背景:当前文献未充分解决应将远程监测整合到慢性呼吸系统疾病(CRD)护理模型中的程度。
目的:本研究通过探索经验,研究了囊性纤维化(CF)的远程监测程序(RMP)。未来的前景,使用行为超过3年,目的是为CRD中的远程监控制定未来的方向。
方法:这是一种混合方法,多中心,在5个荷兰CF中心进行的观察性研究,遵循序贯解释性设计。使用技术接受模型自行设计的问卷被发送给CF患者,他们在RMP和当地医疗保健专业人员(HCP)方面至少有12个月的经验。问卷结果用于告知对HCP和CF患者的半结构化访谈。根据COREQ(报告定性研究的综合标准)清单报告定性结果。分析了所有CF患者使用频率的匿名数据。
结果:在2020年第二季度至2022年底之间,共有608名CF患者参加了该计划,共进行了9418项肺功能检查和2631项症状调查。总的来说,65%(24/37)的HCP和89%(72/81)的CF患者回答了问卷,7名HCP和12名CF患者参加了半结构化访谈。CF和HCP患者对CF护理中的远程监测均呈阳性,并发现RMP是日常护理的良好补充(CF患者:44/72,61%;HCP:21/24,88%)。好处从支持个别患者到减少医疗保健消费不等。最有价值的监测工具是CF患者(66/72,92%)和HCP患者(22/24,92%)的家庭肺活量测定。缺点包括可能会忽视患者和负面的社会心理影响,由于RMP,17%(12/72)的CF患者经历了某种形式的压力。大多数CF(59/72,82%)和HCP(22/24,92%)的人希望将来继续使用RMP,79%(19/24)的HCP和75%(54/72)的CF患者期待在健康期间用数字护理更多地替代面对面护理。RMP的未来前景集中在创建混合护理模式上,个性化远程护理,并平衡个人利益与监测负担。
结论:在CF护理模式下,远程监测在支持CF患者和HCP患者方面具有相当大的潜力。我们确定了CF和CRD护理中远程监测的4个基于实践的未来方向。战略,从患者驱动到预测驱动,可以帮助临床医生,研究人员,政策制定者驾驭快速变化的数字健康领域,将远程监控集成到本地护理模式中,并使远程护理与患者和临床医生的需求保持一致。
BACKGROUND: The current literature inadequately addresses the extent to which remote monitoring should be integrated into care models for chronic respiratory diseases (CRDs).
OBJECTIVE: This study examined a remote monitoring program (RMP) in cystic fibrosis (CF) by exploring experiences, future perspectives, and use behavior over 3 years, with the aim of developing future directions for remote monitoring in CRDs.
METHODS: This was a mixed methods, multicenter, observational study in 5 Dutch CF centers following a sequential explanatory design. Self-designed questionnaires using the technology acceptance model were sent out to people with CF who had a minimum of 12 months of experience with the RMP and local health care professionals (HCPs). Questionnaire outcomes were used to inform semistructured interviews with HCPs and people with CF. Qualitative findings were reported following the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist. Anonymous data on use frequency of all people with CF were analyzed.
RESULTS: Between the second quarter of 2020 and the end of 2022, a total of 608 people with CF were enrolled in the program, and a total of 9418 lung function tests and 2631 symptom surveys were conducted. In total, 65% (24/37) of HCPs and 89% (72/81) of people with CF responded to the questionnaire, and 7 HCPs and 12 people with CF participated in semistructured interviews. Both people with CF and HCPs were positive about remote monitoring in CF care and found the RMP a good addition to daily care (people with CF: 44/72, 61%; HCPs: 21/24, 88%). Benefits ranged from supporting individual patients to reducing health care consumption. The most valued monitoring tool was home spirometry by both people with CF (66/72, 92%) and HCPs (22/24, 92%). Downsides included the potential to lose sight of patients and negative psychosocial effects, as 17% (12/72) of people with CF experienced some form of stress due to the RMP. A large majority of people with CF (59/72, 82%) and HCPs (22/24, 92%) wanted to keep using the RMP in future, with 79% (19/24) of HCPs and 75% (54/72) of people with CF looking forward to more replacement of in-person care with digital care during periods of well-being. Future perspectives for the RMP were centered on creating hybrid care models, personalizing remote care, and balancing individual benefits with monitoring burden.
CONCLUSIONS: Remote monitoring has considerable potential in supporting people with CF and HCPs within the CF care model. We identified 4 practice-based future directions for remote monitoring in CF and CRD care. The strategies, ranging from patient driven to prediction driven, can help clinicians, researchers, and policy makers navigate the rapidly changing digital health field, integrate remote monitoring into local care models, and align remote care with patient and clinician needs.