回复（回复率18%）。访谈了58名工作人员，收到292份调查回复（回复率39%）。使用技术赋能模式的患者往往更年轻（p = 0.005）、教育水平更高（p = 0.011），且更有可能认定自己为英国白人（p = 0.043）。大多数患者认为，无论采用何种方式，传达症状都很容易，不过许多人得到了家人或朋友的帮助。工作人员认为采用混合交付模式有益，使他们能够管理大量患者，并根据需要联系患者进行进一步评估；然而，他们建议改进系统功能，以更好地满足临床和操作需求。在所有远程居家监测选项中，人际接触都很重要。
大规模实施技术赋能远程居家监测的机构应考虑采用混合模式，以满足不同需求的患者；关注技术赋能平台的可用性和互操作性；并鼓励患者实现数字包容性。
