Research and Policy, Nuffield Trust, London, UK.
NIHR Children and Families Policy Research Unit, UCL Great Ormond Street Institute of Child Health, London, UK.
Health Expect. 2024 Aug;27(4):e14145. doi: 10.1111/hex.14145.
The adoption of remote healthcare methods has been accelerated by the COVID-19 pandemic, but evidence suggests that some patients need additional support to engage remotely, potentially increasing health disparities if needs are not met. This study of COVID-19 remote home monitoring services across England explores experiences of and engagement with the service across different patient groups.
This was a mixed-methods study with survey and interview data collected from 28 services across England between February and June 2021. Surveys were conducted with staff and patients and carers receiving the service. Interviews with staff service leads, patients and carers were conducted in 17 sites. Quantitative data were analysed using univariate and multivariate methods, and qualitative data were analysed using thematic analysis.
Survey responses were received from 292 staff and 1069 patients and carers. Twenty-three staff service leads, 59 patients and 3 carers were interviewed. Many service leads reported that they had considered inclusivity when adapting the service for their local population; strategies included widening the eligibility criteria, prioritising vulnerable groups and creating referral pathways. However, disparities were reported across patient groups in their experiences and engagement. Older patients reported the service to be less helpful (p = 0.004), were more likely to report a problem (p < 0.001) and had more difficulty in understanding information (p = 0.005). Health status (p = 0.004), ethnicity (p < 0.001), gender (p < 0.001) and employment (p = 0.007) were associated with differential engagement with monitoring, and minority ethnic groups reported more difficulty understanding service information (p = 0.001). Qualitative data found illness severity to be an important factor in the support required, and patients' living situation and social network affected whether they found the service reassuring.
Addressing health disparities must be a key focus in the design and delivery of remote care. Services should be tailored to match the needs of their local population, encourage access through collaboration and referral pathways with other services and monitor their inclusiveness. Involving patients and staff in service design can illuminate the diversity of patients' needs and experiences of care.
The study team met with service user and public members of the BRACE PPI group and patient representatives from RSET in a series of workshops. Workshops informed study design, data collection tools, data interpretation and dissemination activities. Study documents (such as consent forms, topic guides, surveys and information sheets) were reviewed by PPI members; patient surveys and interview guides were piloted, and members also commented on the manuscript.
COVID-19 大流行加速了远程医疗方法的采用，但有证据表明，一些患者需要额外的支持才能远程参与，这可能会增加健康差距，如果需求得不到满足。本研究对英格兰各地的 COVID-19 远程家庭监测服务进行了调查，探讨了不同患者群体对该服务的体验和参与情况。
这是一项混合方法研究，于 2021 年 2 月至 6 月期间在英格兰的 28 个服务机构中收集了调查和访谈数据。调查对象是接受服务的工作人员和患者及其护理人员。在 17 个地点对工作人员服务负责人、患者和护理人员进行了访谈。使用单变量和多变量方法对定量数据进行分析，使用主题分析对定性数据进行分析。
共收到 292 名工作人员和 1069 名患者及其护理人员的调查回复。对 23 名工作人员服务负责人、59 名患者和 3 名护理人员进行了访谈。许多服务负责人报告说，他们在为当地人口调整服务时考虑到了包容性；策略包括扩大资格标准、优先考虑弱势群体和建立转诊途径。然而，不同患者群体在体验和参与方面存在差异。老年患者报告该服务帮助不大（p=0.004），更有可能报告问题（p<0.001），并且在理解信息方面存在更多困难（p=0.005）。健康状况（p=0.004）、族裔（p<0.001）、性别（p<0.001）和就业（p=0.007）与监测的差异参与相关，少数族裔群体报告说更难理解服务信息（p=0.001）。定性数据发现疾病严重程度是所需支持的一个重要因素，患者的生活状况和社交网络影响他们是否认为该服务令人安心。
在远程护理的设计和实施中，解决健康差距必须是一个关键重点。服务应该根据当地人口的需求进行调整，通过与其他服务的合作和转诊途径来鼓励获得服务，并监测其包容性。让患者和工作人员参与服务设计可以阐明患者需求和护理体验的多样性。
研究团队与 BRACE PPI 小组的服务使用者和公众成员以及 RSET 的患者代表举行了一系列研讨会。研讨会为研究设计、数据收集工具、数据解释和传播活动提供了信息。PPI 成员审查了研究文件（如同意书、主题指南、调查和信息表）；对患者调查和访谈指南进行了试点，成员还对手稿发表了评论。
