Abstract
ObjectiveAs the global burden of chronic disease rises, policy makers are showing a strong interest in adopting telehealth technologies for use in long term condition management, including COPD. However, there remain barriers to its implementation and sustained use. To date, there has been limited qualitative investigation into how users (both patients/carers and staff) perceive and experience the technology. We aimed to systematically review and synthesise the findings from qualitative studies that investigated user perspectives and experiences of telehealth in COPD management, in order to identify factors which may impact on uptake.MethodSystematic review and meta-synthesis of published qualitative studies of user (patients, their carers and clinicians) experience of telehealth technologies for the management of Chronic Obstructive Pulmonary Disease. ASSIA, CINAHL, Embase, Medline, PsychInfo and Web of Knowledge databases were searched up to October 2014. Reference lists of included studies and reference lists of key papers were also searched. Quality appraisal was guided by an adapted version of the CASP qualitative appraisal tool.Findings705 references (after duplicates removed) were identified and 10 papers, relating to 7 studies were included in the review. Most authors of included studies had identified both positive and negative experiences of telehealth use in the management of COPD. Through a line of argument synthesis we were able to derive new insights from the data to identify three overarching themes that have the ability to either impede or promote positive user experience of telehealth in COPD: the influence on moral dilemmas of help seeking—(enables dependency or self-care); transforming interactions (increases risk or reassurance) and reconfiguration of ‘work’ practices (causes burden or empowerment).ConclusionFindings from this meta-synthesis have implications for the future design and implementation of telehealth services. Future research needs to include potential users at an earlier stage of telehealth/service development.
Highlights
The rise of the global burden of chronic disease, such as COPD, has led to a shift in health policy to target the prevention and management of chronic disease [1]
This article focuses on telehealth technologies which we define as those which enable data, such as oxygen saturation levels, blood pressure and pulse, and other information to be remotely exchanged between a patient and health professional as part of their overall management of chronic disease [5]
We are concerned with understanding the perceptions of the users of telehealth to understand the factors which may impact on its uptake and sustained use
Summary
The rise of the global burden of chronic disease, such as COPD, has led to a shift in health policy to target the prevention and management of chronic disease [1]. Policy makers have shown a strong interest in adopting remote monitoring via information and communication (ICT) technologies (termed telemonitoring, telehealth, telecare, telemedicine, or telehealthcare) to reduce the demand for expensive hospital admissions whilst helping people to live independently for longer [2]. Despite such policy drives, remote monitoring has largely failed to be successfully integrated into routine healthcare [3, 4]. Interventions are needed to effectively manage COPD to reduce the burden on health care resources and individuals alike
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