■青光眼是视神经的慢性疾病,是英国严重视力丧失的主要原因。一旦病人被确诊,他们需要定期在医院眼科服务机构进行监测。最近的技术进步意味着青光眼患者现在可以在家监测他们的疾病。这对患者来说可能更方便,并有可能降低成本并增加NHS的容量。然而,对于青光眼患者,自我监测是否可以接受或可能是不确定的.
■目标是:确定哪些患者最适合进行家庭监测;了解关键利益相关者的观点(患者,临床医生,研究人员)关于家庭青光眼监测是否可行和可接受;开发家庭青光眼监测的经济评估的概念框架;并探讨未来研究的必要性并为设计提供证据,以评估用于青光眼家庭监测的数字技术的临床和成本效益。
■青光眼的家庭跟踪:可靠性,可接受性,和成本(I-TRAC)是一项多阶段混合方法可行性研究,其关键组成部分由理论和概念框架提供信息。
■通过专业青光眼协会招募的英国青光眼专家专家;通过英国三家医院眼科服务招募的研究中心工作人员和患者参与者(英格兰,苏格兰,北爱尔兰);英国研究团队通过现有网络招募。
■测量眼压的家用眼压计和带有视觉功能应用程序的平板电脑。要求患者每周使用该技术,持续12周。
■招募了42名患者。成功地保留和完成了后续程序,95%(n=40)完成3个月的随访门诊。对干预措施的依从性普遍较高[对两种设备的依从性(即依从性≥80%)为55%]。总的来说,患者和医疗专业人员对青光眼患者家庭监测数字技术的可接受性持谨慎乐观的态度.虽然大多数临床医生支持青光眼家庭监测可以提供的潜在优势,需要解决有关技术(例如可靠性和错过疾病进展的可能性)以及它们如何适合常规护理的问题。此外,需要明确定义这种干预的理想人群。还确定了在未来研究中如何评估金钱价值的计划。然而,该研究还强调了与未来评估研究的核心组成部分相关的几个未知数,这些研究需要在进展至确定性有效性试验之前进行处理.
■主要限制与我们的样本及其泛化性有关,例如,白人受过教育的人的人数过多,他们通常在技术和研究方面经验丰富。
■青光眼的家庭跟踪:可靠性,可接受性,和成本研究表明,在考虑患者和医疗保健专业人员对数字技术对青光眼患者家庭监测的可接受性的看法时,“谨慎乐观”。然而,该研究还强调了与研究问题和未来评估研究设计相关的几个未知数,这些未知数需要在进入随机对照试验之前解决.
■需要进一步研究以确定适当的人口(即低与进展风险高),并进一步完善干预措施的组成部分和交付计划未来的评估研究。
■本研究注册为研究注册中心#6213。
■该奖项由美国国家卫生与护理研究所(NIHR)卫生技术评估计划(NIHR奖参考:NIHR129248)资助,并在《卫生技术评估》中全文发表;卷。28号44.有关更多奖项信息,请参阅NIHR资助和奖励网站。
青光眼的家庭跟踪:可靠性,可接受性,和成本研究探讨了通常在医院接受监测的青光眼患者是否可以在家中进行一些监测,以及他们是否可以在家中进行自我监控。我们提供了青光眼的家庭跟踪:可靠性,可接受性,和成本在四个阶段:调查专家青光眼专家,以了解哪些患者将从家庭监测中受益最大。为青光眼患者提供iPad平板电脑和测量眼压的设备,每周使用一次,持续3个月。参与研究的患者和临床工作人员对他们的经历进行了采访。采访具有运行大型研究测试数字技术的经验的研究人员,以在家中监测患者的健康状况,以了解挑战。回顾其他研究人员的工作,并将其与我们的工作进行比较,以帮助我们了解青光眼的家庭监测是否物有所值。总的来说,患者和医疗专业人员对青光眼家庭监测的数字技术持谨慎乐观的态度.大多数患者参与者能够使用这些技术,一半的人告诉我们他们更喜欢家庭监控。大多数临床医生认识到青光眼家庭监测的潜在优势,但对技术(特别是可靠性和错过疾病进展的风险)以及它们如何适应常规护理感到担忧。确定了在未来研究中如何评估金钱价值的计划。该研究的目的不是确定数字技术是否比目前更好;需要针对更多患者的不同研究设计来回答这个问题。在设计未来更大的研究之前,这项研究确实确定了几个需要回答的重要问题;例如,如何确保不同的患者参与。这些问题应该是该领域未来研究的重点。
UNASSIGNED: Glaucoma is a chronic disease of the optic nerve and a leading cause of severe visual loss in the UK. Once patients have been diagnosed, they need regular monitoring at hospital eye services. Recent advances in technology mean patients with glaucoma can now monitor their disease at home. This could be more convenient for patients and potentially reduce costs and increase capacity for the NHS. However, it is uncertain whether self-monitoring would be acceptable or possible for patients with glaucoma.
UNASSIGNED: The objectives were to: identify which patients are most appropriate for home monitoring; understand views of key stakeholders (patients, clinicians, researchers) on whether home glaucoma monitoring is feasible and acceptable; develop a conceptual framework for the economic evaluation of home glaucoma monitoring; and explore the need for and provide evidence on the design of a future study to evaluate the clinical and cost-effectiveness of digital technologies for home monitoring of glaucoma.
UNASSIGNED: In-home Tracking of glaucoma: Reliability, Acceptability, and Cost (I-TRAC) was a multiphase mixed-methods feasibility study with key components informed by theoretical and conceptual frameworks.
UNASSIGNED: Expert glaucoma specialists in the UK recruited through professional glaucoma societies; study site staff and patient participants recruited through three UK hospital eye services (England, Scotland, Northern Ireland); and UK research teams recruited though existing networks.
UNASSIGNED: Home tonometer that measures intraocular pressure and a tablet computer with a visual function application. Patients were asked to use the technology weekly for 12 weeks.
UNASSIGNED: Forty-two patients were recruited. Retention and completion of follow-up procedures was successful, with 95% (n = 40) completing the 3-month follow-up clinic visits. Adherence to the interventions was generally high [adherence to both devices (i.e. ≥ 80% adherence) was 55%]. Overall, patients and healthcare professionals were cautiously optimistic about the acceptability of digital technologies for home monitoring of patients with glaucoma. While most clinicians were supportive of the potential advantages glaucoma home monitoring could offer, concerns about the technologies (e.g. reliability and potential to miss disease progression) and how they would fit into routine care need to be addressed. Additionally, clarity is required on defining the ideal population for this intervention. Plans for how to evaluate value for money in a future study were also identified. However, the study also highlighted several unknowns relating to core components of a future evaluative
study that require addressing before progression to a definitive effectiveness
trial.
UNASSIGNED: The main limitation relates to our sample and its generalisability, for example, the over-representation of educated persons of white ethnicity who were generally experienced with technology and research motivated.
UNASSIGNED: The In-home Tracking of glaucoma: Reliability, Acceptability, and Cost study has demonstrated \'cautious optimism\' when considering patients\' and healthcare professionals\' views on the acceptability of digital technologies for home monitoring of patients with glaucoma. However, the study also highlighted several unknowns relating to the research question and design of a future evaluative
study that require addressing before progression to a randomised controlled
trial.
UNASSIGNED: Further research is required to determine the appropriate population (i.e. low vs. high risk of progression) and further refine the intervention components and delivery for planning of future evaluation studies.
UNASSIGNED: This
study is registered as Research Registry #6213.
UNASSIGNED: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR129248) and is published in full in Health Technology Assessment; Vol. 28, No. 44. See the NIHR Funding and Awards website for further award information.
The In-home Tracking of glaucoma: Reliability, Acceptability, and Cost study explored whether glaucoma patients who would normally be monitored in hospital could do some monitoring themselves at home, and whether self-monitoring at home would be acceptable or possible for them. We delivered In-home Tracking of glaucoma: Reliability, Acceptability, and Cost in four phases by: Surveying expert glaucoma specialists to understand which patients would benefit most from home monitoring. Providing glaucoma patients with an iPad tablet and a device which measures eye pressure to use once a week for 3 months. The patients who participated and the clinical staff delivering the study were interviewed about their experiences. Interviewing researchers with experience of running large studies testing digital technologies to monitor patients’ health at home to understand challenges. Reviewing other researchers’ work and comparing it with ours to help us understand whether home monitoring of glaucoma could be good value for money. Overall, patients and healthcare professionals were cautiously optimistic about the digital technologies for home monitoring of glaucoma. Most patient participants were able to use the technologies, and half told us they preferred home monitoring. Most clinicians recognised the potential advantages of glaucoma home monitoring but had concerns about the technologies (specifically reliability and the risk of missing disease progression) and how they would fit into routine care. Plans for how to evaluate value for money in a future
study were identified. The study did not aim to identify whether the digital technology was better than what happens currently; a different study design with many more patients would be required to answer that question. The
study did identify several important questions to answer before designing a future larger
study; for example, how to ensure diverse patient participation. These questions should be the focus of future research in this area.