Descriptive study of the challenges when implementing an app for patients with neovascular age-related macular degeneration to monitor their vision at home

Abstract

Objectives: remote monitoring of health has the potential to reduce the burden to patients of face-to-face appointments and make health care more efficient. Apps are available for patients to self-monitor vision at home, e.g. to detect reactivation of age-related macular degeneration (AMD). Describing the challenges when implementing apps for self-monitoring of vision at home was an objective of the MONARCH study to evaluate two vision-monitoring apps on an iPod Touch (Multibit and MyVisionTrack®).

Design: diagnostic test accuracy study.

Setting: six UK hospitals.

Methods: the study provides an example of the real-world implementation of such apps across health sectors in an older population. Challenges described include: (i) Frequency and reason for incoming calls made to a helpline and outgoing calls made to participants; (ii) Frequency and duration of events responsible for the tests being unavailable; (iii)Other technical and logistical challenges.

Results: patients (n=297) in the study were familiar with technology; 252/296 (85%) had internet at home and 197/296 (67%) had used a smartphone. Nevertheless, 141 (46%) called the study helpline, more often than anticipated. Of 435 reasons for calling, 393 (90%) related to testing with the apps or hardware, which contributed to reduced adherence. The team made at least one call to 131 patients (44%) to investigate why data had not been transmitted. Multibit and MyVisionTrack® apps were unavailable for 15 and 30 of 1318 testing days for reasons which were the responsibility of the app providers. Researchers also experienced technical challenges with a multiple device management system. Logistical challenges included regulations for transporting lithium-ion batteries and malfunctioning chargers.

Conclusions: implementation of similar technologies should incorporate a well-resourced helpline and build in additional training time for participants and troubleshooting time for staff. There should also be robust evidence that chosen technologies are fit for the intended purpose.

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Identifiers

ORCID for A. Lotery: orcid.org/0000-0001-5541-4305

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