Article

Detecting deterioration in patients with chronic disease using telemonitoring: navigating the 'trough of disillusionment'

Department of Primary Care and Public Health, Clinical Epidemiology Interdisciplinary Research Group, Cardiff University, Cardiff, UK.
Journal of Evaluation in Clinical Practice (Impact Factor: 1.58). 08/2011; 18(4):896-903. DOI: 10.1111/j.1365-2753.2011.01701.x
Source: PubMed

ABSTRACT To examine the evidence base for telemonitoring designed for patients who have chronic obstructive pulmonary disease and heart failure, and to assess whether telemonitoring fulfils the principles of monitoring and is ready for implementation into routine settings.
Qualitative data collection using interviews and participation in a multi-path mapping process.
Twenty-six purposively selected informants completed semi-structured interviews and 24 individuals with expertise in the relevant clinical and informatics domains from academia, industry, policy and provider organizations and participated in a multi-path mapping workshop.
The evidence base for the effectiveness of telemonitoring is weak and inconsistent, with insufficient cost-effectiveness studies. When considered against an accepted definition of monitoring, telemonitoring is found wanting. Telemonitoring has not been able so far to ensure that the technologies fit into the life world of the patient and into the clinical and organizational milieu of health service delivery systems.
To develop effective telemonitoring for patients with chronic disease, more attention needs to be given to agreeing the central aim of early detection and, to ensure potential implementation, engaging a wide range of stakeholders in the design process, especially patients and clinicians.

0 Followers
 · 
137 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To (1) map how different stakeholders understand telehealth and telecare technologies and (2) explore the implications for development and implementation of telehealth and telecare services. Discourse analysis. 68 publications representing diverse perspectives (academic, policy, service, commercial and lay) on telehealth and telecare plus field notes from 10 knowledge-sharing events. Following a familiarisation phase (browsing and informal interviews), we studied a systematic sample of texts in detail. Through repeated close reading, we identified assumptions, metaphors, storylines, scenarios, practices and rhetorical positions. We added successive findings to an emerging picture of the whole. Telehealth and telecare technologies featured prominently in texts on chronic illness and ageing. There was no coherent organising vision. Rather, four conflicting discourses were evident and engaged only minimally with one another's arguments. Modernist discourse presented a futuristic utopian vision in which assistive technologies, implemented at scale, would enable society to meet its moral obligations to older people by creating a safe 'smart' home environment where help was always at hand, while generating efficiency savings. Humanist discourse emphasised the uniqueness and moral worth of the individual and tailoring to personal and family context; it considered that technologies were only sometimes fit for purpose and could create as well as solve problems. Political economy discourse envisaged a techno-economic complex of powerful vested interests driving commodification of healthcare and diversion of public funds into private business. Change management discourse recognised the complicatedness of large-scale technology programmes and emphasised good project management and organisational processes. Introduction of telehealth and telecare is hampered because different stakeholders hold different assumptions, values and world views, 'talk past' each other and compete for recognition and resources. If investments in these technologies are to bear fruit, more effective inter-stakeholder dialogue must occur to establish an organising vision that better accommodates competing discourses.
    BMJ Open 07/2012; 2(4). DOI:10.1136/bmjopen-2012-001574 · 2.06 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Electronic Patient Records (EPRs) and telemedicine are positioned by policymakers as health information technologies that are integral to achieving improved clinical outcomes and efficiency savings. However, evaluating the extent to which these aims are met poses distinct evaluation challenges, particularly where clinical and cost outcomes form the sole focus of evaluation design. We propose that a practice-centred approach to evaluation - in which those whose day-to-day care practice is altered (or not) by the introduction of new technologies are placed at the centre of evaluation efforts - can complement and in some instances offer advantages over, outcome-centric evaluation models.
    BMC Health Services Research 06/2014; 14(1):243. DOI:10.1186/1472-6963-14-243 · 1.66 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: A key element in many future-oriented technology analyses is the expert forecasting workshop. These workshops provide a means of combining codified and tacit knowledge to explore the plausibility of various technology options, providing key intelligence for assessing the potential innovations that may stem from them. This paper offers a five-stage approach to conducting such a workshop. It reflects on attributes of one such session, conducted within a larger study concerning biosensor innovation pathways. The workshop drew upon quantitative and qualitative data to stimulate the consideration of future prospects. We reflect on issues in conveying prior analyses to the workshop participants, keying on the value of succinct visualisations. Post-workshop synthesis resulted in the generation of three innovation pathways for nanobiosensors.
    Technology Analysis and Strategic Management 05/2012; 24(5):527-542. DOI:10.1080/09537325.2012.674673 · 0.70 Impact Factor

Full-text

Download
49 Downloads
Available from
May 29, 2014