RT Journal Article
SR Electronic
T1 Descriptive study of the challenges when implementing an app for patients with neovascular age-related macular degeneration to monitor their vision at home
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e077196
DO 10.1136/bmjopen-2023-077196
VO 14
IS 3
A1 Reeves, Barnaby C
A1 Wickens, Robin
A1 O’Connor, Sean R
A1 Gidman, Eleanor Alma
A1 Ward, E
A1 Treanor, Charlene
A1 Peto, Tunde
A1 Burton, Ben J L
A1 Knox, Paul C
A1 Lotery, Andrew
A1 Sivaprasad, Sobha
A1 Donnelly, Michael
A1 Rogers, Chris A
A1 Hogg, Ruth E
YR 2024
UL http://bmjopen.bmj.com/content/14/3/e077196.abstract
AB 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.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.