Dataset Information

Trust and Uncertainty in the Implementation of a Pilot Remote Blood Pressure Monitoring Program in Primary Care: Qualitative Study of Patient and Health Care Professional Views.

ABSTRACT:

Background

Trust is of fundamental importance to the adoption of technologies in health care. The increasing use of telemedicine worldwide makes it important to consider user views and experiences. In particular, we ask how the mediation of a technological platform alters the trust relationship between patient and health care provider.

Objective

To date, few qualitative studies have focused on trust in the use of remote health care technologies. This study examined the perspectives of patients and clinical staff who participated in a remote blood pressure monitoring program, focusing on their experiences of trust and uncertainty in the use of technology and how this telehealth intervention may have affected the patient-provider relationship.

Methods

A secondary qualitative analysis using inductive thematic analysis was conducted on interview data from 13 patients and 8 staff members who participated in a remote blood pressure monitoring program to elicit themes related to trust.

Results

In total, 4 themes were elicited that showed increased trust (patients felt reassured, patients trusted the telehealth program, staff felt that the data were trustworthy, and a better patient-provider partnership based on the mutually trusted data), and 4 themes were elicited that reflected decreased trust (patients' distrust of technology, clinicians' concerns about the limitations of technologically mediated interactions, experiences of uncertainty, and institutional risk).

Conclusions

Managing trust relationships plays an important role in the successful implementation of telemedicine. Ensuring that trust building is incorporated in the design of telehealth interventions can contribute to improved effectiveness and quality of care.

SUBMITTER: Chew E

PROVIDER: S-EPMC9853336 | biostudies-literature | 2023 Jan

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Trust and Uncertainty in the Implementation of a Pilot Remote Blood Pressure Monitoring Program in Primary Care: Qualitative Study of Patient and Health Care Professional Views.

Chew Evelyn E Teo Sok Huang SH Tang Wern Ee WE Ng David Wei Liang DWL Koh Gerald Choon Huat GCH Teo Valerie Hui Ying VHY

JMIR human factors 20230105

<h4>Background</h4>Trust is of fundamental importance to the adoption of technologies in health care. The increasing use of telemedicine worldwide makes it important to consider user views and experiences. In particular, we ask how the mediation of a technological platform alters the trust relationship between patient and health care provider.<h4>Objective</h4>To date, few qualitative studies have focused on trust in the use of remote health care technologies. This study examined the perspective ...[more]

PMID: 36602847

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Project description:IntroductionNumerous factors are intersecting in healthcare resulting in an increased focus on new tools and methods for managing care in patients' homes. Remote patient monitoring (RPM) is an option to provide care at home and maintain a connection between patients and providers to address ongoing medical issues.MethodsMayo Clinic developed a nurse-led RPM program for disease and post-procedural management to improve patient experience, clinical outcomes, and reduce health care utilization by more directly engaging patients in their health care. Enrolled patients are sent a technology package that includes a digital tablet and peripheral devices for the collection of symptoms and vital signs. The data are transmitted from to a hub integrated within the electronic health record. Care team members coordinate patient needs, respond to vital sign alerts, and utilize the data to inform and provide individualized patient assessment, patient education, medication management, goal setting, and clinical care planning.ResultsSince its inception, the RPM program has supported nearly 22,000 patients across 17 programs. Patients who engaged in the COVID-19 RPM program experienced a significantly lower rate of 30-day, all-cause hospitalization (13.7% vs. 18.0%, P = 0.01), prolonged hospitalization >7 days (3.5% vs. 6.7%, P = 0.001), intensive care unit (ICU) admission (2.3% vs. 4.2%, P = 0.01), and mortality (0.5% vs. 1.7%, P = 0.01) when compared with those enrolled and unengaged with the technology. Patients with chronic conditions who were monitored with RPM upon hospital discharge were significantly less likely to experience 30-day readmissions (18.2% vs. 23.7%, P = 0.03) compared with those unmonitored. Ninety-five percent of patients strongly agreed or agreed they were likely to recommend RPM to a friend or family member.ConclusionsThe Mayo Clinic RPM program has generated positive clinical outcomes and is satisfying for patients. As technology advances, there are greater opportunities to enhance this clinical care model and it should be extended and expanded to support patients across a broader spectrum of needs. This report can serve as a framework for health care organizations to implement and enhance their RPM programs in addition to identifying areas for further evolution and exploration in developing RPM programs of the future.

Project description:ImportanceGuidelines recommend using telehealth for hypertension management, but insufficient evidence is available to guide strategies for incorporating telehealth data into clinical practice.ObjectiveTo describe how primary care teams responded to elevated remote blood pressure (BP) alerts in the electronic health record (EHR) in a randomized clinical trial of BP telemonitoring conducted in routine practice settings.Design, setting, and participantsThis retrospective cohort study reviewed EHR documentation from May 8, 2018, to August 9, 2019, in a single urban academic family practice site. Primary care teams comprising 28 attending physicians and nurse practitioners, residents, and nurses cared for 162 patients in a text-based clinical trial of remote BP monitoring remote BP monitoring. Data were analyzed from October 21, 2019, to April 30, 2021.ExposuresClinicians received a direct message in their EHR inbox when patients submitted at least 3 elevated BP readings.Main outcomes and measuresCategories and frequencies of clinician action, created via review of EHR-documented clinician responses to EHR alerts by 2 physicians.ResultsPatients in this study (n = 162) were predominantly female (111 [68.5%]) and Black or African American (146 [90.1%]), whereas attending physicians (n = 21) were predominantly female (13 [61.9%]) and non-Hispanic White (19 [90.5%]) with a mean (SD) age of 51.6 (11.1) years. Five hundred fifty-two alerts fell into 12 categories of clinical actions. Clinicians acted on 343 alerts (62.1%). Common remote activities were to reconcile medications and assess adherence (120 of 552 alerts [21.7%]) and verify BP measurement technique (65 of 552 alerts [11.8%]). Clinicians also commonly requested appointments (120 of 552 alerts [21.7%]) and/or saw the patient in a subsequent office visit (114 of 552 alerts [20.7%]). Ninety-six alerts (17.4%) resulted in medication changes; half of these changes were remote (48 of 96 [50.0%]), and the other half were visit-based. For 209 of 552 alerts (37.9%), no changes were made to the care plan, typically without documenting clinical rationale (196 of 209 instances [93.8%]). Exploratory EHR review was used to infer potential clinical rationale for 106 (54.1%) of such cases, but there was insufficient information for the remaining 90 (45.9%).Conclusions and relevanceThese findings suggest that EHR alerts for elevated BP during remote monitoring were effective in prompting a mix of remote and office-based management. It was also common for the plan of care to remain unchanged, possibly suggesting need for more refined alerts and improved clinician support.

Project description:IntroductionIn long-term illnesses, monitoring is an essential part of successful pharmacotherapy. Medicine users' experiences on monitoring have not been widely studied even though they have an important role in the implementation of pharmacotherapy.ObjectivesThe aim of this study was to investigate the medicine users' experiences on the implementation of pharmacotherapy monitoring. The focus was on the instructions received regarding the frequency of follow-up visits in health care, the actual frequency of the visits, and the experienced sufficiency of monitoring. Furthermore, we aimed to identify the characteristics of respondents and pharmacotherapy that were associated with implementation of pharmacotherapy monitoring.MethodsWe conducted an online survey targeted at Finnish people ≥18 years who have requested a prescription renewal in MyKanta patient portal in October 2021. We used descriptive statistics and logistic regression in the analyses.Results1723 individuals completed the questionnaire. Of them, 97.9% (n = 1687) were using prescription medicines and were included in the study. Of the study population, 57.1% had received instructions regarding follow-up visits in health care related to pharmacotherapy monitoring, 70.3% had an annual follow-up visit, and 64.3% felt monitoring was sufficient with all their pharmacotherapies. Several respondents and pharmacotherapy related characteristics were associated with the implementation of pharmacotherapy monitoring. Having diabetes and a designated health care unit responsible for monitoring were associated with well-implemented monitoring, while unfamiliarity with the goals set for pharmacotherapy was strongly associated with poorly implemented monitoring.ConclusionsIn most cases, the medicine users experienced that the monitoring of pharmacotherapies was well-implemented. Having diabetes, a designated health care unit and familiarity with the goals set for pharmacotherapy were associated with well-implemented monitoring. These findings indicate that monitoring practices are well-implemented for diabetes. Furthermore, centralized monitoring in health care unit and understanding of goals set for pharmacotherapy would enhance individual's monitoring of pharmacotherapy.

Project description:BackgroundAutomated texting platforms have emerged as a tool to facilitate communication between patients and health care providers with variable effects on achieving target blood pressure (BP). Understanding differences in the way patients interact with these communication platforms can inform their use and design for hypertension management.ObjectiveOur primary aim was to explore the unique phenotypes of patient interactions with an automated text messaging platform for BP monitoring. Our secondary aim was to estimate associations between interaction phenotypes and BP control.MethodsThis study was a secondary analysis of data from a randomized controlled trial for adults with poorly controlled hypertension. A total of 201 patients with established primary care were assigned to the automated texting platform; messages exchanged throughout the 4-month program were analyzed. We used the k-means clustering algorithm to characterize two different interaction phenotypes: program conformity and engagement style. First, we identified unique clusters signifying differences in program conformity based on the frequency over time of error alerts, which were generated to patients when they deviated from the requested text message format (eg, ###/## for BP). Second, we explored overall engagement styles, defined by error alerts and responsiveness to text prompts, unprompted messages, and word count averages. Finally, we applied the chi-square test to identify associations between each interaction phenotype and achieving the target BP.ResultsWe observed 3 categories of program conformity based on their frequency of error alerts: those who immediately and consistently submitted texts without system errors (perfect users, 51/201), those who did so after an initial learning period (adaptive users, 66/201), and those who consistently submitted messages generating errors to the platform (nonadaptive users, 38/201). Next, we observed 3 categories of engagement style: the enthusiast, who tended to submit unprompted messages with high word counts (17/155); the student, who inconsistently engaged (35/155); and the minimalist, who engaged only when prompted (103/155). Of all 6 phenotypes, we observed a statistically significant association between patients demonstrating the minimalist communication style (high adherence, few unprompted messages, limited information sharing) and achieving target BP (P<.001).ConclusionsWe identified unique interaction phenotypes among patients engaging with an automated text message platform for remote BP monitoring. Only the minimalist communication style was associated with achieving target BP. Identifying and understanding interaction phenotypes may be useful for tailoring future automated texting interactions and designing future interventions to achieve better BP control.

Dataset Information

Trust and Uncertainty in the Implementation of a Pilot Remote Blood Pressure Monitoring Program in Primary Care: Qualitative Study of Patient and Health Care Professional Views.

Background

Objective

Methods

Results

Conclusions

Publications

Trust and Uncertainty in the Implementation of a Pilot Remote Blood Pressure Monitoring Program in Primary Care: Qualitative Study of Patient and Health Care Professional Views.

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