Odeh, Bassel (2017) Exploring the role of technology in optimising the care of patients with long term conditions. (PhD thesis), Kingston University, .
Abstract
The number of patients diagnosed with long term conditions in the UK is increasing with an expected number of 18 million patients by 2018, responsible for 69% of all spending on health and social care in England. These challenges cannot be solved solely by conventional approaches and other alternatives, such as cost-effective technological solutions, must be considered to increase patient's independence and quality of life, and produce cost savings for the authorities. This practice-based research explored the potential role of technologies in the care of patients with long term conditions, and aimed to evaluate the acceptance and effectiveness of a telehealth service provided to patients' with chronic obstructive pulomary disease and heart failure; to map and compare chronic obstructive pulmonary disease care pathways between different EU countries to better understand how technologies fit within the standard forms of care; to explore how m-health interventions can be developed and designed to support the care of cancer patients and survivors; and to provide data on UK cancer patients' ownership of and interest in m-health technologies. Mixed-mthod research approach was used in this study with a mixture of face-to-face and email semi-structured interviews, postal and online questionnaires, and data extraction from available databases. This approach was selected to harness the strengths of, both quantitative and qualitative methodologies. Seven nurses, working on telehealth for an average of 15 months were interviewed. Lack of resources and organisational support, patient selection criteria, and technological support were identified as barriers for effective implementation of telehealth. Telehealth reduced the number of both A&E and hospital admissions by 36% (P=0.03) and 28% (P=0.02), respectively. 27 patients responded to the postal questionnaire and were very satisfied with the service. They agreed that telehealth had improved their health, was a convenient form of healthcare delivery for them, and that it made them more involved in the decisions about their care or treatment. Five COPD-specialised HCPs were interviewed, and the COPD care pathway was compared between 5 EU countries including Germany, Greece, Ireland, Netherlands and England. Lack of communication among different healthcare providers managing COPD and co-morbities is a common feature of the studies care pathways. In all countries, the lifestyle management services provided were similar with no specific tools used to enhance patients' adherance, and no specified role/training existing for informal carers (partners, family & friends). Telehealth can play a role int he integrated care of long tem conditions by providing means communication allowing better communications between different healthcare providers managing LTCs and co-morbidities. Next, the role of m-health in cancer care was explored. A need for m-health platforms to support cancer patients and survivors was identified, and two m-health platforms were developed and designed using patient's centred approach and Waterfall system development model. MyAppPal and CanAdvice+ were designed to support colorectal cnacer srvivors set up on follow-up care plans and cancer patients receiving oral chemotheraphy at home, respectively. 12 colorectal cancer patients were interviewed and 69 patients responded to the postal questionnaire. Patients expereince with the support provided during follow up plan varied based on appointment type and location. They had problems remembering or accessing information as they moved away from their treatment, and reported needs for more specific and personalised information, more information on how to handle financial difficulties and social care, and more control over their hospital appointments. The usability scores of the developed apps were very positive, and they were seen as simple and attractive to use, and had very positive learnability and usability scores. Finally, 529 cancer patients completed surveys to assess their ownership of smart-technologies and interest in m-health apps. 90.5% of the patients had access to smartphone, tablet or both, and only patients' age significantly affected this ownership. Almost half of the patients showed an interest in the use of m-health apps, and two out of five were willing to download apps in were made available from the hospital. Five factors were found to significantly predict patients' willingness to use and download health applications, including age, health literacy, previous use of apps in general and health apps in particular, and previous use of smartphones/tablets to access related health information in the past six months. Ownership of smart-technologies and interest in m-health apps was independent from all other socio-economic factors. Technologies seem to be acceptable to patients with long term conditions, and can play an important role in improving their clinical outcomes if well designed, introduced, implemented and managed. Patients' perceptions of the usefulness and ease of use of these technologies seem to be a crucial factor in their acceptance of such interventions.
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