Continuity, but at what cost? The impact of telemonitoring COPD on continuities of care: a qualitative study
Open accessAbstract
Background Continuity of care is widely regarded as an important marker of quality in the management of patients with long-term conditions. New services that integrate telemonitoring into care pathways have potential to change aspects of continuity in both positive and negative ways.Aims A telemonitoring service for patients with chronic obstructive pulmonary disease (COPD) was introduced in Lothian, Scotland, in 2009. A qualitative study, nested within the TELESCOT COPD randomised control trial, was undertaken to explore the views of patients and professionals on telemonitoring. The perceived impact of telemonitoring on continuity of care was investigated as part of the research.Methods Semi-structured interviews were undertaken with 38 patients (47% male, mean age 67.5 years). A maximum variation sample in relation to age, sex, socio-economic background, disease severity, and compliance with telemonitoring was recruited. Thirty-two stakeholders (healthcare professionals and managers) were interviewed. Transcribed coded data were analysed thematically using the framework approach. Interpretation was supported by multidisciplinary discussion.Results Patients and healthcare professionals considered that relationship-based continuity of care was important in the delivery of telemonitoring services. Managers placed emphasis on improved continuity of clinical management as a means of reducing healthcare costs. However, professionals described many operational challenges arising from the 'bolting-on' of telemonitoring provision to existing usual care provision which, they considered, resulted in the proliferation of additional managerial discontinuities.Conclusions Managers and healthcare professionals face major challenges in meeting demands for both relationship continuity and continuity of clinical management in the development of telemonitoring services.
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Qualitative explorations of some asthma and COPD interventions suggested that daily professional monitoring of telemonitored parameters (such as pulse oximetry or symptom scores) could engender reliance on professionals rather than supporting self-management.
“However, qualitative explorations of some asthma and COPD interventions suggested that daily professional monitoring of telemonitored parameters (such as pulse oximetry or symptom scores) could engender reliance on professionals rather than supporting self-management [11,76,78,79].”
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Self-citation
- Authors
- Fairbrother, P., Pinnock, H., Hanley, J., McCloughan, L., Sheikh, A., Pagliari, C., & McKinstry, B.
- Affiliations
- University of Edinburgh (GB)
- Edinburgh Napier University (GB)
- Corresponding author
- Fairbrother, Peter
- Venue
- Primary Care Respiratory Journal
- Published
- 2012-08-08
- Volume
- 21
- Issue
- 3
- Pages
- 322-328
- ISSN
- 1471-4418 (ISSN-L)
- 1475-1534
- PMC
- PMC6547965
- OpenAlex
- W2000208662
- Cited by
- 73
- References
- 20
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 2 · 2023: 3 · 2022: 6 · 2021: 6 · 2020: 5 · 2019: 8 · 2018: 4 · 2017: 7 · 2016: 7 · 2015: 11 · 2014: 5 · 2013: 3
- FWCI
- 5.87
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Primary Care Respiratory Journal (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Edinburgh Napier Research Repository (Edinburgh Napier University) (submittedVersion)
- Edinburgh Napier Research Repository (Edinburgh Napier University) (submittedVersion, cc-by)
- Funders
- McKnight Foundation
- Queen Mary University of London
- University of Aberdeen
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- remote patient monitoring, chronic obstructive pulmonary disease, continuity of care, relational continuity, health care costs, chronic disease, Lothian
- MeSH terms
- Adult, Aged, Aged, 80 and over, Continuity of Patient Care, Costs and Cost Analysis, Female, Humans, Male, Middle Aged, Telemedicine, Pulmonary Disease, Chronic Obstructive, Qualitative Research
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