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Abstract
Objectives Remote monitoring of health has the potential to reduce the burden to patients of face-to-face appointments and make healthcare more efficient. Apps are available for patients to self-monitor vision at home, for example, 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 the following: (1) frequency and reason for incoming calls made to a helpline and outgoing calls made to participants; (2) frequency and duration of events responsible for the tests being unavailable; and (3) 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, all but 42 (10%) related to testing with the apps or hardware, which contributed to reduced adherence. The team made at least one call to 133 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.
Trial registration number ISRCTN79058224.
- Telemedicine
- Medical retina
- Aging
Data availability statement
Data are available upon reasonable request. Individual participant data (IPD) sharing plan. Data will not be made available for sharing until after publication of the main results of the study. Thereafter, anonymised individual patient data will be made available for secondary research, conditional on assurance from the secondary researcher that the proposed use of the data is compliant with the MRC Policy on Data Preservation and Sharing regarding scientific quality, ethical requirements, and value for money. A minimum requirement with respect to scientific quality will be a publicly available prespecified protocol describing the purpose, methods, and analysis of the secondary research, for example, a protocol for a Cochrane systematic review. The second file containing patient identifiers would be made available for record linkage or a similar purpose, subject to confirmation that the secondary research protocol has been approved by a UK REC or other similar, approved ethics review body.
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Data availability statement
Data are available upon reasonable request. Individual participant data (IPD) sharing plan. Data will not be made available for sharing until after publication of the main results of the study. Thereafter, anonymised individual patient data will be made available for secondary research, conditional on assurance from the secondary researcher that the proposed use of the data is compliant with the MRC Policy on Data Preservation and Sharing regarding scientific quality, ethical requirements, and value for money. A minimum requirement with respect to scientific quality will be a publicly available prespecified protocol describing the purpose, methods, and analysis of the secondary research, for example, a protocol for a Cochrane systematic review. The second file containing patient identifiers would be made available for record linkage or a similar purpose, subject to confirmation that the secondary research protocol has been approved by a UK REC or other similar, approved ethics review body.
Footnotes
Contributors REH: conceptualisation, funding acquisition, methodology, supervision, writing the original draft, writing-review, and editing. SS: methodology, writing the original draft, writing-review, and editing. RW: data curation, project administration writing-review, and editing. SRO’C: data curation, writing-review, and editing. EAG: data curation, formal analysis, validation, visualisation writing-review, and editing. EW: data curation, project administration writing-review, and editing. CT: data curation, writing-review, and editing. TP, PCK, AL, MD, and BJLB: methodology, writing-review, and editing. CAR: formal analysis, methodology, validation, visualisation, writing-review, and editing. BCR: conceptualisation, funding acquisition, methodology, supervision, validation, visualisation, writing the original draft, reviewing and editing, and guarantor for the overall content.
Funding NIHR Health Technology Assessment Programme (no. 15/97/02). The funder had no role in the write-up or conduct of the study.
Competing interests REH reports attendance at Roche Digital Health Advisory Meeting July 2019. She also received partial PhD Studentship funding from Okko Health 2021 for home monitoring of Diabetic Retinopathy. SS reports grants from Boehringer Ingleheim, receiving consulting fees from Boehringer Ingleheim, Novartis, Apellis, Bayer, Oculis, Oxurion, Roche, and Biogen. She also received payment or honoraria from Boehringer Ingleheim and Bayer, support for attending meetings from Bayer and participation in an advisory board with Bayer. She is also a Macular Society Trustee (unpaid). TP reports grants from Boehringer Ingelheim and Novartis; receiving consulting fees from Boehringer Ingelheim, Novartis, Apellis, Bayer, Oxurion, Roche, and Sandoz. She also received payment or honoraria (speakers fee/and/or advisory board) from Boehringer Ingelheim, Bayer, Roche, Apellis, Sandoz, Heidelberg, Zeiss, Optos. PCK reports software support from Vital Art and Science who produced the My Vision Track App. AL reports receiving consulting fees from and owning stock or stock options of Gyroscope Therapeutics. RW, SRO'C, EAG, EW, CT, BJLB, CAR and BCR have no competing interests.
Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.
Provenance and peer review Not commissioned; externally peer reviewed.