REMOte CARE for COPD
Research type
Research Study
Full title
Exploring the potential opportunities and challenges associated with REMOte CARE for chronic obstructive pulmonary disease (REMO CARE) – A qualitative study
IRAS ID
307368
Contact name
Ratna Sohanpal
Contact email
Sponsor organisation
Queen Mary University of London
Duration of Study in the UK
0 years, 7 months, 30 days
Research summary
A priority during the pandemic was to reduce social contact especially for older people and those with long-term conditions that put them at risk. Healthcare shifted to remote delivery (via websites, video link, smartphone, telephone) and some are predicting that remote consultations will continue even after the pandemic. As restrictions are gradually being eased it is timely to consider whether remote consulting is acceptable, and perceived as appropriate for the care of older patients with moderate to very severe chronic obstructive pulmonary disease (COPD) who often also have other multiple physical and psychological conditions. Many of these patients are from socially deprived communities and reliance on remote consultations may increase inequalities. In contrast, those with severe disease who are housebound may welcome remote care.
Care in COPD could be discussion of self-management plans, assessing symptoms, education on COPD and its treatment, medications/inhaler use, remote pulmonary rehabilitation, smoking cessation advice, need for other types of services and mental health support.
Little is known about the experiences of patients accessing and using this range of care remotely nor the experience of health care professionals providing care remotely to people with complex healthcare problems
Aims:
1) Explore patient and carer views and experiences of remote care to meet different needs, to understand what worked well, what were the challenges and how their experience of care could be improved.
2) Explore health care professionals their views and experiences of providing different types of care remotely, to understand what worked well, what were the challenges and how their experience of providing care could be improved.Study design
We will conduct an interview study involving:
• patients and carers of patients with moderate to very severe COPD, poor mental health and/or additional physical long term conditions.
• health care professionals who provide COPD care remotely
Lay summary of study results: Background and rationale Since the Covid-19 pandemic it is more common for patients to have remote healthcare appointments. Instead of attending a clinic or hospital in person, patients often have appointments by telephone, smartphone, apps, video link, online platforms.
Remote care delivery can be helpful - people can save travel time and it can be convenient - but there may be disadvantages. People may not have the technology or the confidence to use it. Some people might not want to use technology for their healthcare appointments.We wanted to find out what people living with chronic obstructive pulmonary disease (COPD), their carers and health care professionals thought about remote care delivery? Is it an acceptable and appropriate way to provide healthcare?
Methods
The study team spoke to patients with COPD, their carers and healthcare professionals (based in GP practices and in hospital COPD clinics) about their experience of remote care delivery to understand what worked well, what were the challenges and how healthcare delivery could be improved in COPD. The study was carried out in the period as the Covid-19 restrictions were easing.Results
Patients generally preferred face-to-face contact over remote contact. They felt they could express themselves better and had the opportunity to ask more questions. Patients worried that they might miss or forget to say things over the telephone. Patients said that face-to-face appointments helped them to understand the consultation better. It was especially helpful for those with hearing difficulties. Patients said face-to-face felt more personal. It helped to maintain a relationship with their healthcare professional. This was important to patients.
Value in continuing face-to-face contact in COPD. Patients and professionals agreed that patients should have the option to be seen face-to-face. Professionals said that seeing new patients face-to-face helped to build rapport. Looking at how a patient with COPD sits, how they walk, their colour, and their breathing pattern can tell them a lot about how they are doing with their COPD. Professionals also said that carrying out physical checks such as breathing tests, having difficult conversations, and showing or checking breathing techniques were better done face-to-face. Patients said that the physical checks are a way for patients to be kept informed about their illness and how they were doing. This was reassuring to patients.
A mix of telephone and face-to-face contact could be useful to patients and healthcare professionals caring for patients with COPD. Both patients and professionals felt that telephone appointments were useful for routine check-ups and asking basic questions, and for people who were working. Professionals said that telephone appointments were helpful for doing follow-ups and for some patients with severe COPD who might have difficulty walking or if they were anxious about leaving their home. Professionals said that the telephone could also be useful to help decide if a patient needed to be seen face-to-face. The hybrid approach could be timesaving, but more research is needed to assess its usefulness.
Some of the challenges of delivering healthcare remotely. Many patients had poor or no internet connection, and arranging internet connection can be costly. Navigating online platforms can be confusing or may not work. The devices like mobile phone, i-pad, laptop might be old and not work with today’s technology. Patients and professionals both said that some people may not know how to use technology; they may not have the confidence to use the technology, or they might see no need for technology in their daily life. Professionals also mentioned practical difficulties. For example, the images sent by phone were too small or not clear.
There is a place for remote care in COPD for those who want it, but study participants suggested the following improvements would be needed
• Assess patients their preference– offer options of remote care delivery to patients, carers, ask their preference, and assess whether they have access to technology and if they can use it.
• Devices – offer loan of devices or equipment to patients and carers. Provide up to date equipment to professionals.
• Internet connection – offer free internet to patients and carers.
• Instructions and support for patients in using technology – provide basic, step-by-step instructions to navigate online platforms, show patients and carers what to do and allow them to practice. Offer courses in the local community to learn computer skills, have trusted persons e.g., from council visit those who are housebound to provide support.
• Training for health professionals – Training in what clinical care can be safely done by telephone, communication training to help them have effective consultations by telephone using different scenarios, different health conditions.
• Technology – make technology used in remote care appointments/consultations simpler and more straightforward to use. When patients are using remote technologies then technology support must be provided/available.Nest steps
The REMO CARE study team will use these results to share messages more widely so the suggestions can be taken up by various networks and organisations that are working to achieve best care for people with COPD.The various networks or organisations will be patient and carer networks such as Asthma and Lung UK Breathe Easy groups, Carers UK; professional networks such as Primary Care Respiratory Society, Primary care networks including GP practices and Hospitals that took part in the study.
REC name
East Midlands - Leicester Central Research Ethics Committee
REC reference
22/EM/0061
Date of REC Opinion
7 Mar 2022
REC opinion
Further Information Favourable Opinion