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

Elwyn, Glyn, Hardisty, Alex R., Peirce, Susan C., May, Carl, Evans, Robert, Robinson, Douglas K. R., Bolton, Charlotte E., Yousef, Zaheer, Conley, Edward C., Rana, Omer F., Gray, W. Alex and Preece, Alun D. (2011) Detecting deterioration in patients with chronic disease using telemonitoring: navigating the ‘trough of disillusionment’. Journal of Evaluation in Clinical Practice. (doi:10.1111/j.1365-2753.2011.01701.x). (PMID:21848942)

Abstract

Objectives 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.
Design Qualitative data collection using interviews and participation in a multi-path
mapping process.
Participants 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.
Results 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.
Conclusions 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.

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Contributors

Author: Carl May

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